Abstract
Objectives
To investigate if digital approaches can ameliorate the known consequences of social-distancing restrictions in the context of the global COVID-19 pandemic for adolescent participants originally registered for a face-to-face outpatient weight regulation program and whether video-based multiprofessional outpatient obesity therapy is successful for a group of adolescents with preexisting obesity.
Methods
The certified KiCK outpatient training program for children and adolescents with overweight and obesity was remodeled as a consequence of the lockdown traditional face-to-face program to a completely digital and video-based format on short notice. The virtual approach was compared with the results of the conventional program regarding metabolic parameters, body mass index standard deviation score (BMI SDS), well-being, and physical fitness.
Results
Sixty-nine of 77 enrolled participants for KiCK (age 8 to 17 years, BMI z score >2.0) were able and willing to participate virtually. After the first lockdown significant improvements of BMI SDS (mean 0.18; p=0.02), homeostasis model assessment (HOMA) index (mean 1.4; p=0.016), triglycerides (mean 0.18 mmol/dL; p=0.021), 6 minute-walk-test (mean 97.0 m; p=0.030, and well-being according to the World Health Organization 5 (WHO-5) questionnaire (mean 2.5; p=0.002) were found after the virtual intervention, which was comparable to the results observed previously in matched pairs data from the program during the pre-COVID period. After the end of the second lockdown weight SDS, BMI SDS, HOMA INDEX, and cholesterol were also measured reduced compared to baseline parameters measured before program initiation. Walking distance in the 6 MWT and improvement in general well-being in the WHO-5 questionnaire also persisted.
Conclusions
These results indicate good acceptance and efficacy of the video-intervention for youth with overweight and obesity during the lockdown, supporting the use of virtual modules in future programs after the pandemic.
Funding source: #wekickcorona
Funding source: Dr August and Erika Appenrodt Stiftung, Hanover
Acknowledgments
The authors thank the participants and their families for participating in the program. Furthermore we thank the initiative #wekickcorona for a financial support to provide the technical infrastructure. KiCK – Program is partially financially supported by the Dr. August and Erika Appenrodt Foundation.
-
Research funding: This work was financially supported by the Dr. August und Erika Appenrodt-Stiftung Hanover, Germany, and #wekickcorona. The module of sports therapy and the performance of data collection and analysis were financially supported by the Dr. August und Erika Appenrodt-Stiftung Hannover (https://www.sparkassen-stiftungsmanagement.de/stiftungen/dr-august-und-erika-appenrodt-stiftung.html). The cost of purchasing technical hardware (tablet, screens, headsets) and software to conduct video-based counseling was financially supported by the initiative #wekickcorona (https://www.wekickcorona.com/).
-
Author contribution: FR designed the study, performed data analyses, created tables, wrote the initial manuscript, and edited the manuscript. LG, SL and KL designed the study, performed data analyses and edited the manuscript. CW, ES and CG performed data analyses and edited the manuscript. KL and TD conceptualized and designed the study, performed and supervised data analyses, and edited the manuscript. TD is the guarantor of the study and accepts full responsibility for the work and the conduct of the study, had access to the data, and controlled the decision to publish. All authors have read and approved the final manuscript.
-
Competing interest: The authors report to no potential conflicts of interest relevant to this article.
-
Informed consent: Informed consent was obtained from all individual participants included in the study. Written informed consent was obtained from the parents.
-
Available of data and material: The data presented are part of the Video KiCK program. Data collection and analysis were performed at the Center for Clinical Studies of the Children’s Hospital AUF DER BULT, Hanover, with support from the Department of Medical Psychology at Hanover Medical School. All data presented are available as source data and can be provided if desired.
-
Consent for publication: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.
References
1. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet 2017;390:2627–42. https://doi.org/10.1016/S0140-6736(17)32129-3.Search in Google Scholar
2. Cardel, MI, Atkinson, MA, Taveras, EM, Holm, JC, Kelly, AS. Obesity treatment among adolescents: a review of current evidence and future directions. JAMA Pediatr 2020;174:609–17. https://doi.org/10.1001/jamapediatrics.2020.0085.Search in Google Scholar PubMed PubMed Central
3. Antwi, F, Fazylova, N, Garcon, MC, Lopez, L, Rubiano, R, Slyer, JT. The effectiveness of web-based programs on the reduction of childhood obesity in school-aged children: a systematic review. JBI Libr Syst Rev 2012;10:1–14. https://doi.org/10.11124/jbisrir-2012-248.Search in Google Scholar PubMed
4. Cook, S, Kavey, RE. Dyslipidemia and pediatric obesity. Pediatr Clin 2011;58:1363–73. https://doi.org/10.1016/j.pcl.2011.09.003.Search in Google Scholar PubMed PubMed Central
5. Rankin, J, Matthews, L, Cobley, S, Han, A, Sanders, R, Wiltshire, HD, et al.. Psychological consequences of childhood obesity: psychiatric comorbidity and prevention. Adolesc Health Med Therapeut 2016;7:125–46. https://doi.org/10.2147/AHMT.S101631.Search in Google Scholar PubMed PubMed Central
6. Mencin, AA, Lavine, JE. Advances in pediatric nonalcoholic fatty liver disease. Pediatr Clin 2011;58:1375–92. https://doi.org/10.1016/j.pcl.2011.09.005.Search in Google Scholar PubMed
7. Lindberg, L, Hagman, E, Danielsson, P, Marcus, C, Persson, M. Anxiety and depression in children and adolescents with obesity: a nationwide study in Sweden. BMC Med 2020;18:30. https://doi.org/10.1186/s12916-020-1498-z.Search in Google Scholar PubMed PubMed Central
8. Inge, TH, King, WC, Jenkins, TM, Courcoulas, AP, Mitsnefes, M, Flum, DR, et al.. The effect of obesity in adolescence on adult health status. Pediatrics 2013;132:1098–104. https://doi.org/10.1542/peds.2013-2185.Search in Google Scholar PubMed PubMed Central
9. Hu, Y, He, JR, Liu, FH, Li, WD, Lu, JH, Xing, YF, et al.. Effectiveness of a kindergarten-based intervention for preventing childhood obesity. Pediatrics 2017;140:e20171221. https://doi.org/10.1542/peds.2017-1221.Search in Google Scholar PubMed
10. Lee, EY, Yoon, KH. Epidemic obesity in children and adolescents: risk factors and prevention. Front Med 2018;12:658–66. https://doi.org/10.1007/s11684-018-0640-1.Search in Google Scholar PubMed
11. EU Action Plan on Childhood Obesity 2014–2020. Available from: https://ec.europa.eu/health/sites/health/files/nutrition_physical_activity/docs/childhoodobesity_actionplan_2014_2020_en.pdf.Search in Google Scholar
12. JANPA. Joint Action on Nutrition and Physical Activity. Available from: http://www.janpa.eu/default.asp. Accessed 04 May 2022.Search in Google Scholar
13. Sonntag, D. Why early prevention of childhood obesity is more than a medical concern: a health economic approach. Ann Nutr Metab 2017;70:175–8. https://doi.org/10.1159/000456554.Search in Google Scholar PubMed
14. Brown, CL, Halvorson, EE, Cohen, GM, Lazorick, S, Skelton, JA. Addressing childhood obesity: opportunities for prevention. Pediatr Clin 2015;62:1241–61. https://doi.org/10.1016/j.pcl.2015.05.013.Search in Google Scholar PubMed PubMed Central
15. Gori, D, Guaraldi, F, Cinocca, S, Moser, G, Rucci, P, Fantini, MP. Effectiveness of educational and lifestyle interventions to prevent paediatric obesity: systematic review and meta-analyses of randomized and non-randomized controlled trials. Obes Sci Pract 2017;3:235–48. https://doi.org/10.1002/osp4.111.Search in Google Scholar PubMed PubMed Central
16. Salam, RA, Padhani, ZA, Das, JK, Shaikh, AY, Hoodbhoy, Z, Jeelani, SM, et al.. Effects of lifestyle modification interventions to prevent and manage child and adolescent obesity: a systematic review and meta-analysis. Nutrients 2020;12:2208. https://doi.org/10.3390/nu12082208.Search in Google Scholar PubMed PubMed Central
17. Rosenbaum, M, Garofano, R, Liimatta, K, McArthur, K, Paul, E, Starc, T, et al.. The Families Improving Health Together (FIT) Program: initial evaluation of retention and research in a multispecialty clinic for children with obesity. Obes Sci Pract 2021;7:357–67. https://doi.org/10.1002/osp4.498.Search in Google Scholar PubMed PubMed Central
18. Pietrobelli, A, Pecoraro, L, Ferruzzi, A, Heo, M, Faith, M, Zoller, T, et al.. Effects of COVID-19 lockdown on lifestyle behaviors in children with obesity living in verona, Italy: a longitudinal study. Obesity (Silver Spring) 2020;28:1382–5. https://doi.org/10.1002/oby.22861.Search in Google Scholar PubMed PubMed Central
19. Yang, S, Guo, B, Ao, L, Yang, C, Zhang, L, Zhou, J, et al.. Obesity and activity patterns before and during COVID-19 lockdown among youths in China. Clin Obes 2020;10:e12416. https://doi.org/10.1111/cob.12416.Search in Google Scholar PubMed PubMed Central
20. Panda, PK, Gupta, J, Chowdhury, SR, Kumar, R, Meena, AK, Madaan, P, et al.. Behavioral impact of lockdown and quarantine measures for COVID-19 pandemic on children, adolescents and caregivers: a systematic review and meta-analysis. J Trop Pediatr 2021;67:fmaa122. https://doi.org/10.1093/tropej/fmaa122.Search in Google Scholar PubMed PubMed Central
21. Chang, TH, Chen, YC, Chen, WY, Chen, CY, Hsu, WY, Chou, Y, et al.. Weight gain associated with COVID-19 lockdown in children and adolescents: a systematic review and meta-analysis. Nutrients 2021;13:3668. https://doi.org/10.3390/nu13103668.Search in Google Scholar PubMed PubMed Central
22. Valenzise, M, D’Amico, F, Cucinotta, U, Lugarà, C, Zirilli, G, Zema, A, et al.. The lockdown effects on a pediatric obese population in the COVID-19 era. Ital J Pediatr 2021;47:209. https://doi.org/10.1186/s13052-021-01142-0.Search in Google Scholar PubMed PubMed Central
23. Kiess, W, Kirstein, AS, Stein, R, Vogel, M. Obesity after the Covid-19 pandemic and beyond. J Pediatr Endocrinol Metab 2022;35:135–8. https://doi.org/10.1515/jpem-2022-2135.Search in Google Scholar PubMed
24. Robert Koch-Institut. Abteilung für Epidemiologie und Gesundheitsmonitoring. In: Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland (KiGGS Welle 2); 2019. Scientific Use File 1. Version. Available from: https://doi.org/10.7797/17-201417-1-1-1.Search in Google Scholar
25. Reinehr, T, Tittel, SR, Holle, R, Wiegand, S, Gellhaus, I, Hebebrand, J, et al.. Comparison of cardiovascular risk factors between children and adolescents with classes III and IV obesity: findings from the APV cohort. Int J Obes (Lond). 2021;45:1061–73.10.1038/s41366-021-00773-xSearch in Google Scholar PubMed PubMed Central
26. Roschatt, IS, Kapitzke, K, Sadeghian, E, Ziegler, C, Bokelmann, A, Galuschka, L, et al.. Erfolgreiche Teilnahme an einem interdisziplinären Interventionsprogramm für übergewichtige Kinder: verbesserung atherogener metabolischer parameter. Adipositas 2018;12:32–7. https://doi.org/10.1055/s-0038-1636969.Search in Google Scholar
27. Goldschmidt, I, Nanni, AD, Streckenbach, C, Schnell, K, Danne, T, Baumann, U. Improvement of BMI after lifestyle intervention is associated with normalisation of elevated ELF score and liver stiffness in obese children. BioMed Res Int 2015;2015:457473. https://doi.org/10.1155/2015/457473.Search in Google Scholar PubMed PubMed Central
28. Topp, CW, Østergaard, SD, Søndergaard, S, Bech, P. The WHO-5 Well-Being Index: a systematic review of the literature. Psychother Psychosom 2015;84:167–76. https://doi.org/10.1159/000376585.Search in Google Scholar PubMed
29. Foster, C, Moore, JB, Singletary, CR, Skelton, JA. Physical activity and family-based obesity treatment: a review of expert recommendations on physical activity in youth. Clin Obes 2018;8:68–79.10.1111/cob.12230Search in Google Scholar PubMed
30. Geiger, R, Strasak, A, Treml, B, Gasser, K, Kleinsasser, A, Fischer, V, et al.. Six-minute walk test in children and adolescents. J Pediatr 2007;150:395–92. https://doi.org/10.1016/jjpeds.2006.12.052.Search in Google Scholar
31. Morinder, G, Mattsson, E, Sollander, C, Marcus, C, Larsson, UE. Six-minute walk test in obese children and adolescents: reproducibility and validity. Physiother Res Int 2009;14:91–104. https://doi.org/10.1002/pri.428.Search in Google Scholar PubMed
32. Dondi, A, Candela, E, Morigi, F, Lenzi, J, Pierantoni, L, Lanari, M. Parents’ perception of food insecurity and of its effects on their children in Italy six months after the COVID-19 pandemic outbreak. Nutrients 2020;13:121. https://doi.org/10.3390/nu13010121.Search in Google Scholar PubMed PubMed Central
33. Ventura, PS, Ortigoza, AF, Castillo, Y, Bosch, Z, Casals, S, Girbau, C, et al.. Children’s health habits and COVID-19 lockdown in catalonia: implications for obesity and non-communicable diseases. Nutrients 2021;13:1657. https://doi.org/10.3390/nu13051657.Search in Google Scholar PubMed PubMed Central
34. Nicodemo, M, Spreghini, MR, Manco, M, Wietrzykowska, SR, Morino, G. Childhood obesity and COVID-19 lockdown: remarks on eating habits of patients enrolled in a food-education program. Nutrients 2021;13:383. https://doi.org/10.3390/nu13020383.Search in Google Scholar PubMed PubMed Central
35. Bosi Bağcı, TA, Kanadıkırık, A, Somyürek, E, Gerçek, G, Tanrıkulu, HB, Öntaş, E, et al.. Impact of COVID-19 on eating habits, sleeping behaviour and physical activity status of final-year medical students in Ankara, Turkey. Publ Health Nutr 2021;18:1–8. https://doi.org/10.1017/S1368980021003906.Search in Google Scholar PubMed PubMed Central
36. Browne, NT, Snethen, JA, Greenberg, CS, Frenn, M, Kilanowski, JF, Gance-Cleveland, B, et al.. When pandemics collide: the impact of COVID-19 on childhood obesity. J Pediatr Nurs 2021;56:90–8. https://doi.org/10.1016/j.pedn.2020.11.004.Search in Google Scholar PubMed PubMed Central
37. Hoffman, JA, Miller, EA. Addressing the consequences of school closure due to COVID-19 on children’s physical and mental well-being. World Med Health Pol 2020;10:3.365. https://doi.org/10.1002/wmh3.36510.1002/wmh3.365. 32904951.Search in Google Scholar PubMed
38. Cuschieri, S, Grech, S. COVID-19: a one-way ticket to a global childhood obesity crisis? J Diabetes Metab Disord 2020;19:1–4. https://doi.org/10.1007/s40200-020-00682-2.Search in Google Scholar PubMed PubMed Central
39. Donini, LM, Cuzzolaro, M, Gnessi, L, Lubrano, C, Migliaccio, S, Aversa, A, et al.. Obesity treatment: results after 4 years of a nutritional and psycho-physical rehabilitation program in an outpatient setting. Eat Weight Disord 2014;19:249–60. https://doi.org/10.1007/s40519-014-0107-6.Search in Google Scholar PubMed
40. DeVore, S, Kohli, R, Lake, K, Nicholas, L, Dietrich, K, Balistreri, WF, et al.. A multidisciplinary clinical program is effective in stabilizing BMI and reducing transaminase levels in pediatric patients with NAFLD. J Pediatr Gastroenterol Nutr 2013;57:119–23. https://doi.org/10.1097/MPG.0b013e318290d138.Search in Google Scholar PubMed PubMed Central
41. Deal, BJ, Huffman, MD, Binns, H, Stone, NJ. Perspective: childhood obesity requires new strategies for prevention. Adv Nutr 2020;11:1071–8. https://doi.org/10.1093/advances/nmaa040.Search in Google Scholar PubMed PubMed Central
42. Antwi, F, Fazylova, N, Garcon, MC, Lopez, L, Rubiano, R, Slyer, JT. The effectiveness of web-based programs on the reduction of childhood obesity in school-aged children: a systematic review. JBI Libr Syst Rev 2012;10:1–14. https://doi.org/10.11124/jbisrir-2012-248.Search in Google Scholar PubMed
43. Pellegrini, CA, Webster, J, Hahn, KR, Leblond, TL, Unick, JL. Relationship between stress and weight management behaviors during the COVID-19 pandemic among those enrolled in an internet program. Obes Sci Pract 2020;7:129–34. https://doi.org/10.1002/osp4.465.Search in Google Scholar PubMed PubMed Central
44. Nittari, G, Khuman, R, Baldoni, S, Pallotta, G, Battineni, G, Sirignano, A, et al.. Telemedicine practice: review of the current ethical and legal challenges. Telemed J E Health 2020;26:1427–37. https://doi.org/10.1089/tmj.2019.0158.Search in Google Scholar PubMed PubMed Central
45. Fedele, DA, Cushing, CC, Fritz, A, Amaro, CM, Ortega, A. Mobile health interventions for improving health outcomes in youth: a meta-analysis. JAMA Pediatr 2017;171:461–9 [Erratum in: JAMA Pediatr. 2017 May 1;171(5):495. Erratum in: JAMA Pediatr. 2018 Mar 1;172(3):302]. https://doi.org/10.1001/jamapediatrics.2017.0042.Search in Google Scholar PubMed PubMed Central
46. Barney, A, Buckelew, S, Mesheriakova, V, Raymond-Flesch, M. The COVID-19 pandemic and rapid implementation of adolescent and young adult telemedicine: challenges and opportunities for innovation. J Adolesc Health 2020;67:164–71. https://doi.org/10.1016/j.jadohealth.2020.05.006.Search in Google Scholar PubMed PubMed Central
47. Grist, R, Porter, J, Stallard, P. Mental health mobile apps for preadolescents and adolescents: a systematic review. J Med Internet Res 2017;19:e176. https://doi.org/10.2196/jmir.7332.Search in Google Scholar PubMed PubMed Central
48. Hosseini, H, Yilmaz, A. Using telehealth to address pediatric obesity in rural Pennsylvania. Hosp Top 2019;97:107–18. https://doi.org/10.1080/00185868.2019.1629365.Search in Google Scholar PubMed
49. Battineni, G, Nittari, G, Sirignano, A, Amenta, F. Are telemedicine systems effective healthcare solutions during the COVID-19 pandemic? J Taibah Univ Med Sci 2021;16:305–6. https://doi.org/10.1016/j.jtumed.2021.02.009.Search in Google Scholar PubMed PubMed Central
© 2022 Walter de Gruyter GmbH, Berlin/Boston
