JMIR Publications

ABSTRACT

Background:

E-Health obesity programs offer benefits to traditionally-delivered programs and have shown promise in improving obesity-related behaviors in children.

Objective:

To assess the efficacy of a parent-focussed internet-based healthy lifestyle program for preschool-aged children, who are overweight or at risk of becoming overweight, on child BMI, obesity-related behaviors, parent modelling and parent self-efficacy.

Methods:

The Time2bHealthy randomized controlled trial was conducted in the Illawarra and surrounding areas of New South Wales and Melbourne, Victoria, Australia during 2016-2017. Participants were recruited both online and through more traditional means. Parent/carer and child (aged 2-5 years) dyads were randomized into an intervention or comparison group. Intervention participants received an 11-week internet-based healthy lifestyle program, which was underpinned by Social Cognitive Theory, followed by fortnightly emails for 3-months thereafter. Intervention participants were encouraged to access and contribute to a closed (secret) Facebook group to communicate with other participants and a dietitian. Comparison participants received email communication only. Child BMI was the primary outcome, which was objectively measured. Secondary outcomes included objectively-measured physical activity, parent- and objectively-measured sleep habits, and parent-reported dietary intake, screen-time, child feeding, parent modelling and parent self-efficacy. All data were collected at face-to-face appointments at baseline, 3- and 6-months by blinded data collectors. Randomization was conducted using a computerized random number generator post-baseline data collection.

Results:

Eighty-six dyads were recruited, with 42 randomized to the intervention group and 44 to the comparison group. 78 dyads attended the 3- and 6-month follow-ups, with 7 lost to follow-up and one withdrawing. Mean child age was 3.46 years and 91% were in the healthy weight range. Sixty-nine percent of participants completed at least 5 of the 6 modules. Intention-to-treat analyses found no significant outcomes for change in BMI between groups. Compared to children in the comparison group, those in the intervention group reduced frequency of discretionary food intake (estimate -0.360, 95% CI -2.272 to -0.447, P=0.00), and parents showed improvement in child feeding pressure to eat practices (-0.304, 95% CI 0.061 to -0.003, P=0.048) and nutrition self-efficacy (0.429, 95% CI 0.096 to 0.763, P=0.01). No significant time by group interaction was found for other outcomes.

Conclusions:

The trial demonstrated that a parent-focussed eHealth childhood obesity prevention program can provide support to improve dietary-related practices and self-efficacy but was not successful in reducing BMI. The target sample size was not achieved, which would have affected statistical power. Clinical Trial: Australian and New Zealand Clinical Trials Registry (12616000119493). http://www.anzctr.org.au/