SMART goals of children of 6-12 years enrolled in a family-centred lifestyle intervention for childhood obesity: Secondary analysis of a randomized controlled trial

Employing a Phased, Interdisciplinary Approach Across Healthcare and School Settings: mHealth Adaptations for Youth with Autism Spectrum Disorder At-Risk of Experiencing Obesity

Youth with autism spectrum disorder (ASD) are at nearly twice the risk of experiencing obesity, compared to youth without ASD. Wellness Education to Create Healthy habits and Actions to Thrive (WE CHAT) is a novel chatbot that engages participants to enhance primary care delivery and associated care coordination services through mobile health (mHealth) technology focused on social determinants of health (SDOH) and social-emotional health. This study examines multiple perspectives regarding the development and implementation of innovative mHealth technology among youth with ASD. The phases of this study include (1) discussion among individuals and parents of children with ASD, (2) in-depth interviews with primary care providers (PCPs) who treat youth with ASD, and (3) in-depth interviews with interdisciplinary rehabilitation providers who treat youth with ASD. Phases 1 and 2 employed rapid qualitative analysis, and Phase 3 involved inductive thematic analysis to provide context to gaps identified in prior phases. Key themes across the three phases included the variability of symptoms among individuals with ASD, the differences in perceived value of mHealth technology, the importance of family-centered care, and the role of interdisciplinary support. Participants recommended the development of branching logic to increase the flexibility of mHealth technology designed for youth with ASD. This study gathered insight from multiple perspectives to identify opportunities for supporting independent participation in mHealth technology while reducing associated caregiver burden among youth with ASD. These findings may inform refinement and expansion of WE CHAT for patients with varying health needs.

Lifestyle Interventions in Pediatric Primary Care

Pediatric clinicians should offer guidance on age-appropriate nutrition, physical activity, sleep and screen time for families of children and adolescents with obesity. They should build rapport with families, ask permission before discussing obesity-related health concerns, use preferred terminology, and recommend whole family change. Using principles of shared decision-making, pediatric clinicians and families should set individualized goals for lifestyle changes, prioritizing reducing sugar-sweetened beverage intake, increasing physical activity, and reducing screen time. Families of children and adolescents with obesity should be connected to the highest level of support accessible to and desired by the family, including intensive health behavior and lifestyle treatment programs.

Family-Based WhatsApp Intervention to Promote Healthy Eating Behaviors Among Amazonian School Children: Protocol for a Randomized Controlled Trial

BACKGROUND

Stunting and micronutrient deficiencies have persistently affected children in the Brazilian Amazon for decades. However, in recent years, a notable increase in childhood overweight prevalence has been observed, particularly in the context of heightened food insecurity exacerbated by the COVID-19 pandemic. Despite the limited number of effective solutions proposed to tackle this problem, digital interventions have shown great promise worldwide in preventing obesity and promoting healthy diets.

OBJECTIVE

This study aims to describe the protocol of a family-based WhatsApp intervention, specifically designed to investigate the efficacy of multimedia messaging in preventing excessive weight gain and improving healthy eating practices among school-aged children in the Amazon region.

METHODS

This study protocol outlines a theory-driven randomized controlled trial based on the cognitive theory of multimedia learning and the social cognitive theory. A total of 240 parents or caregivers of children enrolled in the Maternal and Child Health and Nutrition Cohort Study in Acre (MINA-Brazil) will be recruited by phone and social media. The intervention group will receive persuasive multimedia messages through WhatsApp over 19 weeks, while the waitlist control group will remain in the usual care. The primary outcome is a change in children's BMI in z score. Secondary outcomes are changes in dietary intake and biochemical indicators of the children. Outcome measures will be assessed at baseline and 5 months after randomization in comparison to usual care. The analysis will use an intent-to-treat approach and will be conducted using the statistical package Stata (version 18.0), with a significance level set at P<.05. Paired and unpaired 2-tailed t tests will be applied to compare mean changes in the outcomes.

RESULTS

Data collection started in June 2023, and final measurements are scheduled to be completed in December 2023. The results of the main analysis are expected to be available in 2024.

CONCLUSIONS

This innovative multimedia message intervention holds significant potential for fostering behavioral changes among Amazonian children.

TRIAL REGISTRATION

Brazilian Clinical Trials Registry RBR-5zdnw6t; https://ensaiosclinicos.gov.br/rg/RBR-5zdnw6t.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/54446.

Supporting early childhood routines to promote cardiovascular health across the life course

Optimal cardiovascular health is an essential component of human health and well-being across the life course. Heart healthy practices around diet, physical activity, and sleep early in childhood have the potential to greatly improve lifespan and quality (Mehta et al., 2020). Early childhood routines, defined as functional practices that are predictable and repeatable, predict positive growth and development across the lifecourse (Fiese et al., 2002; Ferretti and Bub, 2017; Spagnola and Fiese, 2007). The American Heart Association has identified key heart healthy routines, such as daily regular activities including diet, physical activity, and sleep that promote cardiovascular health (Lloyd-Jones et al., 2022). Integrating the strength-based relational aspects of routines with the acquisition of cardiovascular health development capabilities allows children to establish their own optimal cardiovascular health trajectory early on. A systematic life course approach to supporting heart healthy routines in early childhood would inform clinical, research, and policy strategies to promote long-term cardiovascular health, and contribute to reducing inequalities in cardiovascular outcomes.