Aim2Be mHealth intervention for children with overweight and obesity: study protocol for a randomized controlled trial

Abstract

Background: The prevalence of overweight and obesity remains high in Canada, and the current standard for the treatment of childhood obesity is in-person, family-based, multidisciplinary interventions that target lifestyle behaviors (e.g., diet, physical activity, and sedentary behaviors). These programs are costly to operate, have limited success, and report recruitment and retention challenges. With recent advances in technology, mobile health or mHealth has been presented as a viable alternative to in-person interventions for behavior change, especially with teens. Purpose: The primary aim of this study is to test the efficacy of Aim2Be, a gamified app based on behavior change theory with health coaching to improve weight outcomes (i.e., decrease in standardized body mass index (zBMI)) and lifestyle behaviors (i.e., improve dietary quality, increase fruit and vegetable intake, reduce sugar-sweetened beverage intake, increase physical activity, and reduce screen time) among children 10-to 17-years old with overweight or obesity versus their peers randomized into a waitlist control condition. The secondary aims of this study are to 1) test whether supplementing the Aim2Be program with health coaching increases adherence and 2) examine the mediators and moderators of adherence to the Aim2Be intervention. Methods: We will employ a randomized controlled trial design and recruit 200 child and parent dyads to participate in the study (2019-2020). Participants will be recruited from Canadian pediatric weight management clinics and through online advertisements. Child participants must be between the ages of 10 and 17 years, have overweight or obesity, be able to read English at least at a grade 5 level, and have a mobile phone or home computer with internet access. Following baseline data collection, participants will be randomized into intervention and waitlist control groups. Intervention participants will receive access to Aim2Be, with access to health coaching. After having their data collected for 3 months, the control group will gain access to Aim2Be, with no access to health coaching. Participants will control their frequency and duration of app usage to promote autonomy. Discussion: Findings from this study will determine the efficacy of using Aim2Be in improving child weight outcomes and lifestyle behaviors and guide future mHealth interventions for pediatric weight management. Trial registration: ClinicalTrials.gov, NCT03651284. Registered 29 August 2018.

A look at engagement profiles and behavior change: A profile analysis examining engagement with the Aim2Be lifestyle behavior modification app for teens and their families

“…While Aim2Be can also be accessed via a home computer >95% of the participants downloaded the app on their phones. Briefly, the Aim2Be app is a gamified health behavior modification program that supports adopting healthy behaviors such as improving dietary quality, increasing physical activity, reducing screen time, and improving sleep (see theoretical description eslewhere ( Mâsse et al, 2020 ). In addition, Aim2Be integrates a living green focus (i.e., addresses how health behaviors impact the environment) as well as emphasizes healthy body image and self-esteem.…”

“…This paper aimed to address these aforementioned research gaps, by evaluating version (v1) of the Aim2Be app – an mHealth gamified lifestyle behavior modification app for teens and their parents with the goal of improving children’s dietary quality (i.e. increasing fruit and vegetable intake, reducing sugar-sweetened beverage intake), increasing physical activity, reducing screen time, and meeting sleep recommendations ( Mâsse et al, 2020 ). Specifically, this paper: 1) examined teens engagement with the main features of Aim2Be; 2) investigated whether teens’ profiles of engagement differed by socio-demographic characteristics and parental engagement; and 3) assessed whether engagement profiles were associated with change in the targeted mediators (knowledge, self-efficacy, and intrinsic motivation) and/or health behaviors primarily targeted by the app.…”

Improving Serious Games to Tackle Childhood Obesity

“…To date, four research groups took the initiative to develop multidisciplinary serious games including different game modules that can be used to promote healthy behaviors in children with obesity. Three of them were recently published ( Espinosa-Curiel et al, 2020 ; Mack et al, 2020 ; Ruggiero et al, 2020 ), while one is still in progress ( Mâsse et al, 2020 ). The overall content (i.e., available online) and outcome goals were to provide knowledge, enhance motivation, and encourage behavior change related to healthy eating, PA, and stress coping.…”

TCO App: Telemonitoring and Control of Pediatric Overweight and Obesity

“…In [35], it is shown that 76% of overweight pediatric patients abandon treatment after 6 months, alleging a lack of time to attend checkups and a lack of tools to support their treatment from home. This problem is highlighted by the World Health Organization (WHO), which suggests that the development of telemedicine and mHealth, in that sense, should include parents or caregivers of children as agents of change during the treatment of patients [1,30]; only in this way could be overcome the barriers of face-to-face visits, long distances and insufficient resources [18,27].…”

“…The family member, following the indications of the specialist (via Videoconferences) or the application (which uses the home protocol of the Centers for Disease Control and Prevention [27]), enters the following data in the application: weight in kilograms or pounds, height in meters, waist in centimeters, and other data such as age, gender, and region. Then, on the mobile device, the calculation of the Body Mass Index (BMI) is obtained from the formula: weight/(height x height) [3], which, together with the waist circumference, are the indicators used to identify the nutritional status of the patient.…”