Background: Pediatric obesity continues to be a national health crisis. Parents play a critical role in obesity interventions. Digital health interventions, like personal activity trackers (PATs), can help better engage parents in pediatric obesity interventions and improve outcomes. Objective: 1) Assess the #feasibility and acceptability of implementing personal activity trackers as part of a comprehensive family-based lifestyle intervention for pediatric obesity (BodyWorks) in a federally qualified health center. 2) Evaluate the impact of personal activity trackers on parents on child anthropometrics and the overall program. 3) Examine the associations between steps/day and usage (minutes) with body composition outcomes. Methods: : In this randomized controlled trial, 158 families were randomized to receive the BodyWorks (BW) curriculum alone (control) or BW plus a PAT for the parent (intervention). Data were collected at baseline and post-intervention (8 weeks). Child weight outcomes, including BMI, BMI z-score, and BMI percent of the 95th percentile (%BMIp95), were compared using generalized estimating equations. Parent and child PAT usage was analyzed with multivariable models Results: There were no baseline differences between groups. After adjustment, children in the intervention group had significantly greater reductions in BMI z-score compared to controls (–0.035 vs –0.001; p for interaction = 0.009). There were no significant differences in %BMIp95. Among intervention participants, each 1,000-step increase per day was associated with a 0.009 increase in BMI z-score (p = 0.005). Most parents reported high satisfaction with PATs; 95% agreed or strongly agreed that devices were easy to use and motivating Conclusions: PATs are feasible and acceptable tools for engaging families in pediatric obesity programs. While short-term weight outcomes showed modest benefit, further research is needed to assess clinical significance and long-term effects. Digital health tools may enhance engagement in low-resource settings without exacerbating the digital divide. Clinical Trial: ClinicalTrials.gov NCT03215641; https://clinicaltrials.gov/study/NCT03215641

Pediatric Research - Weighing the future: strategic measures against rising childhood obesity