FitwitsTM Leads to Improved Parental Recognition of Childhood Obesity and Plans to Encourage Change

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Figure 1.
Our physicians and 17 Fitwits flashcards guide each child and parent through an interactive conversation about body mass index status, “obesity,” nutrition, activity, and hand-based portion sizes. The thumb portion size (shown) is a recommended serving of peanut butter, mayonnaise, hummus, or other spreads at 1 meal. Responsive parent and child survey comments are captured in this word cloud.

Table 1.

Descriptive Characteristics of Child Participants (n = 140)^*

↵* Well child enrollment occurred May 2012 through November 2013. Frequencies not adding to 140 are because of missing responses and/or unknown data.
↵† Percentages were rounded to the nearest percent.
↵‡ Many respondents (n = 54) did not answer for ethnicity. Pittsburgh has a relatively low but growing Hispanic population/familiarity.
BMI, body mass index.

Table 2.

Preintervention Parent Report of Physician Interactions and Child's Behaviors^*

Questions	Responses, n (%)
Within the past 2 years, my child's weight and height were measured in a doctor's office.
Yes	130 (94)
No	6 (4)
N/A	2 (2)
Within the past 2 years, my child's doctor discussed BMI with me.
Yes	82 (60)
No	49 (36)
N/A	6 (4)
Within the past 2 years, my child's doctor helped me to understand BMI.
Yes	74 (55)
No	49 (36)
N/A	11 (8)
My child's doctor has done Fitwits in the office with my child before today.^{^†}
Yes	38 (29)
No	88 (67)
N/A	6 (5)
My child eats a portion size of food at each meal that is:
Too little	7 (5)
About right	101 (72)
Too much	32 (23)
My child eats this number of fruits and vegetable servings each day:
≤2	68 (49)
3–4	69 (49)
≥5	3 (2)
My child drinks this number of sweetened drinks each day (soda/pop, juice, punch, sports drinks, powdered drinks, sweet tea, etc.):
≤1	49 (35)
2	51 (36)
>2	40 (29)
My child eats this number of junk food snacks each day (candy, cookies, cake, pastries, chips, fries, etc.):
≤1	46 (33)
2	56 (40)
>2	38 (27)
My child eats this number of fast food meals in a week:
≤1	96 (69)
2	28 (20)
>2	15 (11)
My child actively plays this number of hours each day:
0–1	10 (7)
1	19 (14)
>1	111 (79)
My child watches this number of hours of screen time (television + video + computer) each day (not including school):
0–2	43 (31)
2–3	53 (38)
>3	42 (30)
A home television is located:
Don't own a television	0 (0.0)
Child's sleeping area	92 (68)
Not in child's sleeping area	43 (32)
A home computer is located:
Don't own a computer	28 (20)
Child's sleeping area	12 (9)
Not in child's sleeping area	100 (71)

↵* Sample size varied from 132 to 140.
↵† Fitwits feasibility or physician studies or informally prior to this study.
BMI, body mass index; N/A, no response available for preadolescents without a well child visit within the past 2 years (preadolescents tend to have fewer well child visits than in early childhood).

Table 3.

Comparison of Parent Responses Before and After the Intervention^*

↵* There were 138 responses from parents before the intervention and 137 responses after.

Table 4.

Goals Selected by Parents and Children After the Intervention (Instructed to Select 2 of 25 Example Goals)^*

Food and drink	Eat 5 fruits and vegetables each day^{^†}	Eat less junk food, more healthy snacks	Decrease sugary drinks to 1 or none each day	Drink more water	Choose low-fat milk
Food and drink	31	32	21	25	1
Eating habits	Eat fast food no more than once a week	Eat more home-cooked meals with your family	Eat snacks and meals at the table	Eat a healthy breakfast each day	Make a bag lunch for school
	12	2	4	6	0
	Eat healthier portion sizes	Talk to family and friends at dinner table	Chew your food slowly	Make eating changes as a family	Your idea __________
	23	6	6	9	5
Activity	Be active and play ≥1 hour each day	Be active: dance, bicycle, walk, run, or swim	Be active and try a team sport	Be active and try an individual sport	Your idea __________
Activity	20	13	8	2	2
Child and parent	Limit screen time to 2 hours each day	Move television out of your child's sleeping area	Help your child get a good night's sleep	Reward your child without using food	Work with school on physical activity
Child and parent	14	0	5	5	0

↵* A total of 127 selected 1 goal (13 missing), and 125 selected 2 goals (15 missing).
↵† Boldfaced goals (191/252, 75.8%) represent goals that correspond to recommended behaviors found in the Fitwits flashcards and/or physician training.

Table 5.

Qualitative Physician Comments and Parent Comments upon a Visit with the Doctor

Initial Comments	Responses (n)
Physician comments^*
Engaged adult at visit	28
Engaged child at visit	24
Information was received and understood	10
Adult not engaged at visit	8
Child not engaged at visit	5
High-calorie foods problematic	5
Adult confused/in denial about BMI	5
Adult supportive of information and motivated to change	4
Parent comments^{^†}
Mentioned improved understanding about healthy eating/drinking; informative	13
Positive comment about doctor	9
Increased understanding/knowledge about weight/BMI	9
Positive comment about visit	7

↵* Of 53 participating physicians, 39 wrote at least 1 comment; 83 surveys included physician comment(s) about the visit, with 89 remarks listed. Most frequently mentioned comments are rank ordered by frequency of response
↵† Of parents, 43 wrote a comment. The most frequently mentioned comments are ordered by frequency of response.
BMI, body mass index.