Healthy Lifestyles Program for You (HLP4U): Augmenting Childhood Obesity Treatment Through Provider-to-parent Text Messaging.

Protocol Title Healthy Lifestyles Program for You (HLP4U): Augmenting childhood obesity treatment through provider-to-parent text messaging.

Significance One in three children in the US are overweight or obese, a condition known to increase the risk of adult obesity and chronic disease. Behavioral treatment of pediatric and adolescent obesity is strongly recommended, and in research settings treatment has shown efficacy in reduction of child body mass index (BMI) and improved long-term health outcomes. However, clinical treatment models must operate within the constraints of the outpatient practice, and are limited in their ability to deliver the same intensity of intervention or outreach. Not surprisingly, clinic-based treatment of child obesity is less effective than in research settings.

"Motivational Interviewing" (MI) has emerged as a promising clinical method for improving health outcomes in childhood obesity treatment. "Motivation" is defined as an individual's expressed intention to change, and is divided into three measurable elements: importance, confidence, and readiness. The theoretical framework of MI focuses on the interpersonal aspects of behavioral change between patient and provider. MI emphasizes provider empathy, support for patient autonomy, exploring ambivalence and reinforcing change talk. Several studies have demonstrated that childhood obesity treatments that use MI effectively are more likely to achieve improved child outcomes than those who do not. These outcomes include decreased BMI,6 increased physical activity, and improvements in parental confidence.

The Healthy Lifestyles (HL) program is an AAP Stage 2-4 childhood obesity program3 located in Durham, NC. Children with BMI above the 95th percentile are referred to HL by their primary provider. The Healthy Lifestyles clinical protocol has been described elsewhere. In short, children aged 22 years and under with BMI ≥ 95th percentile are referred by their primary physician to the multidisciplinary HL clinic for treatment of obesity and related co-morbidities. The intervention involves monthly visits for one year to meet with medical, dietary, exercise and behavior specialists all certified in Motivational Interviewing. Despite the comprehensive model, and despite consistent delivery of behavior change counseling using motivational interviewing, the Healthy Lifestyles model does not lead to significant decreases in body mass index. Less than 25% of patients who initially enroll complete treatment. These outcomes are similar to other comprehensive child obesity programs nationally. There is a clear need for effective treatment options.

A rapidly evolving field of study is investigating the use of healthcare provider-to-text messages to augment patient behavior change. Text messaging is attractive, in part, because text penetrance to mixed ethnic, racial, and socioeconomic populations is high, and 80-81% of sent messages are read with a mean response time of 6 minutes. Text messages as simple reminders can lead to improvements in patient compliance with medications and immunizations. Text messages targeting behaviors can decrease TV viewing time among young children when texts are delivered to the parent. Text messages can also improve self-efficacy when they offer encouragement, recognize the difficulty of change, and congratulate the patient on change. To date, no studies have investigated the use of provider-to-parent text messages utilizing MI theory to increase the effectiveness of childhood obesity treatment.