• Victor Cueto, C Jason Wang, and Lee Michael Sanders.
• Division of General Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States.
• JMIR Mhealth Uhealth. 2019 Nov 15; 7 (11): e14458.

BackgroundEffective treatment of obesity in children and adolescents traditionally requires frequent in-person contact, and it is often limited by low participant engagement. Mobile health tools may offer alternative models that enhance participant engagement.ObjectiveThe aim of this study was to assess child engagement over time, with a mobile app-based health coaching and behavior change program for weight management, and to examine the association between engagement and change in weight status.MethodsThis was a retrospective cohort study of user data from Kurbo, a commercial program that provides weekly individual coaching via video chat and supports self-monitoring of health behaviors through a mobile app. Study participants included users of Kurbo between March 2015 and March 2017, who were 5 to 18 years old and who were overweight or obese (body mass index; BMI ≥ 85th percentile or ≥ 95th percentile) at baseline. The primary outcome, engagement, was defined as the total number of health coaching sessions received. The secondary outcome was change in weight status, defined as the change in BMI as a percentage of the 95th percentile (%BMIp95). Analyses of outcome measures were compared across three initial commitment period groups: 4 weeks, 12 to 16 weeks, or 24 weeks. Multivariable linear regression models were constructed to adjust outcomes for the independent variables of sex, age group (5-11 years, 12-14 years, and 15-18 years), and commitment period. A sensitivity analysis was conducted, excluding a subset of participants involuntarily assigned to the 12- to 16-week commitment period by an employer or health plan.ResultsA total of 1120 participants were included in analyses. At baseline, participants had a mean age of 12 years (SD 2.5), mean BMI percentile of 96.6 (SD 3.1), mean %BMIp95 of 114.5 (SD 16.5), and they were predominantly female 68.04% (762/1120). Participant distribution across commitment periods was 26.07% (292/1120) for 4 weeks, 61.61% (690/1120) for 12-16 weeks, and 12.32% (138/1120) for 24 weeks. The median coaching sessions (interquartile range) received were 8 (3-16) for the 4-week group, 9 (5-12) for the 12- to 16-week group, and 19 (11-25) for the 24-week group (P<.001). Adjusted for sex and age group, participants in the 4- and 12-week groups participated in -8.03 (95% CI -10.19 to -5.87) and -9.34 (95% CI -11.31 to -7.39) fewer coaching sessions, compared with those in the 24-week group (P<.001). Adjusted for commitment period, sex, and age group, the overall mean change in %BMIp95 was -0.21 (95% CI -0.25 to -0.17) per additional coaching session (P<.001).ConclusionsAmong overweight and obese children using a mobile app-based health coaching and behavior change program, increased engagement was associated with longer voluntary commitment periods, and increased number of coaching sessions was associated with decreased weight status.©Victor Cueto, C Jason Wang, Lee Michael Sanders. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 15.11.2019.

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