New research shows that combining a new digital intervention with traditional health behavior counseling is an effective early way to prevent childhood obesity, according to a study published Nov. 3 in the Journal of the American Medical Association.
The Greenlight Plus study was a large, randomized trial of 900 children from six medical centers across the United States and was led by investigators at Monroe Carell Jr. Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, including Bill Heerman, MD, MPH, director of the Division of General Pediatrics, and Russell Rothman, MD, MPP, professor of Internal Medicine, Pediatrics and Health Policy and Ingram Professor of Integrative and Population Health. The goal of this study was to test whether a text-messaging and web-based intervention could prevent obesity in the first two years of life.
Specifically, researchers examined if childhood obesity could be prevented by leveraging a combination of health behavior counseling offered by pediatric primary care clinicians and modern digital health literacy tools such as text messages and a web dashboard, and if the two were more effective than health behavior counseling alone.
The trial enrolled children from birth and followed them closely until they reached the age of 2.
Participants were divided into two distinct groups. The Greenlight Plus Group received comprehensive health behavior counseling along with digital support through regular text messages, including personally tailored and responsive content, and a user-friendly web dashboard. Among the clinic and digital intervention group, 90% of the planned 265 messages per participant were confirmed as sent. In contrast, the Greenlight Group received only health behavior counseling without the additional digital tools.
The results showed that children in the Greenlight Plus Group exhibited healthier growth patterns compared to their peers in the Greenlight Group. Most notably, by the age of 2, the prevalence of obesity was significantly lower in the Greenlight Plus Group, with only 7.4% of children affected compared to 12.7% in the Greenlight Group.
“These findings underscore the critical importance of early intervention in preventing obesity and its related health issues later in life,” said Heerman, holder of the William K. Warren Foundation Chair in Medicine. “The use of digital tools in conjunction with traditional health counseling makes health advice more accessible and effective, particularly for families who may face barriers to accessing health care.”
The study also revealed that the intervention was particularly effective for certain demographics, including racially and ethnically diverse populations and those groups at elevated risk for childhood obesity. Non-white participants, families with low health literacy and families experiencing food insecurity saw the most significant benefits from the Greenlight Plus intervention. Tailored interventions, the authors noted, have the potential to help bridge gaps in health equity and ensure that all children have the opportunity to grow up healthy.
Previously, few trials had examined the impact of text-messaging interventions on obesity prevention among children, and none have been effective at preventing obesity in the first two years of life. Many unhealthy behaviors that contribute to childhood obesity are shown to begin in the early weeks of life.
The substantial reduction in risk of childhood obesity observed in this study could have significant population-level impact if implemented at scale, suggesting that broader implementation studies are warranted for the future, the researchers noted.
Other Vanderbilt researchers participating in the study are Jacarra Lampkin, MPH, Colin J. Orr, MD, MPH, Jonathan S. Schildcrout, PhD, and Shelby Wallace.
The research was supported with funding from the Patient Centered Outcomes Research Institute, PCORI grant number AD-2018C1-11238, and the National Institutes of Health’s National Center for Advancing Translational Sciences, grant number UL1-TR000445.
