The Aim2Be Intervention
obesity, overweight
OBESITY, OBESE
Throughout this manuscript, the Aim2Be intervention included access to the Aim2Be app and the live coach. The theoretical framework guiding the development of the Aim2Be app has been previously published and summarized below [Aim2Be was developed iteratively to reflect the current recommendations and best clinical practices for pediatric obesity management. Aim2Be became a gamified app that supports youth and their families in initiating sustainable behaviors in 4 primary areas: healthy eating, active living, reducing screen time, and healthy sleeping habits. It retained its focus on linking behaviors with health and living green, as well as adding emphasis on healthy body image and self-esteem. The Aim2Be app uses strategies to strengthen self-regulatory skills through self-guided goals, as well as both planning and self-monitoring of lifestyle behaviors. Strategies used by the various app features were grounded in the behavior change taxonomy by Michie et al [The first version of the app was field-tested for 4.5 months among 301 teens (aged 14-17 years, 33% of whom were overweight or obese) [The following 3 versions of the improved version of the app were used in this RCT: a preteen version (for adolescents aged 10-13 years), a teen version (14-17 years), and a companion parent app, with some variations in app features depending on the user type. Once they enrolled in the app, all preteen and teen users were asked to select a personalized animal avatar as part of the onboarding process to personalize their profile. After enrolling in the app, users were offered a selection of aims to address (eg, “Drop sugary drinks” and “Be a healthy family”) and then provided with tasks to help them set incremental goals, plan, and self-monitor their behaviors. Users then progress along their journey by completing quick wins and quizzes. In the preteen and teen versions of the app, users received currency that they could draw on to unlock items (collectibles) and purchase their own adventure stories. All users (preteens, teens, and parents) were provided with tools within the app, including self–check-ins and articles, to further support their journey. In the teen and parent versions of the app, users were able to interact with one another through a moderated social wall, where they could post, comment, and react to each other’s posts. Participants who were randomized to the intervention arm of the trial received an initial in-app text message from the live coach and were sent follow-up supportive messages within the app on a regular basis.