The Impact of the ENDORSE Digital Weight Management Program on the Metabolic Profile of Children and Adolescents with Overweight and Obesity and on Food Parenting Practices

Abstract

Childhood obesity is a serious public health problem worldwide. The ENDORSE platform is an innovative software ecosystem based on Artificial Intelligence which consists of mobile applications for parents and health professionals, activity trackers, and mobile games for children. This study explores the impact of the ENDORSE platform on metabolic parameters associated with pediatric obesity and on the food parenting practices of the participating mothers. Therefore, the metabolic parameters of the 45 children (mean age: 10.42 years, 53% girls, 58% pubertal, mean baseline BMI z-score 2.83) who completed the ENDORSE study were evaluated. The Comprehensive Feeding Practices Questionnaire was used for the assessment of food parenting practices. Furthermore, regression analysis was used to investigate possible associations between BMI z-score changes and changes in metabolic parameters and food parenting practices. Overall, there was a statistically significant reduction in glycated hemoglobin (mean change = -0.10, p = 0.013), SGOT (mean change = -1.84, p = 0.011), and SGPT (mean change = -2.95, p = 0.022). Emotional feeding/food as reward decreased (mean change -0.21, p = 0.007) and healthy eating guidance increased (mean change = 0.11, p = 0.051). Linear regression analysis revealed that BMI z-score change had a robust and significant correlation with important metabolic parameters: HOMA-IR change (beta coefficient = 3.60, p-value = 0.046), SGPT change (beta coefficient = 11.90, p-value = 0.037), and cortisol change (beta coefficient = 9.96, p-value = 0.008). Furthermore, healthy eating guidance change had a robust negative relationship with BMI z-score change (beta coefficient = -0.29, p-value = 0.007). Conclusions: The Endorse digital weight management program improved several metabolic parameters and food parenting practices.

Keywords: child and adolescent obesity; digital weight management program; food parenting practices; metabolic parameters.

Figure 1

The components of the ENDORSE project consisted of mobile applications directed at both parents and health professionals and aimed to support self-monitoring by mothers. The ENDORSE Recommendation System generated personalized messages to mothers participating in the pre-pilot and pilot intervention groups, while in the pilot active control group, weekly personalized messages were sent by the healthcare professionals to mothers. Activity trackers were provided to all participating children to monitor physical activity and sleep, and an educational mobile game was provided to children participating in the pre-pilot and pilot intervention groups [35]. Parts of the figure were drawn using pictures from Servier Medical Art (smart.servier.com, accessed on 10 March 2023), provided by Servier, licensed under a Creative Commons Attribution 3.0 unported license and flaticon.com (accessed on 10 March 2023).

Figure 2

User interface of the parental version of the ENDORSE mobile application: (A) initial screen of the ENDORSE application, (B) summary of behavioral goals, and (C) example of self-monitoring of weight and health behavior goals [35].

Figure 3

Healthy eating guidance was promoted through the ENDORSE digital platform [35]. Healthy eating guidance is a concept that includes the following five food parenting practices: encouragement of balance and variety in children’s diet, parental modeling of healthy eating, availability of healthy foods at home, child involvement in meal planning and preparation, and teaching about nutrition. It is based on the Greek version [38] of the Comprehensive Feeding Practices Questionnaire by Musher-Eizenman et Holub [39]. Parts of the figure were drawn using pictures from Servier Medical Art (smart.servier.com, accessed on 10 March 2023), provided by Servier, licensed under a Creative Commons Attribution 3.0 unported license and flaticon.com (accessed on 10 March 2023).