Mobile Health Apps in Pediatric Obesity Treatment: Process Outcomes From a Feasibility Study of a Multicomponent Intervention

Background: Multicomponent family interventions underline current best practice in childhood obesity treatment. Mobilehealth (mHealth) adjuncts that address eating and physical activity behaviors have shown promise in clinical studies.Objective: This study aimed to describe process methods for applying an mHealth intervention to reduce the rate of eating andmonitor physical activity among children with obesity.Methods: The study protocol was designed to incorporate 2 mHealth apps as an adjunct to usual care treatment for obesity.Children and adolescents (aged 9-16 years) with obesity (BMI ≥98th centile) were recruited in person from a weight managementservice at a tertiary health care center in the Republic of Ireland. Eligible participants and their parents received informationleaflets, and informed consent and assent were signed. Participants completed 2 weeks of baseline testing, including behavioraland quality of life questionnaires, anthropometry, rate of eating by Mandolean, and physical activity level using a smart watchand the myBigO smartphone app. Thereafter, participants were randomized to the (1) intervention (usual clinical care+Mandoleantraining to reduce the rate of eating) or (2) control (usual clinical care) groups. Gender and age group (9.0-12.9 years and 13.0-16.9years) stratifications were applied. At the end of a 4-week treatment period, participants repeated the 2-week testing period.Process evaluation measures included recruitment, study retention, fidelity parameters, acceptability, and user satisfaction.Results: A total of 20 participants were enrolled in the study. A web-based randomization system assigned 8 participants to theintervention group and 12 participants to the control group. Attrition rates were higher among the participants in the interventiongroup (5/8, 63%) than those in the control group (3/12, 25%). Intervention participants undertook a median of 1.0 training mealusing Mandolean (25th centile 0, 75th centile 9.3), which represented 19.2% of planned intervention exposure. Only 50% (9/18)of participants with smart watches logged physical activity data. Significant differences in psychosocial profile were observedat baseline between the groups. The Child Behavior Checklist (CBCL) mean total score was 71.7 (SD 3.1) in the interventiongroup vs 57.6 (SD 6.6) in the control group, t-test P<.001, and also different among those who completed the planned protocolcompared with those who withdrew early (CBCL mean total score 59.0, SD 9.3, vs 67.9, SD 5.6, respectively; t-test P=.04). Conclusions: A high early attrition rate was a key barrier to full study implementation. Perceived task burden in combination with behavioral issues may have contributed to attrition. Low exposure to the experimental intervention was explained by poor acceptability of Mandolean as a home-based tool for treatment. Self-monitoring using myBigO and the smartwatch was acceptable among this cohort. Further technical and usability studies are needed to improve adherence in our patient group in the tertiary setting.