What Role Can eHealth Play in Preventing Childhood Obesity?
Researchers at the Health-e Technologies Initiative at Brigham & Women's Hospital in Boston sought to determine what role electronic technologies can play in preventing and reducing childhood obesity, especially in low-income and culturally diverse communities. Project staff defined "eHealth" as the use in health care of emerging interactive technologies, including the Internet, interactive TV, personal digital technology, kiosks, Internet-enabled cell phones, and CD-ROMs and DVDs.
From 2005 to 2007, project staff reviewed published research and commentary about technology and childhood obesity, convened an interdisciplinary panel of experts to explore perspectives and issued a report, Childhood Obesity Prevention and Reduction: Role of eHealth.
- "Screen time" is often identified as a primary cause of childhood obesity. However, some uses of technology are more passive than others so the relationship needs to be more clearly delineated.
- The ubiquity of technology in the lives of today's youth means interventions to prevent and treat childhood obesity need to be adapted to their unique learning and information-seeking styles.
- Partnerships between the entertainment industry and software developers could play a key role in the battle against childhood obesity.
- More qualitative and quantitative research is necessary to better understand the use of eHealth applications to address childhood obesity.
The Robert Wood Johnson Foundation (RWJF) supported this solicited project with a grant of $139,797 from November 2005 to December 2007.
About 16 percent of children and teens between the ages of 6 and 19 in the United States are considered obese, more than triple the rate in the 1960s and 1970s, according to a 2008 report by the Centers for Disease Control and Prevention. A recent study estimates that private insurers pay $11 billion for obesity-related medical care to children in the United States, while Medicaid pays an additional $3 billion.
At the same time, almost 90 percent of U.S. teens ages 12–17 use the Internet and more than half do so on a daily basis, according to a 2005 Pew Foundation report, Teens and Technology.
There has been little research on how eHealth might be used to help prevent childhood obesity, particularly in lower income communities of color where obesity rates exceed national averages, according to project director David K. Ahern, Ph.D. Ahern is the program director of the RWJF national program Health e-Technologies Initiative, which supports research to determine how interactive technology can be used to promote health behavior change and chronic disease management. The national program office is based at Brigham & Women's Hospital in Boston; it also managed this project.
RWJF is committed to tackling one of today's most pressing threats to the health of children and families—childhood obesity. The goal is to help halt the rise in childhood obesity rates by promoting healthy eating and physical activity in schools and communities throughout the nation.
RWJF places special emphasis on reaching children at greatest risk: African-American, Hispanic, Native American and Asian/Pacific Islander children living in low-income communities.
RWJF has a four-pronged approach to halting the increase in childhood obesity:
- Building the evidence regarding what works to promote healthy eating and increase physical activity among kids.
- Testing innovative approaches in order to spread promising models.
- Educating leaders and investing in advocacy strategies.
- Working on ways to help health care providers screen and counsel to prevent and manage childhood obesity.
This project sought to determine what role eHealth could play in preventing and reducing childhood obesity, especially in low-income and culturally diverse neighborhoods and communities. Project staff defined eHealth as the use in health care of "emerging interactive technologies" including the Internet, interactive TV, personal digital assistants, kiosks, Internet-enabled cell phones, and CD-ROMs and DVDs.
From 2005 to 2007, researchers at the Health e-Technologies Initiative:
- Reviewed current research and commentary in the field of technology and childhood obesity.
- Recruited and convened an advisory panel of interdisciplinary experts from fields that included obesity prevention, nutrition, eHealth development and research, pediatrics and behavioral science, as well as a student representative. For a list of members, see the Appendix.
- Issued a report, Childhood Obesity Prevention and Reduction: Role of eHealth. Project staff distributed some 4,000 copies of the report to individuals on the Health e-Technologies Initiative listserv and at conferences where they gave presentations.
Among the findings reported in Childhood Obesity Prevention and Reduction: Role of eHealth, as well as comments provided by the project director from in an interview conducted for this report:
- "Screen time" is often identified as a primary cause of childhood obesity, but the relationship needs to be more clearly delineated. Screen time is used to describe both passive activities, such as watching television, and more active computer use, such as playing certain video games. "The evidence is compelling that excessive TV watching leads to obesity in youth," said Ahern, the project director. Less is known about how other uses of technology affect specific populations.
- The ubiquity of technology in the lives of today's youth requires new pedagogical approaches and new paradigms for intervention. "We need to be on top of how technology impacts learning and how we can leverage technology," Ahern said. Interventions to prevent and treat childhood obesity need to be adapted to the learning and information-seeking styles preferred by frequent users of technology, and should integrate seamlessly into their daily lives.
- Partnerships between the entertainment industry and software developers could play a key role in the battle against childhood obesity. The entertainment industry has "the expertise to create fun applications that target the youth demographic in creating eHealth applications for children," according to the report.
- More qualitative and quantitative research is necessary to better understand the use of eHealth applications to address childhood obesity. Researchers and developers need to know more about the feasibility, acceptability, patterns of use and potential effectiveness of technology, especially for traditionally underserved populations.
- The tools of eHealth can help mobilize and engage citizens and communities to advocate for environmental changes in their neighborhoods. These changes can include increasing access to healthy, inexpensive foods and creating safe recreational spaces. Social networking can advance these efforts, observes Ahern, pointing out, "the youth are on Facebook, MySpace and Twitter."
- Developing the computing hardware and software for eHealth applications involves substantial upfront costs. However, the cost of the technologies used for eHealth will inevitably decrease over time, making them more accessible to traditionally underserved populations.
- Public health interventions are a priority, and will produce the greatest long-term results in combating childhood obesity. However, maintaining focus on the immediate, pressing needs of families and children is also imperative.
The Childhood Obesity Prevention and Reduction: Role of eHealth report recommends that the following areas be considered for further inquiry:
- Stimulating the development of eHealth applications that can inform families about food choices and options and improve their nutritional habits.
- Fostering the creation of technologies and platforms that software developers can access to build eHealth programs to prevent or reduce obesity. Google Health and Microsoft HealthVault are examples of such technologies.
- Supporting systematic evaluation and applied research into video games (such as Dance Dance Revolution and Guitar Hero II) and platforms (such as Nintendo's Wii and Sony Playstation II) to determine their potential for increasing physical activity among youth.
GRANT DETAILS & CONTACT INFORMATION
Determining the role that evidence-based e-Health can play in reducing the incidence and prevalence of childhood obesity
Brigham & Women's Hospital (Boston, MA)
Dates: November 2005 to December 2007
David K. Ahern, Ph.D.
Advisory Panel Members
Lilian Cheung, D.Sc., R.D.
Lecturer, Department of Nutrition
Harvard School of Public Health
M. Christopher Gibbons, M.D., M.P.H.
Associate Director, Johns Hopkins Urban Health Institute
Director, Center for Community Health
Assistant Professor of Public Health and Medicine
Johns Hopkins Medical Institutions
Terry T-K Huang, Ph.D., M.P.H.
Health Scientist Administrator
Program Director, Pediatric Obesity & Metabolic Syndrome
Endocrinology, Nutrition and Growth Branch
Center for Research for Mothers and Children
National Institute of Child Health and Human Development
Stephen Intille, Ph.D.
Massachusetts Institute of Technology
Ann Maloney, M.D.
Clinical Assistant Professor
University of Vermont College of Medicine
Department of Psychiatry
Maine Medical Center Research Institute
Kevin Patrick, M.D., M.S.
Professor, Department of Family and Preventive Medicine
University of California, San Diego
Editor-in-Chief, American Journal of Preventive Medicine
San Diego, Calif.
Student, Northeast Metropolitan Regional Vocational School
Member, Boys and Girls Club of Chelsea, Mass.
Co-Founder, Games for Health Project
Dirk G. Schroeder, Sc.D., M.P.H.
Executive Vice President
DrTango Inc. and HispaniCare
Associate Professor of Global Health
Marlene Schwartz, Ph.D.
Director of Research and School Programs
Rudd Center for Food Policy and Obesity at Yale
Department of Psychology
New Haven, Conn.
Deborah Tate, Ph.D.
Department of Health Behavior and Health Education
Department of Nutrition
School of Public Health
University of North Carolina at Chapel Hill
Chapel Hill, N.C.
Elsie M. Taveras, M.D., M.P.H.
Center for Child Health Care Studies
Department of Ambulatory Care and Prevention
Harvard Medical School and Harvard Pilgrim Health Care
Debbie Thompson, Ph.D.
U.S. Department of Agriculture/Agricultural Research Service Scientist/Nutritionist-Child Obesity
Assistant Professor of Pediatrics
Children's Nutrition Research Center
Baylor College of Medicine
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Ahern DK, Goldman R, Le LX, Phalen J. Childhood Obesity Prevention and Reduction: Role of eHealth. Boston: Health e-Technologies Initiative, 2007. Available online.
Presentations and Testimony
Terry T-K Huang, "Harnessing Technology in a Multidimensional Approach to Childhood Obesity," at the International Conference on Urban Health, Oct. 31, 2007, Baltimore. Available online.
Lan X. Le, "Role of eHealth in Childhood Obesity Prevention and Reduction," at the Annual Meeting of the American Public Health Association, Nov. 3–7 2007, Washington. Available online.
Report prepared by: Paul Jablow
Reviewed by: Karyn Feiden
Reviewed by: Molly McKaughan
Program Officer: Terry L. Bazzarre