Effectiveness of mobile health interventions targeting parents to prevent and treat childhood Obesity: Systematic review

Abstract

Childhood obesity is a high prevalence condition that causes a high burden of disease in adulthood. Mobile phone app are increasingly used to prevent it. We summarized the evidence on the effectiveness of mobile apps for devices used by parents to prevent and treat childhood and adolescent obesity. An update of a systematic review of the literature (De Lepeleere et al., 2017) was carried out. PubMed, Embase, Cochrane, CINAHL, PsycINFO, Scopus, and ERIC were searched up to 2020. The included studies should target children 1-18 years, compare an app aimed at preventing or treating overweight and obesity, as stand-alone intervention or as part of a complex program, installed on parents' mobile devices, to no intervention or an intervention without the app. Outcomes related to weight status, diet, and physical activity (PA) behaviors were considered. Nineteen studies (14 RCTs and 5 non-randomized trials) were included. The app was mainly used to record food consumption and PA, to set goals, to view progress, and send health promotion messages. One study reported a significant decrease and one a suggestive decrease in anthropometric measures in obese and overweight children, while other studies observed no effect. One study reported a significant increase in PA. Six interventions proved to be effective in changing dietary behaviors. Interventions targeting overweight and/or obese children had the most positive results. All studies reported high acceptability and feasibility of interventions. The differences between interventions and the small sample size of the studies did not allow this review to reach conclusion on effectiveness.

Keywords: BMI, body mass index; Childhood obesity prevention; Healthy lifestyles; Mobile health; PICO(S), Population, Intervention, Comparator, Outcomes, Study design; RCTs, Randomized clinical trials; RoB, risk of bias; WHR, waist-to-hip ratio.

Fig. 1

PRISMA Flow diagram describing the study selection process. Notes: * Articles included in the bibliography of the following reviews: Hammersley 2016 (Hammersley et al., 2016); Quelly 2016 (Quelly et al., 2016), Rose 2017 (Rose et al., 2017); Schoeppe 2016 (Schoeppe et al., 2016), Wang 2017 (Wang et al., 2017), Fowler 2021 (Fowler et al., 2021); Mehdizadeh 2020 (Mehdizadeh et al., 2020); Zarnowiecki 2020 (Zarnowiecki et al., 2020).

Fig. 2

Schematic description of the interventions. The following are highlighted: mHealth and the other components, the main target subjects, and the target behaviors. Note: * All interventions are aimed at reducing childhood overweight and obesity but the agents of change may be different. We indicate the agent of change as the “main target” of the intervention.

Fig. 3

Risk of bias summary: review authors' judgements on each risk of bias item for each included RCT.

Fig. 4

Anthropometric (A), physical activities (B), and dietary habit (C) outcomes considered in the included studies. Note: Arrows indicate the strength and the direction of the association and the authors' interpretations of their results. Green arrows indicate positive changes, red arrows indicate negative changes. Dashed-line arrows indicate a result that is not statistically significant. *No statistical test performed. ** Data derived from the text.

Fig. 5

Usability, acceptability, applicability, and transferability of interventions in evidence-based public health schemes (adapted by Wang 2006 (Wang et al., 2006) and their measurability for apps and tools in obesity prevention. The four domains can be considered as subsequent steps in the evaluation, although they can be assessed simultaneously. Once assessed the exportability and eventually adapted the intervention to another context, the evaluation in the new context can start again.