Interactive text messaging lowered the incidence of obesity in a diverse group of infants.

The American Academy of Pediatrics 2023 clinical practice guidelines for managing obesity focuses on children aged 2 years and older (NEJM JW Gen Med Mar 1 2023 and Pediatrics 2023; 151: e2022060640), but what if healthy weight behaviours were encouraged starting as soon as birth? In this multicentre US randomised trial involving 900 newborns, health behaviour counselling for parents of newborns (provided in person by paediatric primary care clinicians at eight well-child visits during two years) was compared with an intervention that added interactive text messaging and a web-based dashboard to the standard in-office counselling. The intervention facilitated goal setting and automated biweekly check-ins. Participants represented a diverse population based on race, ethnicity, health literacy and food access.

Key findings for the clinic-plus-digital-intervention group compared with the clinic-only group included the following:

• lower mean weight-for-length trajectory at age 24 months (−0.33kg/m)
• lower rates of obesity at 24 months using US Centers for Disease Control and Prevention criteria (7.4% vs 12.7%)
• measurable effects of the intervention beginning as early as age 4 months.

Comment: Given the lower incidence of obesity imparted by this low-burden, low-cost intervention, asynchronous and two-way text messaging clearly is an effective modality for delivering clinical care. Equally important, this strategy helps to ensure equitable access to care for diverse populations of children and parents. I think it is time to consider how we might implement digital tools like this one into our busy clinical practices.

James A. Feinstein, MD, MPH, Associate Professor of Pediatrics, Children’s Hospital Colorado and University of Colorado School of Medicine, Aurora, USA.

Heerman WJ, et al. A digital health behavior intervention to prevent childhood obesity: the Greenlight Plus randomized clinical trial. JAMA 2024; 332: 2068-2080.

This summary is taken from the following Journal Watch titles: Pediatrics and Adolescent Medicine.