Use of a mobile lifestyle intervention app as an early intervention for adolescents with obesity: Single-cohort study

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Article
Citation
Chew, C. S. E., Davis, C., Lim, J. K. E., Lim, C. M. M., Tan, Y. Z. H., Oh, J. Y., Kumudhini Rajasegaran, Chia, Y. H. M., & Finkelstein, E. A. (2021). Use of a mobile lifestyle intervention app as an early intervention for adolescents with obesity: Single-cohort study. Journal of Medical Internet Research, 23(9), Article e20520. https://doi.org/10.2196/20520
Author
Chew, Elaine Chu Shan
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Davis, Courtney
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Lim, Ethel Jie Kai
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Lim, Micheal Chee Meng
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Tan, Henny Yi Zhen
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Oh, Jean Yin
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Kumudhini Rajasegaran
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Chia, Michael 
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Finkelstein, Eric Andrew
Abstract
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.
Keywords
Date Issued
2021
Publisher
JMIR Publications
Journal
Journal of Medical Internet Research
DOI
10.2196/20520
Description
The open access publication is available at: https://doi.org/10.2196/20520
Grant ID
PAEDACP-TCL/2017/CLIN/006
Funding Agency
Pediatrics Academic Clinical Programme