A Digital Health Behavior Intervention to Prevent Childhood Obesity: The Greenlight Plus Randomized Clinical Trial

Area of Science:

• Pediatric Health
• Obesity Prevention
• Digital Health Interventions

Background:

• Infant growth is a predictor of long-term obesity and cardiovascular disease.
• Early childhood obesity interventions (first 2 years) have historically shown limited success.
• Obesity prevalence is disproportionately high in racial and ethnic minority groups.

Purpose of the Study:

• To compare the effectiveness of adding a digital childhood obesity prevention intervention to standard health behavior counseling provided by pediatric primary care clinicians.

Main Methods:

• An individually randomized, parallel-group trial was conducted across 6 US medical centers.
• Participants included parents speaking English or Spanish and infants born after 34 weeks' gestational age.
• The intervention group received text messages and a web dashboard, while the control group received clinic-based counseling with booklets.

Main Results:

• The digital intervention group showed a lower mean weight-for-length trajectory (-0.33 kg/m) and reduced weight-for-length z scores (-0.19) and BMI z scores (-0.19) at 24 months.
• Obesity rates at 24 months were lower in the digital intervention group (7.4%) compared to the clinic-only group (12.7%).
• The intervention demonstrated effectiveness across a racially and ethnically diverse population.

Conclusions:

• A health literacy-informed digital intervention significantly improved child weight-for-length trajectory and reduced obesity in the first 24 months of life.
• This digital approach is effective in diverse populations, including those at elevated risk for childhood obesity.
• The findings suggest a promising new strategy for early childhood obesity prevention within primary care settings.