Efficacy of the Aim2Be Intervention in Changing Lifestyle Behaviors Among Adolescents With Overweight and Obesity: Randomized Controlled Trial

Abstract

Background Aim2Be is a gamified lifestyle app designed to promote lifestyle behavior changes among Canadian adolescents and their families. Objective The primary aim was to test the efficacy of the Aim2Be app with support from a live coach to reduce weight outcomes (BMI Z score [zBMI]) and improve lifestyle behaviors among adolescents with overweight and obesity and their parents versus a waitlist control group over 3 months. The secondary aim was to compare health trajectories among waitlist control participants over 6 months (before and after receiving access to the app), assess whether support from a live coach enhanced intervention impact, and evaluate whether the app use influenced changes among intervention participants. Methods A 2-arm parallel randomized controlled trial was conducted from November 2018 to June 2020. Adolescents aged 10 to 17 years with overweight or obesity and their parents were randomized into an intervention group (Aim2Be with a live coach for 6 months) or a waitlist control group (Aim2Be with no live coach; accessed after 3 months). Adolescents’ assessments at baseline and at 3 and 6 months included measured height and weight, 24-hour dietary recalls, and daily step counts measured with a Fitbit. Data on self-reported physical activity, screen time, fruit and vegetable intake, and sugary beverage intake of adolescents and parents were also collected. Results A total of 214 parent-child participants were randomized. In our primary analyses, there were no significant differences in zBMI or any of the health behaviors between the intervention and control groups at 3 months. In our secondary analyses, among waitlist control participants, zBMI (P=.02), discretionary calories (P=.03), and physical activity outside of school (P=.001) declined, whereas daily screen time increased (P<.001) after receiving access to the app compared with before receiving app access. Adolescents randomized to Aim2Be with live coaching reported more time being active outside of school compared with adolescents who used Aim2Be with no coaching over 3 months (P=.001). App use did not modify any changes in outcomes among adolescents in the intervention group. Conclusions The Aim2Be intervention did not improve zBMI and lifestyle behaviors in adolescents with overweight and obesity compared with the waitlist control group over 3 months. Future studies should explore the potential mediators of changes in zBMI and lifestyle behaviors as well as predictors of engagement. Trial Registration ClinicalTrials.gov NCT03651284; https://clinicaltrials.gov/ct2/show/study/NCT03651284 International Registered Report Identifier (IRRID) RR2-10.1186/s13063-020-4080-2

Effectiveness of mHealth App–Based Interventions for Increasing Physical Activity and Improving Physical Fitness in Children and Adolescents: Systematic Review and Meta-Analysis

“…As shown in Table 1 , the included studies have the following basic characteristics. The age of the participants varied from 3 to 18 years with 5 (18%) of the 28 studies involving preschool children [ 26 , 44 , 46 , 48 , 50 ], 8 (29%) studies involving children [ 28 - 31 , 33 , 36 , 37 , 51 ], and 15 (53%) studies involving adolescents [ 20 , 32 , 34 , 35 , 38 - 43 , 45 , 47 , 49 , 52 , 53 ]. The objectives of the studies differed, and the selection criteria for the target population varied inconsistently.…”

“…The objectives of the studies differed, and the selection criteria for the target population varied inconsistently. Most studies (16/28, 57%) focused on healthy children and adolescents; however, of the 28 studies, 9 (32%) included participants with overweight and those with obesity [ 29 - 31 , 35 , 36 , 39 , 43 , 45 , 52 ], 2 (7%) involved children with cancer [ 34 , 53 ], and 1 (4%) enrolled youth with congenital heart disease [ 40 ]. Of the 28 studies, 8 (29%) were conducted in Asia [ 31 , 36 , 37 , 39 - 41 , 44 , 45 ], while the remaining studies were performed in Oceania (7/28, 25%) [ 29 , 30 , 35 , 38 , 46 , 50 , 53 ], North America (5/28, 18%) [ 28 , 33 , 34 , 43 , 51 ], and Europe (8/28, 29%) [ 20 , 26 , 32 , 42 , 47 - 49 , 52 ].…”

“…These included 9 commercial apps [ 20 , 31 - 33 , 35 , 38 , 41 , 47 , 49 ] and 14 research apps [ 28 - 30 , 39 , 40 , 42 - 46 , 48 , 51 - 53 ], and 5 mHealth apps did not provide the corresponding information [ 26 , 34 , 36 , 37 , 50 ]. The type of intervention used in 15 studies was stand-alone apps [ 20 , 26 , 28 , 32 , 33 , 40 , 41 , 43 - 47 , 49 - 51 ], and 13 studies used concerted intervention [ 29 - 31 , 34 - 39 , 42 , 48 , 52 , 53 ]. Participant engagement with the intervention was mentioned in 28 studies, 8 studies focused on parent-centered [ 26 , 31 , 36 , 37 , 44 , 46 , 48 , 50 ], the remaining studies were child centered.…”

“…Overall, of the 28 studies, 11 (39%) were classified as having a low risk of bias [ 20 , 26 , 28 , 29 , 34 , 35 , 37 , 39 , 51 - 53 ], and a high risk of bias was identified in 17 (61%) studies [ 30 - 33 , 36 , 38 , 40 - 50 ]. The methods for random sequence generation were adequately reported in 28 studies, and 14 (50%) of the 28 studies described allocation concealment protocols [ 20 , 26 , 29 , 31 , 35 , 37 , 39 , 43 , 46 , 48 , 50 - 53 ]. Of the 28 studies, blinding of participants and personnel was unclear in 17 studies [ 20 , 28 - 33 , 38 - 41 , 43 - 45 , 47 , 49 , 51 ], high risk of bias was identified in 7 (25%) studies [ 26 , 34 , 35 , 37 , 50 , 52 , 53 ], and blinding of outcome assessment was unclear in 18 (64%) studies [ 18 , 28 - 34 , 38 , 40 , 41 , 44 , 45 , 47 - 51 , 53 ].…”

“…The methods for random sequence generation were adequately reported in 28 studies, and 14 (50%) of the 28 studies described allocation concealment protocols [ 20 , 26 , 29 , 31 , 35 , 37 , 39 , 43 , 46 , 48 , 50 - 53 ]. Of the 28 studies, blinding of participants and personnel was unclear in 17 studies [ 20 , 28 - 33 , 38 - 41 , 43 - 45 , 47 , 49 , 51 ], high risk of bias was identified in 7 (25%) studies [ 26 , 34 , 35 , 37 , 50 , 52 , 53 ], and blinding of outcome assessment was unclear in 18 (64%) studies [ 18 , 28 - 34 , 38 , 40 , 41 , 44 , 45 , 47 - 51 , 53 ]. Four studies provided data regarding subjects lost to follow-up [ 30 - 32 , 34 ], while one study had unclear information on this aspect [ 51 ].…”