A New Digital Tool for Preventing Childhood Obesity

Childhood obesity is a growing problem in the United States, with early prevention seen as a key opportunity to improve long-term cardiometabolic health outcomes. However, “prior interventions designed to prevent obesity in the early stages of life have mostly been unsuccessful,” says Shonna Yin, MD, an associate professor of pediatrics and population health at NYU Langone Health.

Dr. Yin and collaborators sought to change this by developing a health literacy-informed digital intervention to support parents in reducing early childhood obesity risk. In a large randomized controlled trial, they demonstrated that the intervention is capable of reducing the incidence of childhood obesity through age 24 months. Their findings, published in the journal JAMA, highlight a major breakthrough in obesity prevention. “This is the only trial that has been able to show prevention of early childhood obesity in a large, diverse population,” Dr. Yin notes.

According to Dr. Yin, digital tools offer unique advantages in reaching families at scale. “Digital interventions uniquely enable frequent contact, asynchronous from a doctor’s visit, and can leverage personalized health data,” says Dr. Yin. “The convenience and availability of smartphone technology makes it possible for digital tools to reach underserved populations, including racial and ethnic minority groups.”

A Digital Health Behavior Intervention

The intervention consists of health literacy-sensitive, responsive text messages and a web-based dashboard, combined with health behavior counseling administered by a pediatric specialist in a clinical setting.

The text messaging component of the intervention was built using evidence-based behavior change techniques, such as self-monitoring, facilitated goal-setting, and tailored feedback. Goals are divided into two-week cycles, where a goal is set on the first day of the cycle, after which five automated check-in text messages are sent to the parent over the two-week period.

“We had parents self-rate their goal progress,” explains Dr. Yin. “Immediate personalized feedback, tips, and encouragement were then provided by an automated system, based on how they were doing with their goal.”

Using the web-based dashboard, parents could track goal progress, monitor their child’s weight and length, and access intervention materials that were specifically developed based on social cognitive theory principles, emphasizing effective communication techniques.

Healthier Growth Trajectories

In a randomized controlled trial involving 900 parent–infant pairs, Dr. Yin and colleagues compared outcomes between those who received the combined digital health and clinic-based counseling intervention versus those who received clinic-based counseling alone. Those in the digital intervention group had a lower mean weight-for-length trajectory, translating into a reduction in obesity from 12.7 to 7.4 percent (according to CDC BMI criteria) or 5.7 to 2.6 percent (according to WHO BMI criteria) at 24 months.

“By improving early growth trajectories, the digital intervention could help prevent obesity and cardiometabolic diseases later in life,” says Dr. Yin.

Dr. Yin explains that the effect of the digital intervention was primarily seen at the highest ends of the weight-for-length—and BMI—distributions. This was significant as the study was not designed to modify healthy weight trajectories, but rather unhealthy ones.

Furthermore, the digital intervention had a greater effect on children from households with food insecurity, starting at approximately age 15 months. According to Dr. Yin, this finding could have important implications for children from populations who have traditionally experienced a higher risk of obesity.

The Implementation Roadmap

Eventually, Dr. Yin hopes the digital intervention could have a significant population-level impact if implemented more broadly. She says that digital tools hold the promise of improving outcomes in underserved populations for many health behavior-driven chronic illnesses, especially among young children.

“Few trials have demonstrated that an intervention can prevent obesity in the first two years of life,” she says. “These findings have very important population-level implications.”