Limitations
overweight or obesity
RECRUITMENT
This study had several limitations. The first and likely the most relevant being the generalizability of the findings given who were eligible to participate in this study (parent-adolescent dyads in Canada with either overweight or obesity). Therefore, these results may not apply to other populations (children without overweight or obesity) and adolescents outside Canada. Second, we found that preteens and teens predominantly spent time in the gamified components of the app instead of using its active ingredients (such as setting aims and completing tasks). There was an effort to strengthen access to the gamified or “fun” elements of the revised version of the app for this trial, which might explain why there was no association in the evaluation phase as compared with an earlier formative evaluation phase. Third, we could not control for seasonality effects, as the recruitment of participants for this trial could not occur over a year because of limited funds. Fourth, participants in both conditions were provided with their Fitbit at baseline (shortly after randomization), which could have resulted in an early PA intervention effect among the waitlisted control participants. Fifth, this study presented only the findings related to intervention efficacy, and there is a growing consensus on the need to explore metrics beyond efficacy, such as cost-effectiveness, reach, and engagement, which could allow a broader examination of the impact of such interventions [