Obesity and Telehealth, Continued

The previous post left off by describing a study of weight loss technology, as applied to young adults. The kids who participated were asked what kinds of information they did not have enough of. Among many other things, they expressed a need for help in defining reasonable goals. They were not averse to hearing experts give advice about how to overcome barriers (internal and external) and get results.

They talked about what they would want from a weight-management app: an individualized program tailored to their “height, weight, gender, age, and weight loss goals.” And again, as researcher Janna Stephens noted…

Very few young adults knew that any of these features were available in current smartphone applications and when they heard that it was available, they were excited to use this type of technology.

What kind of personal feedback would kids want from their ideal telehealth program? The “how” was easy — text message or email. A weekly summary of the objective facts would be fine: records of their food consumption, physical activity, and measurable progress. What they did not want was negative feedback of any kind. Apparently, most teens get enough of that at home and school.

Short time, big change

Five years later, the telehealth field exploded. It was forced to, by the worldwide COVID-19 emergency. A large number of pediatric nurses collaborated on a paper to explain how things were going. It mentioned the lack of income that massive societal disruption imposed on many families, and the consequent dearth of health insurance for them. Long-distance doctoring became essential, and many primary care providers adopted telemedicine as an integral part of their practices.

Two years later the American Academy of Pediatrics held its national conference, where telemedicine was gratefully credited for its contributions to the management of pediatric obesity during the pandemic. Journalist Celeste Krewson gave an example:

[C]are at the WELL clinic shifted to telemedicine delivery… The telemedicine program during the COVID-19 pandemic involved 20-minute sessions based on the Wheel of Health, a health management chart including social and emotional wellness, sleep, screen time, physical activity, and nutrition.

Primary care pediatricians refer patients to WELL, where they meet with a specially trained board-certified pediatrician or nurse practitioner. They are then given counseling for obesity and any comorbidities. Patients receive support in scheduling, follow-up, and care coordination.

Overall, the results showed that telemedicine is “clinically and financially feasible for obesity intervention in pediatric patients,” and “could give children access to a high-quality program no matter what background they come from.”

Today

This post would be incomplete without a reminder to check out the very comprehensive, effective, state-of-the-art telehealth program, BrainWeighve.

Your responses and feedback are welcome!

Source: “When Pandemics Collide: The Impact of COVID-19 on Childhood Obesity,” PediatricNursing.org, 11/11/20
Source: “Telemedicine intervention effective against childhood obesity,” ContemporaryPediatrics.com, 10/11/22
Image by Esther Vargas/CC BY-SA 2.0

A Decade of Tech, Part 14

Sitting around all the time is a sure recipe for obesity. Everybody knows that. But what if it’s the other way around? What if being obese is the cause of too much sitting around? Someone wanted to get to the bottom of this mystery, and used information gleaned from 3,864 mother-offspring pairs to help figure out what is really going on. The project required technology of course, so monitoring devices would play a very important role.

An article published in 2020 explains the background. First of all…

[…] it is important to understand whether early-life obesity drives sedentary behavior in adulthood, as this further highlights the importance of controlling childhood obesity for preventing poor behaviors that are likely to impact health outcomes in later life.

The researchers wondered if a basic tenet of causality has been too easily accepted. It seemed important to establish that weight causes immobility, as much as immobility causes weight. In fact, it looked to them as if “the association more strongly operates in the direction from obesity to sedentary behavior/moderate-vigorous intensity physical activity (MVPA) rather than inactivity causing obesity.”

In other words, obesity leads sometimes to sloth, except for the times when it leads to moderate and even intense activity (and in some cases, TV contracts). At the same time, no one denies that sedentary behavior can and does contribute to obesity. So, there is a lot going on here.

Stage one

The first round of information was lifted from the 1970 British Cohort Study when, at ages 31 and 10, respectively, the height and weight of each mother-offspring pair had been recorded, along with other information. In 2016 the researchers returned to take a second look, when the younger generation of subjects had reached the age of 46 or 47.

Information was collected by a motion-detecting device called activPAL fastened around each participant’s thigh to report on the person’s level of activity. The activPAL device had started being used in 2001, so it was well-established by that time. The accuracy of the information was undoubtedly higher than in the first round, when activity levels had been determined by self-reporting. According to the study results,

Intergenerational data on mother-offspring pairs were utilized in an instrumental variable analysis to examine the longitudinal association between BMI and sedentary behavior.

A causal pathway was found, leading from high BMI in early life to greater device-measured sitting behavior in adulthood. The study authors concluded that “There is strong evidence for a causal pathway linking childhood obesity to greater sedentary behavior.”

The report said that the study “aimed to assess causal associations between obesity in childhood and sitting behavior in middle age,” which has an unintentional ring of satire. It also refers to a number of observational studies “that have suggested adiposity to be a stronger predictor of future sedentary behavior and lower MVPA rather than the reverse (i.e., activity predicting obesity).”

Pinning down this relationship is said to be vital because, if we can keep kids from getting obese, they won’t sit around so much in later life. According to the study authors,

Our findings suggest that obesity in early life may be causally related to adverse sitting and physical activity behaviors in adulthood, potentially further amplifying the risks of obesity and other cardiometabolic conditions. Policies to promote physical activity should focus on preventing childhood obesity and weight gain.

Your responses and feedback are welcome!

Source: “Childhood Obesity and Device-Measured Sedentary Behavior: An Instrumental Variable Analysis of 3,864 Mother–Offspring Pairs,” Wiley.com, 11/01/20
Image by Katy Warner/CC BY-SA 2.0

A Decade of Tech, Part 13

PCORI is short for Patient-Centered Outcomes Research Institute, an independent nonprofit organization authorized by Congress in 2010 to fund research that will provide patients, their caregivers and clinicians with the evidence-based information needed to make better-informed healthcare decisions.

In 2018 it awarded a seven-million dollar research grant to a team for the purpose of “comparing clinic and consumer information technology approaches,” in the service of preventing childhood obesity by promoting healthy behaviors. This was innovative because few clinical trials were even concerned with obesity prevention in the first year of life.

Another difference was that an effort was being made here to be “literacy-sensitive,” to be conscious that some parents, for whatever reason, are not prepared to deal competently with the written word. Would information technology be more efficacious in helping such parents develop the necessary awareness and skills to give their kids the healthiest possible start in life?

Nine hundred families were involved in this effort, through six pediatric clinics all participating in protocols recommended by the CORNET and PCORnet research networks. During each child’s first 18 months of life, there would be nine well-child visits, which would be handled in one of two different ways. For some of the infants, the pediatricians would distribute “low-literacy, age-specific parent education booklets” designed to encourage healthy family behaviors that would prevent obesity.

In the other arm of the study, rather than booklets, parents would receive the same information by way of “a technology-assisted parent education program that includes a web/mobile platform for education and behavior change and a text messaging strategy designed for lower socioeconomic status populations.”

The team was led by Russell Rothman, M.D., MPP, of Vanderbilt University Medical Center who said,

This study design will allow us to determine whether added technology can provide support outside the clinic to promote behavior change and obesity prevention.”

The two parts were called Greenlight and Greenlight Plus:

Families randomized to Greenlight Plus receive the Greenlight intervention plus a health information technology intervention, which includes: 1) personalized, automated text-messages that facilitate caregiver self-monitoring of tailored and age-appropriate child heath behavior goals; and 2) a web-based, personalized dashboard that tracks child weight status, progress on goals, and electronic Greenlight content access.

Your responses and feedback are welcome!

Source: “Study uses IT to prevent early childhood obesity,” Vanderbilt.edu, 12/20/18
Source: “The greenlight plus trial…,” JohnHopkins.edu, Dec. 2022
Image by Oak Ridge National Laboratory/CC BY 2.0

Two Worrisome Trends

Picture this: 745,000 subjects. If that is not an impressive number, then what is? Although these individuals are from 41 different countries, according to a study published in the journal Child and Adolescent Obesity, an awful lot of them have one thing in common:

More and more teens all over the world are underestimating their own body weight. [T]his trend could undermine, or render increasingly ineffective, ongoing public health interventions…

Researchers from the University of Luxembourg analyzed 16 years’ worth of data to learn how thoroughly the kids are fooling themselves. When young people underestimate their weight, lead author Doctor Anouk Geraets told the media, it is a matter of concern, because “they may make unhealthy lifestyle choices.” More accurately, they will continue to stick with the same unhealthy habits they have been practicing all along.

A BWP, or Discrepancy in body Weight Perception, goes one of two ways. A person has a self-image of either being skinnier than they are, or fatter. When someone believes their body to be less corpulent than it actually is, that self-deception can be dangerous. On the other hand, the belief that one is disgustingly fat can lead to horrific eating disorders that are astonishingly difficult to cure.

But apparently, there is less reason than ever before to worry about anorexia, because while people’s overestimation of their own weight status happens less often, their self-underestimation has ominously increased.

It’s a world-beater

This research was undertaken as part of a WHO collaborative study of International Health Behavior in School-Aged Children. The scholars reached several main findings, including, “Correct weight perception increased over time among girls but decreased among boys.” Males can more easily fool themselves into believing they are in good shape. This ties in with a problem experienced by the U.S. military establishment, which is still overwhelmingly male.

The Army, for instance, needs about 130,000 new recruits per year. Out of all the 17- to 24-year-olds in America, 11% are military-ineligible strictly due to being overweight. At the end of 2022, it was estimated that the next fiscal year would come up about 10,000 recruits short. The deficit actually reached nearly 15,000. The news gets worse:

However, the Department of Defense’s most recent figures show that an astonishing 77 percent of Americans of prime recruiting age would be ineligible for military service… Over three-quarters of American young people are ineligible due to some combination of factors, chief among them obesity.

The COVID pandemic did not help to rectify matters. Between early 2019 and mid-2021, in the Army alone, nearly 10,000 active-duty soldiers became obese. Before that crisis, about 18% of soldiers were obese, but by 2021 the percentage grew to 23%:

Overweight and obese troops are more likely to be injured… The military loses more than 650,000 workdays each year because of extra weight…

[T]hree-quarters of Americans aged 17 to 24 are not eligible for military service for several reasons, including extra weight. Being overweight is the biggest individual disqualifier…

Your responses and feedback are welcome!

Source: “OK with obesity? Fewer teens see themselves as overweight, survey reveals,” StudyFinds.org, 07/04/23
Source: “Addressing childhood obesity also supports US military readiness,” TheHill.com, 12/14/22
Source: “Pandemic pounds push 10,000 U.S. Army soldiers into obesity,” USNews.com, 04/02/23
Image by Dept. of Defense/Public Domain

A Decade of Tech, Part 9

What could be more technical than Analytics, one of the forces by which society is ruled? Like so many other branches of science, Analytics can be good or bad. From a 2015 news story,​ how does this sound?

[B]rands can identify those children most reactive to food and drink marketing and target them specifically with their Facebook advertisements.

The Irish Heart Foundation published a report called “Who’s Feeding the Kids Online?” that outlined the methods used by advertisers, on behalf of manufacturers, to fly under parental radar and spread the junk food gospel. Did it work? You bet. For instance, journalist Danny Gridley pointed to “a French Coca-Cola campaign, where Facebook ads accounted for 2 percent of marketing cost but 27 percent of the increase in sales.” The writer remarked, “All we can hope is that Facebook can find a way to use its powers for good and not evil.”

A 2018 article​ also pointed a finger at Facebook, as having been “embroiled in controversy with Cambridge Analytica, and cited modern technology in general as having developed “a bad habit of letting people down.” A powerful influencer named Martha Lane Fox who sits on the boards of several media giants spoke at an industry conference where she urged businesses to take more responsibility for considering unintended consequences and especially for practicing more transparency.

At the time, the coalition of technology and advertising was under fire for contributing to childhood obesity, and the idea of placing restrictions on the junk food and sugar-sweetened beverage industries was being seriously discussed. “Make responsible tech the new normal,” was the phrase that writer Michaela Jefferson chose for the piece’s title — even if that meant implementing some degree of regulation.

Characterizing childhood obesity epidemic as public health epidemic, a program was designed​ to evaluate the importance of caregivers, especially parents, and also to confront the problem of parents being less engaged during the summer, and of school not being in session. And since kids are heavily involved with texting, social media and other technology anyway, why not take advantage of it?

Importantly, the potential for such technology approaches to serve as theoretically sound behavior change intervention strategies, either singularly or as part of a multi-component approach, for self-monitoring with immediate feedback, as well as an opportunity for support, behavioral nudging, and positive reinforcement, has rapidly emerged.

The experimental program seems to be kind of a virtual camp, encouraging parents to engage their children in the same type of nutrition, education, recreation, and fitness program they would partake in if away at an actual camp. Parents liked the “quick and easy access to healthy habit suggestions” and the non-invasive nature of text messaging. One takeaway was that “this work is critical for informing changes to technology-based caregiver engagement strategies to be tested in future interventions.”

Your responses and feedback are welcome!

Source: “Facebook And Childhood Obesity Linked In Latest Report,” TheDailyMeal.com, 06/16/16 ​
Source: “Martha Lane Fox: ‘We’re trying to make responsible tech the new normal’,” The-Media-Leader.com, 07/19/18
Source: “Feasibility and acceptability of technology-based caregiver engagement strategies delivered in a summertime childhood obesity prevention intervention: results from an internal pilot of the Camp NERF (Nutrition, Education, Recreation, and Fitness) study,” BiomedCentral.com, 09/27/18
Image by fsse8info/CC BY-SA 2.0