BALTIMORE – More than two-thirds of teens consistently wore and synced a digital activity tracker in a small study of an integrating mobile health (mHealth) approach for teens who had or were at risk to acquire obesity.
The devices were well accepted by the adolescent participants, whose activity increased for several months after beginning the study. Of the teens who participated for the full 9 months of the study, 85% of them had maintained or decreased their body mass index.
Dr. Raquel Hernandez
Set in a high school in St. Petersburg, Fla., an intervention called “Teens Tracking for Health,” or TT4H, examined 9th graders with a BMI greater than the 85th percentile, Dr. Raquel Hernandez said at the annual meeting of the Pediatric Academic Societies. The study population was identified through a schoolwide health assessment.
“You wouldn’t be surprised to learn that physical activity exposure was quite minimal” at the participants’ high school, said Dr. Hernandez, professor of pediatrics at Johns Hopkins University, based at All Children’s Hospital in St. Petersburg. “We were also not surprised, but concerned, to learn that the prevalence of morbid obesity in this student body was over 9%, which is twice what is observed nationally.”
Nutrition and fitness sessions were conducted within the school day during lunch hours. Motivational counseling was offered twice a month after school.
Each student received individual tailored texts, as well as group texts reinforcing the content delivered in group sessions. Investigators created Instagram and Twitter accounts to help the teens connect as well.
All participants received a digital tracking device – a Fitbit Flex – that was used for the duration of the study period. The step goal for participants was set at 8,000 steps per day.
Participants were also asked to track food intake via MyFitnessPal.
The 18 participants were mostly African American (11, 61%) and female (11, 61%), and most (11, 61%) participated in the free and reduced lunch program.
“There were significant fluctuations in activity of the entire group based on seasonality,” noted Dr. Hernandez. Dips in activity were seen during schoolwide standardized testing, during the winter holiday, and at the beginning of summer.
The greatest activity and consistency in syncing devices was seen in the first 20 weeks of the 9-month program.
“We noted an increase in activity in our male participants of about 1,000 steps early in the study; that, unfortunately, waned as we followed the teens,” said Dr. Hernandez. Female participants also had a progressive decline in activity over the course of the study. Overall, females were substantially less active than males in the study; data analysis is ongoing to quantify the difference and to identify associations with the lower activity level.
Data from individual activity monitors were exported into the research database whenever a device was synced, allowing for real time monitoring and feedback for participants in the form of individualized texts.
Messaging in the texts sent to students was congratulatory and encouraging, rather than nagging, Dr. Hernandez said in an interview. “So if a participant was 2,000 steps away from their goal for the day, we could send them a text cheering them on and encouraging them to be a little more active for the rest of the day,” she said.
Dietary tracking was “problematic” among the adolescent participants. “Teens had many reasons for not logging their food, primarily confusion and uncertainty in terms of logging their food in the app,” said Dr. Hernandez. Efforts at further education were unsuccessful in improving the rate of diet tracking.
The study was funded by a Building Healthy Communities Grant from the Florida Blue Foundation.