Nutrition Journal Club: Pediatric Obesity 2017
With Dr. Kristen Fuller · hosted by Dr. Doctor Wallace · StayCurrentMD
Part of
Pediatric Obesity 9 items
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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Rapid Fire and Conclusion: Pediatric Obesity 2017
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What the experts said
Specific goal setting, review of behavioral goals, modeling and demonstrating behavior, identifying barriers, and prompting follow-ups were rarely found in the apps despite being core components of effective clinical weight management programs
In the Strong for Life clinic, 24-hour recalls are used to identify the schedule of when the child eats and any structure around meals and snacks, which provides insight into parenting and household structure
Photo food logs are used to assess the quality of food, balance in food groups, and how people eat, with table settings providing additional behavioral information
Written food logs are used less frequently, primarily to discuss emotions and feelings with food
In-person professional feedback about food photos using motivational interviewing skills is the most crucial part of the photo food log process and what is missing from commercial apps
Families typically complete photo food logs about 3 times to see substantial improvement, working on small changes each round
When patients move very fast at meals and cannot remember to take pictures, it provides insight into eating behaviors and indicates bigger non-food-related issues to address before focusing on dietary changes
Photo food logs are typically set up for about 1 month, with families sending one picture per day on average, usually of the meal when the family is together at home
The dietitian responds to acknowledge receipt of pictures and provide encouragement, but reserves detailed review and motivational interviewing for in-clinic visits because that interaction cannot be replicated over email
Patients frequently use calorie counting apps like MyFitnessPal, often becoming very restrictive and unable to stick with them long-term
The photo food log system requires a separate HIPAA-compliant email account where patients send pictures that are filed and organized by patient and by round number for review during clinic visits
The goal of photo food logs is not to send a perfect picture but to send a picture and connect about food, with the most important element being maintaining rapport
The photo food log approach tracks closely with the USDA MyPlate visual method, making it accessible for non-nutritionists to provide preliminary suggestions
Photo food logs take more time in background preparation before seeing the patient but less time during the actual clinic visit compared to reviewing written food journals
64% of the population owns smartphones
Weight loss is one of the most popular categories for health-related mobile app downloads
Evidence-based behavioral change techniques are proven to support weight loss
There has not been research to see if evidence-based behavior change techniques are actually incorporated in the programming of diet tracking apps
Portions are frequently underestimated with barcode scanning and food item searching methods of diet tracking
Adherence and frequency of diet self-monitoring is significantly associated with weight loss and is of greater importance than the accuracy of the nutritional data tracked
Just-in-time reporting using smartphones to take pictures of food has been studied and proven as a valid assessment of dietary intake in both adults and adolescents
Diet self-monitoring is associated with weight loss with the addition of immediate provision of feedback
The study reviewed 29 mobile apps that met inclusion criteria for diet tracking via photos
Two apps (YouFood and Food Feedback) included 11 of the 13 behavior change techniques evaluated
18 out of 29 apps (62%) did not provide any feedback at all on food photo posts
Only 1 of the 29 apps used professionals exclusively to provide feedback
3 apps offered an option of professional feedback
7 of the 29 apps used only crowdsourcing or collective feedback
6 apps did not use any self-regulation techniques at all
Providing general encouragement, providing information about others' feedback, and feedback on user performance were the behavior change techniques found most often in the apps