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Aim: We evaluated the effect on body mass index standard deviation score (BMI-SDS) of a combined treatment (Web-COP) for children with obesity, including a web-based component targeting their parents.

Methods: This randomised controlled trial recruited children 5–12 years of age with obesity (International Obesity Task Force BMI [IOTF-BMI] ≥30 kg/m2) from school health care and outpatient paediatric clinics in in Northern Sweden from 1 June 2019 to 21 June 2020. The children were randomised to Web-COP, an intervention with group sessions and a 12-week web-based component, or standard care. The primary outcome was the change in IOTF BMI-SDS after 6 months.

Results: In total, 75 children (33 girls), mean age 9.5 years, were randomised, and 65/75 (87%) children and their parents completed the study, 35/39 (90%) in the Web-COP intervention and 30/36 (83%) in the standard care group. BMI-SDS at 6 months was changed from 3.08 to 2.81 in the intervention group compared to an increase from 3.07 to 3.16 in the standard care group, representing a significant difference between groups (p < 0.001). In the intervention group, 14/30 (47%) reduced their BMI-SDS ≥0.25, compared to none in the standard care group.

Conclusion: The parent-focused intervention significantly improved BMI-SDS in children with obesity as compared to children in standard care.

Childhood obesity is a threat to public health worldwide. In Sweden around 15% of children 5-19 years of age are overweight and 3-4 % have obesity. Early prevention is crucial as are effective treatments for children and adolescents who have already developed obesity. The use of web-based treatment programs in childhood obesity are not yet established, this technology has been suggested to be a promising method for children and adolescents. The overall aim of this thesis was to examine whether rapid growth at an early age was associated with overweight later in life and to study the feasibility, parental experience, and effectiveness of web-based treatment of obesity in children.

Study I: The study population comprised all children born in Sweden on the 15th of each month in 1981. Information on weight and height was collected for 3537 children. Results showed that weight at 12 months of age was associated with being overweight at both 16 and 18 years of age. Weight gain between 18 months and four years of age was the strongest risk factor for being overweight in late adolescence.

Study II: Web-Childhood Obesity Prevention (Web-COP) was a prospective feasibility study with a pre-post design, offered to children with obesity 5-13 years of age. The intervention consisted of four group-based education sessions, physical activity on prescription, and a 12-week web-based program. Using a continuous algorithm, 42/51 (81%) of the children lowered their BMI-SDS.

Study III: This was an interview study with an inductive qualitative approach. Data were collected from individual interviews with 14 parents to children with obesity. The overarching theme “A transformative journey of lifestyle changes for the whole family” described how the participation impacted the lifestyle of the whole family. The parents shared predominantly positive experiences of the intervention but also expressed feelings of guilt and struggled to address their child´s obesity.

Study IV: The Web-COP RCT was a randomized controlled trial conducted in four cities and compared group sessions, physical activity on prescription, and a web-based program to standard care treatment for children with obesity. A total of 80 children were included in the analysis. BMI-SDS was significantly reduced in the intervention group compared to the control group six months after baseline. Rapid growth rate during early childhood was associated with an increased risk of having overweight later in life, emphasising the importance of early prevention. In treating young children with obesity, we added group sessions and a web-based programme (Web-COP) to standard care. Web-COP was feasible, and two thirds of included children reduced their BMI. Parents who participated in Web-COP found the program helpful for achieving healthier lifestyles for the whole family. When Web-COP was studied in a randomized controlled trial, the program had significant effect on BMI-SDS in children with obesity.

AIM: Web-based interventions have shown promising results in paediatric obesity treatment with the potential to increase coverage of care. This study aimed to explore parental experiences about participating in an intervention to improve healthy behaviours and lower BMI-SDS in children with obesity.

METHODS: This was an interview study with an inductive qualitative approach. Data were collected from individual interviews with 14 parents of 5- to 13-year-old children with obesity. The respondents had participated in a family-based treatment intervention consisting of four group sessions followed by 12-week web-based support. The interviews were analysed using qualitative manifest and latent content.

RESULTS: The overarching theme 'A transformative journey of lifestyle changes for the whole family' described how the participation impacted the lifestyle of the whole family. Four categories: parental awareness, introducing new routines, negotiating family battles and a feeling of support, represented various experiences made by respondents. The parents shared predominantly positive experiences of the intervention but also expressed feelings of guilt and struggled to address their child's obesity.

CONCLUSION: Parents who participated in a study for children with obesity with a web-based component found the programme helpful for achieving healthier lifestyles for the whole family.

Background: Internet‐based treatments have proven effective for various health issues. There is a need to scale up interventions targeting children with obesity, also in less densely populated areas where the prevalence in many countries is higher than in urban areas. The aim of this study was to design and implement an internet‐based program as an add‐on to standard treatment for childhood obesity.

Methods: Web‐Childhood Obesity Prevention (Web‐COP) was a prospective feasibility study with a pre‐ post‐ design. The intervention consisted of four group‐based education sessions at the clinic, physical activity on prescription, and a new 12‐week internet‐based program. Web‐COP was offered to children with obesity (International Obesity Task Force Body Mass Index (IOTF‐BMI) ≥ 30 kg/m2) and their parents in two counties in Northern Sweden from August 2018 to June 2019. The primary outcome was change in BMI standard deviation score (BMI‐SDS).

Results: The study included 55 children 5–13 years of age. The internet‐based component was well received, and retention rate was 51/55 (92.7%). Data was analysed for 51 children. Mean BMI‐SDS was 3.3 at start and decreased by 0.2, 0.3, and 0.4 at two, four, and six months from baseline. Using a continuous algorithm, 42/51 (81%), children lowered their BMI‐SDS and 33/51 (65%) lowered their BMI.

Conclusion: Adding group sessions and an internet‐based program to standard care was feasible and two thirds of included children with obesity reduced their BMI.

AIM: We evaluated whether body mass index (BMI) and rapid growth in early life were associated with an increased risk of becoming overweight at 16 and 18 years of age.

METHODS: The study population comprised all children born in Sweden on the 15th of each month in 1981. Individuals born on the 5th, 10th and 20th of every month were added for counties with low population densities. Information on weight and height was collected from birth up to 18 years of age for 98.6% of the 3537 children identified.

RESULTS: Weight at 12 months of age was associated with being overweight at both 16 and 18 years of age. Rapid weight gain from birth to 12 months was associated with higher odds for being overweight later in life, and the weight gain between 18 months and four years of age was the strongest risk factor for being overweight in late adolescence in both sexes. There was no association between a birthweight of <2500 g or >4500 g and being overweight at 16 or 18 years of age.

CONCLUSION: Fast growth during early childhood was associated with an increased risk of being overweight later in life, emphasising the importance of early prevention.