New Johns Hopkins study shows digital tools help prevent obesity in high-risk young children
· News-MedicalIn an effort to extend the improvements through 2 years of age, when pediatrics office visits become less frequent, the new study focused on using digital technology to reinforce elements of the Greenlight Program, which previously only consisted of written materials and health counseling during primary care visits.
Building on that knowledge, to conduct the new study, which was co-led by Vanderbilt University and five other academic medical institutions, the researchers recruited nearly 900 parent-infant pairs between October 2019 and January 2022 from newborn nurseries or pediatric primary care clinics at Duke University, University of Miami, New York University/Bellevue Hospital Center, University of North Carolina, Stanford University and Vanderbilt University Medical Center.
At the start of the trial, all babies were 21 days old or younger, born after 34 weeks gestation, at a healthy weight, and with no chronic medical conditions that might affect weight gain.
The infant-parent pairs were randomly sorted into two groups. Both groups received Greenlight Program education, with counseling on healthy nutrition and behaviors from their primary care providers, along with eight educational booklets matching the child's age at regular well visits, with guidance and goal-setting tips in English or Spanish on feeding, physical activity, sleep and screen time.
Next, half (449) of the infant-parent pairs received personalized, interactive text messages from a fully automated system to support health behavior goals and also access to a web-based "dashboard" designed to help parents keep track of healthy goals.
Goals (such as fewer sugar-sweetened beverages or less screen time) were texted in English or Spanish every two weeks until 2 years of age. Those texts were followed by five automated check-in messages throughout the two weeks. Parents were asked to self-rate their goal progress.
Based on parents' responses, the automated digital intervention system then provided immediate feedback, tips for addressing challenges and encouragement based on progress.
The researchers conclude that their digital intervention led to healthier weight-for-length paths and reduced the incidence of obesity at 2 years of age when added to in-person health counseling.
The investigators say the digital services were effective in populations that traditionally experience the highest risk of obesity, and "could have significant impact" if implemented on a broader scale.
Moreover, they concluded "the intervention effect" occurred as early as 4 months and sustained throughout the two years. The researchers say this study may be one of the first ever to prevent early childhood obesity, particularly in a large group of diverse participants.
Perrin indicated that research shows most young children with obesity do not outgrow it. "What is kind of exciting from our study is we prevented those children who would have had an unhealthy weight in the first place and helped them have a healthier weight, which sets them up better for health throughout their lives," she says.
Finally, the researchers say the digital intervention had a greater effect on children from households with food insecurity, on Hispanic and non-Hispanic Black children, and those with lower health literacy. "If we can prevent obesity in these children at greatest risk, we can also create better health equity in the future," Perrin says.
The researchers hope to be able to follow the patients as they grow up.
Additional authors include William Heerman, Russell Rothman, Jonathan Schildcrout, Aihua Bian, Laura Adams and Evan Sommer from Vanderbilt University Medical Center; Lee Sanders from Stanford University; Kori Flower from University of North Carolina at Chapel Hill; Alan Delamater from University of Miami; Melissa Kay from Wake Forest University; Charles Wood from Duke University; Rachel Gross and H. Shonna Yin from New York University; and other Greenlight investigators.
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