This story was originally published by the UNC Health and UNC School of Medicine Newsroom.

A new study shows that adding text messaging to traditional in-clinic health counseling for parents about feeding habits, playtime, and exercise prevents very young children from developing obesity and potentially lifelong obesity-related problems.

Findings from the study, co-led by Kori Flower, MD, MS, MPH, division chief of General Pediatrics and Adolescent Medicine at the UNC School of Medicine, were published in JAMA. The work stems from decades of research showing that having obesity in early childhood significantly increases the risk of lifetime obesity, cardiovascular disease, diabetes and other serious diseases, particularly in low-income and minority populations. Samantha Schilling, MD, MSHP, associate professor in the Division of General Pediatrics and Adolescent Medicine at UNC, was also a co-investigator on the study. Both Flower and Schilling are Faculty Fellows at the UNC Frank Porter Graham Child Development Institute.

About 1 in 5 school-aged children were affected by obesity in 2017–18, according to the U.S. Centers for Disease Control and Prevention — rates that have only increased during and since the COVID-19 pandemic. Efforts to reduce the rate have relied heavily on in-person interventions by pediatric providers, with limited success.
In an earlier study, also co-led by Flower, investigators demonstrated that a “health literacy-informed” primary care-based intervention called the Greenlight Program, which Flower and colleagues at other medical centers developed for parents, improved healthy growth in newborns until 18 months of age, but found that improvements were not sustained at age 2 years.

In an effort to extend the improvements through 2 years of age, when pediatrics office visits become less frequent, the new study focused on adding text messaging to reinforce elements of the Greenlight Program, which previously only consisted of written materials and health counseling during primary care visits.

“Parents and pediatricians have told us how much they enjoy using the materials, which are available in both English and Spanish, and are designed to meet the needs of diverse families,” said Flower.

Building on that knowledge, to conduct the new study, which was co-led by UNC and five other academic medical institutions, the researchers recruited nearly 900 parent-infant pairs between October 2019 and January 2022 from newborn nurseries or pediatric primary care clinics at Duke University, University of Miami, New York University/Bellevue Hospital Center, Stanford University and Vanderbilt University Medical Center. Johns Hopkins University also collaborated in the study.

The infant-parent pairs were randomly sorted into two groups. Both groups received Greenlight Program education, with counseling on healthy nutrition and behaviors from their primary care providers, along with eight educational booklets matching the child’s age at regular well visits, with guidance and goal-setting tips in English or Spanish on feeding, physical activity, sleep and screen time.

Next, half (449) of the infant-parent pairs received personalized, interactive text messages from a fully automated system to support health behavior goals.

The researchers conclude that their digital intervention led to healthier weight-for-length paths and reduced the incidence of obesity at 2 years of age when added to in-person health counseling.

“It’s unusual to be able to prevent obesity in children, and we’re thrilled to have an intervention that has evidence behind it and can be implemented widely,” said Flower.

To learn more about the study, read the full UNC Health and UNC School of Medicine Newsroom news story.