The Promise of Social Networks and Social Media in Tackling Childhood Obesity
Disclosure: Dr. Rao has nothing to disclose.
Pub Date: Monday, Dec. 3, 2012
Author: Goutham Rao, MD
Affiliation: Department of Family Medicine, University of Chicago Pritzker School of Medicine and North Shore University Health System
Li JS, Barnett TA, Goodman E, Wasserman RC, Kemper AR; on behalf of the American Heart Association Atherosclerosis, Hypertension and Obesity in the Young Committee of the Council on Cardiovascular Disease in the Young, Council on Epidemiology and Prevention, and Council on Nutrition, Physical Activity and Metabolism. Approaches to the prevention and management of childhood obesity: the role of social networks and the use of social media and related electronic technologies: a scientific statement from the American Heart Association. Circulation. 2013: published online before print December 3, 2012, 10.1161/CIR.0b013e3182756d8e.
Despite some evidence that the prevalence of obesity among children is stabilizing, pediatric obesity remains an extremely serious public health problem. An estimated 31.8% of all American children ages 2-19 and 33.6% of adolescents ages 12-19 are currently either overweight or obese.1 Pediatric obesity is associated with serious medical, psychological, and social consequences including hypertension, diabetes, hyperlipidemia, depression, and social isolation. Unfortunately, solutions to the problem remain elusive. Effective weight management programs for children are scarce, and those that do exist are expensive to deliver.2 Changes in public policy, such as changing the way unhealthy foods and beverages are marketed to children, do hold the promise of helping to reverse the epidemic. Such changes, however, are difficult to bring about and may take many years to impact the problem. Many experts in the field, myself and Dr. Li and her colleagues included, believe changing our built environment is ultimately at least part of the solution to the problem of obesity. Relying entirely upon a healthier built environment, which may take a generation or more to create, leaves the question of what’s best to do now unanswered. Desperately needed are inexpensive, engaging, easily accessible strategies for promoting healthy habits and preventing and treating obesity in children that can be implemented immediately. This is why the statement by Dr. Li and her colleagues is so timely and important.
I led the development of the AHA’s scientific statement on new and emerging weight management strategies for adults and served on the AMA’s Expert Committee on the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity, both referred to in this new statement.3,4 In the adult AHA statement, we did explore the use of technology, especially the Internet, as a strategy for engaging adults in weight management, but not the use of social networks and social media. Similarly, as Dr. Li points out, the Expert Committee makes no mention of social networks and social media, which at the time the recommendations were released were relatively new phenomena. Over the past 5 years, for example, the number of Facebook users has grown from roughly 50 million to roughly 900 million people worldwide.5 There are three compelling reasons why social networks and social media may be effective means for helping children achieve or maintain a healthy weight. First, as Dr. Li and her colleagues point out, nearly everyone is part of a social network, whether it be technologically, family, or community-based. Just as Sesame Street became a useful medium for delivering education to pre-schoolers when almost all families had access to television, social networks and social media, especially those involving technology, may now be a useful way to deliver interactive weight management help. Second, the explosive growth in social media and the use of technology in general, has already resulted in a generation of technologically-savvy children and adolescents who are quite different from prior generations. Consider that approximately 75% of American adolescents ages 12-17 have mobile phones and 2/3 of mobile phone users ages 15-24 have devices with “smartphone” features such as mobile Internet access.6 This would have been unimaginable only a few years ago. Not surprisingly, as Dr. Li et al point out, children actually prefer technologically tailored interactive weight management programs to more traditional programs that make use of paper diaries for self-monitoring. Finally, as the former Clinical Director of the Weight Management and Wellness Center at the Children’s Hospital of Pittsburgh, I was confronted with the enormous amount of time and other resources required to deliver an in-person clinical weight management program to a significant number of children. Not only were highly specialized personnel who invested many hours with each child required, but families themselves were forced to invest a large amount of their own time, often sacrificing school and work, to attend appointments, group classes, and other intensive services. One important advantage of the promising strategies that makes use of social networks, social media, and various technologies described by Dr. Li et al will certainly be their relatively low cost to deliver and administer.
What have we learned so far? Dr. Li et al point out that social networks do influence health – Overweight children, for example, are more likely to have peers with the same characteristics and behaviors, either through selection of similar peers or adoption of specific habits of those in their network. This phenomenon has been well documented. The next logical step is to see if one can make use of social networks to influence health in positive ways. To date, there have been few systematic efforts to try this for overweight and obesity. We do have some indirect evidence that such a strategy might work. Peer-led programs have been successfully used for tobacco prevention among adolescents.7 As Dr. Li et al point out, a number of social networks, such as the Weigh2Rock program have been created specifically to address the problem of overweight and obesity.8 Systematic assessment of their effectiveness is not yet available.
Results from trials of Internet-based weight management programs have shown mixed results. These have not specifically used social networks. Technology and its use among young people is changing so rapidly that “traditional” Internet-based weight management programs, as opposed to programs that make explicit use of social networks or other technology like text messaging, may already be perceived as obsolete among children and adolescents. New email and texting interventions may be more successful in engaging youngsters. Dr. Li et al briefly discuss active video games, which have been shown to boost short-term though not sustained physical activity and energy expenditure.9 Their long-term impact upon overweight and obesity, however, is unknown.
Dr. Li and her colleagues make excellent recommendations for future research directions in this promising area. Most importantly, they call for evaluating the role of social networks and social media and other technology to support collaborative approaches for weight management. In other words, the role that social networks and social media can play in weight management needs to be further explored. A conventional weight management program, for example, may make use of social media to provide social support, motivation, and important information to enrollees.
Though everyone is part of a social network of some sort, the statement doesn’t address the extent to which overweight and obese children are able to take advantage of their social networks to improve their own health. One can be a member of a social network, but not feel well connected to its key members, or worse still, be perceived as an unimportant or insignificant member. This is an especially important issue for overweight and obese children, who tend to be socially marginalized. Social networks and social media can only be successful in engaging children in weight management, if the children feel like they are important members whose voices are heard. This is why the creation of social networks specifically for children who are trying to achieve or maintain a healthy weight may be an especially promising strategy.
The statement by Dr. Li and colleagues introduces a number of new concepts and promising strategies. I am hopeful that in a few years we will have more useful evidence for the effectiveness of social networks, social media, and related technologies for weight management in children. Of course, by then, the technology and social media landscape will likely have changed!
- Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010. JAMA. 2012;307:483-490.
- Bluford DAA, Sherry B, Scanlon KS. Interventions to prevent or treat obesity in preschool children: A review of evaluated programs. Obesity 2007;15(6):1356-72.
- Rao G, Burke LE, Spring B, et al. New and emerging weight management strategies for busy ambulatory settings. Circulation 2011;10:1182-1203.
- Rao G. Childhood obesity: Highlights of AMA Expert Committee recommendations. Am Fam Physician 2008;78(1): 56-63.
- Facebook user growth chart. http://www.benphoster.com/facebook-user-growth-chart-2004-2010/. Accessed 18 July 2012.
- US youth have higher smartphone penetration than adults. http://www.marketingcharts.com/uncategorized/us-youth-have-higher-smartphone-penetration-than-adults-15665/. Accessed 24 September 2011.
- Starkey F, Audrey S, Holliday J, Moore L, Campbell R. Identifying influential young people to undertake effective peer-led health promotion: the example of A Stop Smoking In Schools Trial (ASSIST). Health Educ Res 2009;24(6):977-88. http://www.weigh2rock.com. Accessed 20 July 2012.
- Barnett A, Cerin E, Baranowski T. Active video games for youth: A systematic review. J Phys Act Health 2011;8(5): 724-37.
-- The opinions expressed in this commentary are not necessarily those of the editors or of the American Heart Association --