Evaluation of a group family-based intervention programme for adolescent obesity: the LITE randomised controlled pilot trial

Effectiveness of a school-based nutrition education program on waist circumference and dietary behavior among overweight adolescents in Puducherry, India

BACKGROUND

The influence of western lifestyle such as high-caloric dense food and sedentary lifestyle has a great influence on Indian children, and the current prevalence of childhood overweight in India ranges between 4% and 22%. The primary aim of the study was to determine the change in growth parameters (waist circumference) as well as dietary behaviors at baseline and at the end of first, third, sixth, and ninth months among overweight adolescent girls and boys following a school-based nutritional education program.

MATERIALS AND METHODS

The study was conducted in 2019 in four urban schools at Puducherry which were randomly assigned to study and control groups by lottery method, and 140 overweight children aged 11-14 years were in the study group and 140 children were in the control group. Simple random sampling method was used to select the samples A nutrition education program highlighting the importance of balanced nutrition and the ill effects of obesity was imparted to students in the study group through a PowerPoint presentation. As a means of reinforcement, posters and pamphlets were distributed. The waist circumference and the mean calorie, protein, and fat intake were assessed at baseline and at the first, third, sixth, and ninth months and compared between groups using independent t test.

RESULTS

There was a statistically significant reduction in waist circumference in the study group when compared to the control group at P < 0.05. A significant decrease in the calorie intake at P < 0.001 and fat intake at P < 0.01 was observed in the study group. The protein intake in the study group increased at the end of 9 months, which was significant at P < 0.001.

CONCLUSION

School-based nutritional education program has been found to be a successful intervention in controlling unnecessary weight gain among overweight adolescents.

Use of a Mobile Lifestyle Intervention App as an Early Intervention for Adolescents With Obesity: Single-Cohort Study

Background

Effective, resource-efficient treatment is urgently needed to address the high rates of pediatric and adolescent obesity. This need has been accelerated by the COVID-19 pandemic. The use of a mobile health tool as an early intervention before a clinic-based multidisciplinary weight management program could be an effective treatment strategy that is appropriate during a pandemic.

Objective

This study aims to assess the effectiveness of and adolescent engagement with a mobile app–based lifestyle intervention program as an early intervention before enrollment in a clinic-based multidisciplinary weight management program.

Methods

This prospective single-cohort study involved adolescents, aged 10-16 years, who were overweight and obese (defined as BMI percentile above the 85th percentile). Participants used the mobile Kurbo app as an early intervention before enrolling in a clinic-based multidisciplinary weight management program. Kurbo’s health coaches provided weekly individual coaching informed by a model of supportive accountability via video chat, and participants self-monitored their health behavior. The implementation of Kurbo as an early intervention was evaluated using the reach, effectiveness, adoption, implementation, and maintenance framework by reach (number who consented to participate out of all patients approached), implementation (Kurbo engagement and evaluation), and effectiveness as measured by the primary outcome of the BMI z-score at 3 months. Secondary outcome measures included changes in body fat percentage, nutrition and physical activity levels, and quality of life at 3 months. Maintenance was defined as the outcome measures at 6-month follow-up.

Results

Of the 73 adolescents who were approached for enrollment, 40 (55%) of adolescents were recruited. The mean age was 13.8 (SD 1.7) years, and the mean BMI z-score was 2.07 (SD 0.30). In the multiethnic Asian sample, 83% (33/40) of the participants had household incomes below the national median. Kurbo engagement was high, with 83% (33/40) of participants completing at least 7 coaching sessions. In total, 78% (18/23) of participants rated the app as good to excellent and 70% (16/23) stated that they would recommend it to others. There were no statistically significant changes in BMI z-scores at 3 months (P=.19) or 6 months (P=.27). Participants showed statistically significant improvements in measured body fat percentage, self-reported quality of life, and self-reported caloric intake from the 3-day food diaries at 3 and 6 months.

Conclusions

The use of Kurbo before enrollment in an outpatient multidisciplinary clinical care intervention is a feasible strategy to expand the reach of adolescent obesity management services to a low-income and racially diverse population. Although there was no significant change in BMI z-scores, the use of Kurbo as an early intervention could help to improve quality of life and reduce body fat percentage and total caloric intake.