Healthcare Text Messaging to Improve Diet, Physical Activity and Weight Loss in a Pediatric Lipid Clinic

Phase 1: We will recruit 5 participants the from the UF Pediatric Lipid and Obesity clinic
for pre-intervention cognitive interviewing to assess acceptability of the intervention and
request their input on a representative sample of text messages. Then, 20 participants will
be recruited from the same clinic for the intervention (10 controls, 10 intervention
participants). Controls will receive current standard care - clinic visits every three months
anthropometric assessments and counseling on physical activity and nutrition goals by a
healthcare provider, typically with no patient-provider communication between visits. The
intervention group will receive the typical clinic visits plus daily text messages in between
visits with fitness and nutrition messages to support their health goals. All participants
will have anthropometric measurements at baseline, 3 and 6 months. Each participant will
complete a Schwartz Diet and Activity History at 0, 3 and 6 month visits, and a post
intervention survey will be completed at the 3 month time point.

Phase 2: The second phase will be a larger scale study to assess for statistically
significant effects of the text messaging intervention. One hundred participants will be
recruited from the UF Pediatric Lipid and Obesity Clinic, one hundred from the UF Pediatric
Headache Clinic and one hundred from the Congenital Heart Center for a total of three hundred
(n=300) participants at three clinic locations. Participants will be randomized at each
clinic location to one of two groups, Group A (immediate intervention, n=50) or Group B
(control group, delayed intervention, n=50).

Participants randomized to Group A will receive the typical clinic visits (which includes
anthropometric measures every three months, counselling on physical activity and nutrition
goals by a healthcare provider and for those prescribed medication for a chronic condition,
medication counseling by a healthcare provide) plus daily text messages in between visits for
3 months to support their health goals. Group B will initially act as the control and will
receive the typical clinic visits (which includes anthropometric measures every three months,
counseling on physical activity and nutrition goals by a healthcare provider, and for those
prescribed medication for a chronic condition, medication counseling by a healthcare
provider) with typically with no patient-provider communication between visits. After a
6-month delay, Group B will then receive the intervention which includes the typical clinic
visits as stated previously plus daily text messages in between visits for 3 months to
support their health goals. Participants will be seen in clinic at standard intervals for
routine follow up (typically every 3 months). Three months after participants finish
receiving the text messages, the same anthropometric and medication measures (for those
prescribed chronic medication) that were collected at baseline as part of routine care will
be repeated. Each participant will complete a Block Food Screener and Block Physical Activity
Screener at 0, 3, and 6 months. Participants who are prescribed a chronic medication will
also complete the Morisky Medication Adherence Scale-8 at 0, 3 and 6 months. A
post-intervention survey will be completed after the participants have stopped receiving text
messages.

Phase 1:

Inclusion Criteria:

- Adolescents age 13-17

- Overweight or obese (BMI > 85th percentile)

- Attend or will start attending UF Pediatric Lipid Clinic during the study period

- Own a cell phone that can receive text messages

Exclusion Criteria:

- Current diagnosis of a psychiatric eating disorder (anorexia nervosa or bulimia)

- Pregnancy

- Medical disease that would contraindicate moderate physical activity, as determined by
clinician (MD or NP) from the Lipid Clinic

Phase 2:

Inclusion criteria

- Ages 11-21

- Overweight or obese (BMI > 85th percentile)

- Attend or will start attending UF Health Pediatric Lipid and Obesity Clinic,UF Health
Pediatric Headache Clinic or UF Health Congenital Heart Center during the study period

- Own a cell phone that can receive text messages (or parent owns a cell phone that can
receive text messages)

Exclusion criteria

- Current diagnosis of a psychiatric eating disorder (anorexia nervosa or bulimia)

- Pregnancy

- Medical disease that would contraindicate moderate physical activity