Digital patient engagement tool cut early childhood obesity

Adding digital patient engagement strategies could enhance existing models for supporting healthy behaviors and growth trajectories for young kids, according to a JAMA Network study.

The study, which compared in-clinic healthy behavior counseling for parents of newborns up to age 24 months with a text message patient engagement strategy, showed that the digital approach was more effective. Specifically, kids whose parents received in-clinic healthy behavior counseling and support via text message were less likely to have obesity by their second birthdays, the study authors said.

These findings come as conversations about preventing and treating overweight and obesity enter the zeitgeist. GLP-1 drugs have transformed obesity treatment and brought the topic to the forefront. This latest study adds to a different pillar of obesity prevention and management: lifestyle intervention.

"Childhood obesity is highly prevalent in the United States, with well-described health disparities by race, ethnicity, and socioeconomic status," the study authors said. "Despite this well-established prevention paradigm, childhood obesity has been recalcitrant to many interventions, including those aimed at prevention."

The study authors, funded by the Patient-Centered Outcomes Research Institute, pointed out some effective prevention strategies that have emerged but noted that such engagement strategies haven't had long-lasting results. At best, in-person healthy behavior counseling helps maintain healthy growth trajectories for kids until they are 18 months.

"Digital interventions allow for frequent and asynchronous contact as well as the ability to incorporate personalized health information that can be readily updated in real time. In addition, the nearly ubiquitous access to mobile phone technology in the United States enables digital interventions to reach most of the country's population," the researchers explained, acknowledging the racial disparities in childhood obesity.

The data proved that hypothesis right.

The researchers enrolled 900 children and their caregivers in a two-cohort comparative study. Around half were in the clinic-only group, meaning their pediatric clinicians used "health literacy-informed booklets at well-child visits to promote health behaviors," the researchers said.

The remaining participants received the in-person standard care as well as digital patient engagement via text message. Messages were personalized and health literacy-informed, the team noted.

Children enrolled in the digital patient engagement group tended to have better growth trajectory outcomes, or slower weight gain relative to height. Overall, the digital intervention group saw an estimated reduction of 0.33 kg/m at 24 months.

When looking at weight-for-length and BMI z-scores, the researchers also found that children in the intervention group were closer to healthier growth norms.

The intervention proved more effective at preventing obesity than overweight, the data showed. At 24 months, 23.3% of kids in the digital intervention group had obesity or overweight compared to 24.5% of kids in the clinic-only group. This finding is small and not statistically significant, the researchers said.

But when comparing only kids with obesity at 24 months, the differences were more pronounced, the study continued. At the study's end, 7.4% of kids in the digital patient engagement group had obesity. Comparatively, 12.7% of kids in the clinic-only group had obesity.

"Taken together, these results indicate that the effect of the digital intervention was predominantly among children at the highest ends of the weight-for-length (and BMI) distributions," the researchers said. "This is important, because the goal of the intervention was not to change healthy weight trajectories but unhealthy ones."

It's notable that text messaging helped improve outcomes, considering the low-cost scalability of digital engagement. Still, the researchers suggested more studies into utilizing digital booklets for the in-clinic component of the intervention and strategies to assess other health system barriers to implementation.

Sara Heath has covered news related to patient engagement and health equity since 2015.