KK Women's and Children's Hospital, Singapore, Singapore.
ReMark Group, Singapore, Singapore.
J Med Internet Res. 2021 Sep 28;23(9):e20520. doi: 10.2196/20520.
Effective, resource-efficient treatment is urgently needed to address the high rates of pediatric and adolescent obesity. This need has been accelerated by the COVID-19 pandemic. The use of a mobile health tool as an early intervention before a clinic-based multidisciplinary weight management program could be an effective treatment strategy that is appropriate during a pandemic.
This study aims to assess the effectiveness of and adolescent engagement with a mobile app-based lifestyle intervention program as an early intervention before enrollment in a clinic-based multidisciplinary weight management program.
This prospective single-cohort study involved adolescents, aged 10-16 years, who were overweight and obese (defined as BMI percentile above the 85th percentile). Participants used the mobile Kurbo app as an early intervention before enrolling in a clinic-based multidisciplinary weight management program. Kurbo's health coaches provided weekly individual coaching informed by a model of supportive accountability via video chat, and participants self-monitored their health behavior. The implementation of Kurbo as an early intervention was evaluated using the reach, effectiveness, adoption, implementation, and maintenance framework by reach (number who consented to participate out of all patients approached), implementation (Kurbo engagement and evaluation), and effectiveness as measured by the primary outcome of the BMI z-score at 3 months. Secondary outcome measures included changes in body fat percentage, nutrition and physical activity levels, and quality of life at 3 months. Maintenance was defined as the outcome measures at 6-month follow-up.
Of the 73 adolescents who were approached for enrollment, 40 (55%) of adolescents were recruited. The mean age was 13.8 (SD 1.7) years, and the mean BMI z-score was 2.07 (SD 0.30). In the multiethnic Asian sample, 83% (33/40) of the participants had household incomes below the national median. Kurbo engagement was high, with 83% (33/40) of participants completing at least 7 coaching sessions. In total, 78% (18/23) of participants rated the app as good to excellent and 70% (16/23) stated that they would recommend it to others. There were no statistically significant changes in BMI z-scores at 3 months (P=.19) or 6 months (P=.27). Participants showed statistically significant improvements in measured body fat percentage, self-reported quality of life, and self-reported caloric intake from the 3-day food diaries at 3 and 6 months.
The use of Kurbo before enrollment in an outpatient multidisciplinary clinical care intervention is a feasible strategy to expand the reach of adolescent obesity management services to a low-income and racially diverse population. Although there was no significant change in BMI z-scores, the use of Kurbo as an early intervention could help to improve quality of life and reduce body fat percentage and total caloric intake.
需要有效的、资源高效的治疗方法来解决儿童和青少年肥胖率高的问题。由于 COVID-19 大流行，这种需求加速了。在诊所为基础的多学科体重管理计划之前，使用移动健康工具作为早期干预可能是一种有效的治疗策略，适合在大流行期间使用。
本研究旨在评估基于移动应用的生活方式干预程序作为诊所为基础的多学科体重管理计划之前的早期干预措施的有效性和青少年参与度。
这项前瞻性单队列研究涉及超重和肥胖的 10-16 岁青少年（定义为 BMI 百分位高于第 85 百分位）。参与者在参加诊所为基础的多学科体重管理计划之前使用 Kurbo 移动应用程序作为早期干预。Kurbo 的健康教练每周通过视频聊天提供支持问责制模型的个人辅导，参与者自我监测他们的健康行为。使用可及性、有效性、采用、实施和维持框架来评估 Kurbo 的实施情况，可及性（同意参与的人数与所有接触到的患者之比）、实施（Kurbo 参与和评估）和有效性（以 3 个月时 BMI z 分数的主要结果衡量）。次要结果指标包括 3 个月时体脂肪百分比、营养和身体活动水平以及生活质量的变化。维持是指 6 个月随访时的结果测量。
在 73 名被招募的青少年中，有 40 名（55%）被招募。平均年龄为 13.8（SD 1.7）岁，平均 BMI z 分数为 2.07（SD 0.30）。在多民族亚洲样本中，83%（33/40）的参与者家庭收入低于全国中位数。Kurbo 的参与度很高，83%（33/40）的参与者完成了至少 7 次辅导。共有 78%（18/23）的参与者对该应用程序的评价为好到优秀，70%（16/23）的参与者表示会推荐给他人。3 个月时（P=.19）或 6 个月时（P=.27）BMI z 分数均无统计学显著变化。参与者在 3 个月和 6 个月时的自我报告身体脂肪百分比、自我报告生活质量和自我报告的 3 天食物日记中的卡路里摄入量均有统计学显著改善。
在参加门诊多学科临床护理干预之前使用 Kurbo 是一种可行的策略，可以将青少年肥胖管理服务的可及性扩大到低收入和种族多样化的人群。尽管 BMI z 分数没有显著变化，但 Kurbo 作为早期干预可以帮助改善生活质量，降低体脂肪百分比和总卡路里摄入量。
