Feasibility of Using a Commercial Fitness Tracker as an Adjunct to Family-Based Weight Management Treatment: Pilot Randomized Trial

Abstract

BackgroundFitness trackers can engage users through automated self-monitoring of physical activity. Studies evaluating the utility of fitness trackers are limited among adolescents, who are often difficult to engage in weight management treatment and are heavy technology users.ObjectiveWe conducted a pilot randomized trial to describe the impact of providing adolescents and caregivers with fitness trackers as an adjunct to treatment in a tertiary care weight management clinic on adolescent fitness tracker satisfaction, fitness tracker utilization patterns, and physical activity levels.MethodsAdolescents were randomized to 1 of 2 groups (adolescent or dyad) at their initial weight management clinic visit. Adolescents received a fitness tracker and counseling around activity data in addition to standard treatment. A caregiver of adolescents in the dyad group also received a fitness tracker. Satisfaction with the fitness tracker, fitness tracker utilization patterns, and physical activity patterns were evaluated over 3 months.ResultsA total of 88 adolescents were enrolled, with 69% (61/88) being female, 36% (32/88) black, 23% (20/88) Hispanic, and 63% (55/88) with severe obesity. Most adolescents reported that the fitness tracker was helping them meet their healthy lifestyle goals (69%) and be more motivated to achieve a healthy weight (66%). Despite this, 68% discontinued use of the fitness tracker by the end of the study. There were no significant differences between the adolescent and the dyad group in outcomes, but adolescents in the dyad group were 12.2 times more likely to discontinue using their fitness tracker if their caregiver also discontinued use of their fitness tracker (95% CI 2.4-61.6). Compared with adolescents who discontinued use of the fitness tracker during the study, adolescents who continued to use the fitness tracker recorded a higher number of daily steps in months 2 and 3 of the study (mean 5760 vs 4148 in month 2, P=.005, and mean 5942 vs 3487 in month 3, P=.002).ConclusionsDespite high levels of satisfaction with the fitness trackers, fitness tracker discontinuation rates were high, especially among adolescents whose caregivers also discontinued use of their fitness tracker. More studies are needed to determine how to sustain the use of fitness trackers among adolescents with obesity and engage caregivers in adolescent weight management interventions.

Mobile Health Apps in Pediatric Obesity Treatment: Process Outcomes From a Feasibility Study of a Multicomponent Intervention

“…We found similar barriers among our older group and facilitators among younger participants. Research with a commercial fitness tracker among adolescents with obesity reported a discontinuation rate of 68% before the end of the study that was linked to barriers to physical activity not being addressed by a tracker, seasonality, feelings of activity incompetence, and gradual withdrawal of parental and clinical support [ 42 ]. Our finding that high acceptability of a smartwatch does not translate to adherence is also reported by Phan et al [ 42 ].…”

“…Research with a commercial fitness tracker among adolescents with obesity reported a discontinuation rate of 68% before the end of the study that was linked to barriers to physical activity not being addressed by a tracker, seasonality, feelings of activity incompetence, and gradual withdrawal of parental and clinical support [ 42 ]. Our finding that high acceptability of a smartwatch does not translate to adherence is also reported by Phan et al [ 42 ]. The physical activity self-monitoring tool available on the smartwatch screen in our study was cited by a number of children and parents as a benefit because they were trying to increase their activity levels.…”

Adolescents' Use of Digital Technologies and Preferences for Mobile Health Coaching in Public Mental Health Settings

“…Among all teens, 42% had searched for fitness and exercise information online and 19% had searched for information on stress and anxiety. Digital technology has been studied as a way to deliver sexual health education (8), weight management (9–11), physical activity (12–14), and nutrition interventions (15, 16), and to enhance medication adherence (17) among adolescents in the general population. Several early studies have highlighted the promise of using technology to address adolescent mental health, including suicide prevention and outreach (18, 19) and treatment for depression and anxiety (20).…”

Wearable Activity Tracking Device Use in an Adolescent Weight Management Clinic: A Randomized Controlled Pilot Trial

“…Wearable fitness trackers have become a prominent component of the effort in initiating behavioral lifestyle modifications to combat obesity [ 17 , 18 ]. Activity tracking technology has become increasingly prevalent in the United States, with the wearable fitness industry showing exponential growth within the past few years [ 19 ].…”

“…Wearable devices have demonstrated accuracy with respect to measurements such as heart rate, step count, move distance, and sleep duration; however, accuracy does deteriorate under conditions of increased activity [ 20 , 21 ]. Despite any inaccuracies devices may have, users often report high satisfaction and perception of increased physical fitness [ 17 , 22 ]. The ease of use, increased utilization, and mobility of activity tracking devices has brought about new opportunities for data collection and subsequent research [ 19 , 23 ].…”