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

BACKGROUND: Fitness 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. OBJECTIVE: We 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. METHODS: Adolescents 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. RESULTS: A 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). CONCLUSIONS: Despite 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.

Parent perceptions to promote a healthier lifestyle for their obese child.

Parents of children referred to a pediatric multidisciplinary weight-management clinic were queried regarding the importance of and their readiness to promote healthy lifestyle behaviors with their children and also regarding their confidence in their ability to adopt those changes. Among the 193 children's parents who completed a questionnaire (93.7% response), greater than 75% of respondents recognized the importance of healthy eating and physical activity, and many indicated feeling both confident and ready to make changes. Surprisingly, even among those not confident, parents also indicated they were ready to change their child's eating (p < .001). This study explores the discrepancy between parents indicating a high level of importance and readiness to promote healthy lifestyle behaviors but having less confidence that they would actually be able to enact change.

5-2-1-almost none: parents' perceptions of changing health-related behaviors in their obese child.

OBJECTIVE: Recent clinical pediatric practice guidelines reiterate the importance of key messages to prevent childhood overweight and obesity, including the consumption of at least five servings of fruits or vegetables each day, a limit to screen time (time spent watching TV, using a computer, and playing video games) of two hours or less per day, engagement in at least one hour of physical activity per day, and the consumption of no sugary beverages each day. The perceptions of primary caregivers of obese children of these key messages are less clear. We explored parents' (or caregivers') awareness of and confidence in adopting a variation of the expert committee's recommended (5-2-1-Almost None [AN]) behaviors. MATERIALS AND METHODS: Before the initiation of treatment, parents of obese children completed a survey designed to explore their awareness of and confidence in adopting 5-2-1-AN behaviors. Qualitative and quantitative analyses were conducted to assess how aware these families are of 5-2-1-AN behaviors and how confident they would be of their ability to guide adoption of these specific behaviors. RESULTS: Parents from 193 families indicated that weight management depends substantially on physical activity (63%). However, parents rated as less important consuming fruits and vegetables (17%), controlling portions (13%), eliminating sugary drinks (4%), reducing screen time (3%), eating breakfast each morning (1%), and having family dinners (1%). Almost universally, respondents reported significantly reduced confidence in helping their child adopt nonspecific lifestyle changes in eating and physical activity versus the targeted behaviors identified in 5-2-1-AN. CONCLUSION: Parents surveyed for this clinical study readily accept certain aspects of the 5-2-1-AN message as factors in healthy living. Despite low levels of reported awareness of the message, the consumption of almost no sugary drinks was the only actionable behavior in the 5-2-1-AN message that parents felt significantly more confident they could achieve than the nonspecific goal of improved eating. These perceptions can be used to help guide the adoption of 5-2-1-AN strategies as well as help clinicians target messages for specific healthy behavior adoption.