A digital health behavior intervention to prevent childhood obesity – the greenlight plus randomized clinical trial

Heerman WJ; Rothman RL; Sanders LM; Schildcrout JS; Flower KB; Delamater AM; Kay MC; Wood CT; Gross RS; Bian A; Adams LE; Sommer EC; Yin HS; Perrin EM

doi:10.1530/ey.22.11.10

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ESPE Yearbook of Paediatric Endocrinology (2025) 22 11.10 | DOI: 10.1530/ey.22.11.10

ESPEYB25 11. Obesity and Weight Regulation Innovative Interventions (4 abstracts)

11.10. A digital health behavior intervention to prevent childhood obesity - the greenlight plus randomized clinical trial

Heerman WJ , Rothman RL , Sanders LM , Schildcrout JS , Flower KB , Delamater AM , Kay MC , Wood CT , Gross RS , Bian A , Adams LE , Sommer EC , Yin HS & Perrin EM

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Greenlight Investigators University Medical Center, Nashville, US

JAMA. 2024;Dec 24;332(24):2068-2080. doi: 10.1001/jama.2024.22362. https://pubmed.ncbi.nlm.nih.gov/39489149/

Brief Summary: There remains an urgent need for practicable and effective childhood obesity prevention strategies. This multicenter randomized parallel-group trial, involving 900 newborns and their families, evaluated a digital health behavior intervention (automated tailored text messages plus web-based dashboard) alongside standard pediatric counseling (“clinic+digital”, n=449) vs counseling alone (“clinic-only”, n=451). Over 24 months (~15% lost-to-follow-up per group), children in the digital intervention group showed healthier weight-for-length trajectories (mean reduction: –0.33 kg/m [95% CI: –0.57 to –0.09]) and lower BMI z-scores (–0.19 [95% CI: –0.36 to –0.01]). Effects emerged by 4 months and were most pronounced in food-insecure families. Obesity rates (CDC) at 24 months were 7.4% vs. 12.7% (adjusted risk ratio: 0.56 [95% CI: 0.36 to 0.88]).

The study, with robust design and a low-cost scalable digital tool, underscores the effectiveness of early-life prevention strategies in improving weight outcomes during the first 2 years of life, particularly in underserved populations. Intervention starting in the first weeks of life is a time-fame, when many obesity-related habits begin [1,2]. Long-term sustainability remains uncertain, especially if diverse external influencing factors (e.g. peer group) emerge in later life. Nonetheless, rapid weight gain within the first 3 months of life has been linked to future cardiovascular risk [3], supporting the importance of early intervention. Study limitations include lack of data on dashboard use or isolated effects of text messaging vs. dashboard, and limited generalizability (English-/Spanish speaking families from the US with smartphones). On average only 54% responded to the text messages. No information on length is provided although growth impairment is one concern in children living with obesity. Nevertheless, the findings support high potential for broad implementation in pediatric primary care.

References: 1. Wood CT et al. Association between bottle size and formula intake in 2-month-old-infants. AcadPediatr. 2016;16(3):254-259. doi: 10.1016/j.acap.2015.08.0012. Yin HS et al. Parent health literacy and “obesogenic” feeding and physical activity-related infant care behaviors. J Pediatr. 2014;164(3):577-583. doi: 10.1016/j.jpeds.2013.11.0143. Leunissen RW et al. Timing and tempo of first-year rapid growth in relation to cardiovascular and metabolic risk profile in early adulthood. JAMA 2009;301(21):2234-2242. doi: 10.1001/jama.2009.761