IMPACT: Increased Monitoring of Physical Activity and Calories with Technology

Since severe obesity in youth (BMI for age ≥120th percentile) has been steadily increasing, intensive clinical intervention is necessitated, which is often delivered in specialized pediatric obesity clinics. Since the home environment and parental behavioral modeling are two of the strongest predictors of child weight loss during behavioral weight loss interventions, a family-based treatment approach is warranted. This strategy has been moderately successful in our existing, evidence-based pediatric weight management program (Brenner FIT), but since programs such as Brenner FIT rely on face-to-face delivery of programmatic elements, the dose delivered is limited by the time constraints experienced by families enrolled in treatment. Therefore, the purpose of this study is to refine and pilot a tailored, mobile (mHealth) component to augment an existing, evidence-based pediatric weight management program (Brenner FIT) to determine acceptability from a patient and clinical staff perspective, feasibility, and economic costs relative to the established weight management protocol alone [i.e., Brenner FIT vs. Brenner FIT + mHealth (Brenner mFIT)]. Primary Aim 1: Finalize an intervention for adolescent youth with obesity, consisting of podcasts/videos and electronic self-monitoring, to promote reduced caloric intake and increase physical activity. Primary Aim 2: Pilot the intervention in dyads (n = 40) recruited from a pediatric weight loss clinic, to establish acceptability and feasibility of the intervention relative to standard care (n = 40). Secondary Aim: To establish costs associated with development and implementation of mHealth components when delivered with the Brenner FIT program. Study design: For this project, we will randomize 80 youth with obesity (13 – 18yrs) and a caregiver (dyads) to the Brenner FIT condition or the Brenner mFIT condition. All participants will complete baseline measures prior to randomization, and at three and six months. All youth participants will receive a commercially available activity monitor. Caregivers will receive podcasts with a story about a caregiver supporting weight loss in a child by providing healthy foods/activities for his/her family, including healthy eating and physical activity information. Children will receive animated videos that contain healthy eating and physical activity messaging, with an engaging story of a child losing weight. All participants will have access to a website and mobile apps where they will track weight, diet, and physical activity for themselves (youth) or their child (parents). Based on their reports of weight, eating, and physical activity, the messaging received from clinical staff by the families will be individually tailored to promote healthy behaviors and overcome perceived barriers. The proposed research is innovative in that it explicitly incorporates theory into the intervention and evaluation components of the project and builds upon an existing literature on mHealth interventions that use mobile technology.

This project has great public health value in that it addresses the significant need of clinicians for tools to augment current obesity treatment programs. This project will lead to the development of new tools (eg, podcasts, videos) and a protocol for the use of commercially available tools which are or will be available to clinicians and families. This is relevant, because current clinical interventions/treatments for youth with obesity have been only marginally successful despite being resource intensive, but if lower cost, higher reach tools can be developed to leverage existing technology, more youth could be reached in a cost-effective manner.

A Coordinated Parent/Child Dyad Weight Loss Intervention: DYAD PLUS

The prevalence of overweight and obesity in youth is emerging as a global health concern, necessitating clinical interventions to treat obesity through promotion of lifestyle modification. Interventions in adolescents have demonstrated improvements in healthy eating and physical activity, with only modest weight loss outcomes. As a result, there is growing interest in developing strategies to enhance effectiveness of clinical interventions, especially those targeting adolescents who have the highest rates of obesity and dropout from treatment. Targeting family members to treat obesity in youth can be an effective approach, but adherence to family treatment can be sub-optimal despite research suggesting that parent-child interventions can be more effective than treatment programs that focus primarily on the child. We propose to develop a coordinated care model and assess the feasibility, acceptability, and effectiveness relative to standard care. The proposed study will leverage two successful weight loss programs administered at the Wake Forest Baptist Medical Center: Brenner Families in Training (Brenner FIT) and By Design. Brenner FIT is a family-based pediatric weight management clinic for youth 2-18 years old referred by a physician for overweight or obesity.11-14 By Design is an adult (>18yrs) weight loss clinic that includes tailored dietary and physical activity behavioral counseling. Our preliminary data suggest that most adolescent youth who enroll in Brenner FIT have at least one adult caregiver who is eligible and would benefit from enrollment in By Design. Therefore, we propose the development of a coordinated program (Dyad Plus) that would be a theoretically- based, coordinated approach designed to facilitate self-monitoring, positive communication, joint problem solving, and social support to increase physical activity, healthy eating, and weight loss relative to a non-coordinated approach or Brenner FIT alone. We will randomize 45 parent/adolescent Dyads to one of three conditions (n=15 for each); Brenner FIT only, Dyad where the child and parent both enrolled simultaneously in the age appropriate program, or Dyad Plus where the child and parent both enrolled simultaneously, but with the coordinated component. The study will achieve the following aims: Specific Aim 1: Develop a coordinated intervention for adolescents and adults with obesity co-enrolled in the Brenner FIT and By Design weight loss clinics. Specific Aim 2: Pilot the coordinated intervention in adolescent/caregiver dyads to establish the feasibility of the intervention in terms of accrual, retention, and adherence.17 Specific Aim 3: Establish costs associated with the implementation of Dyad Plus relative to delivering By Design and Brenner FIT without the coordination component. The proposal is significant, as it addresses a pressing chronic disease (obesity) in an underserved population (adolescents) and would be the first to develop a coordinated adolescent/adult weight loss intervention.

This project has great potential public health value in that it addresses the significant need of clinicians for tools to augment current obesity treatment efforts. This project will lead to the development of a new strategy to enhance weight loss programs for adolescents and their caregivers, which is relevant since current clinical treatments for adolescents and adults with obesity have been only marginally successful. If proven effective, our novel approach would provide a new strategy to enhance the effectiveness of currently existing youth and adult obesity treatment programs.