Background: The Coronavirus 2019 (COVID-19) is an infectious disease, which was first identified in December 2019 and has then spread rapidly around the world. COVID-19 spreads mainly through respiratory droplets and causes people to experience mild to moderate respiratory illness. On 11 March 2020, the World Health Organisation (WHO) declared COVID-19 a pandemic. With the surge in cases and to contain the spread of this disease, Singapore implemented a circuit breaker to reduce movements and interactions in public and private places. People are advised to stay at home and practise social distancing. With restrictions in movements, parents and children are likely to be more sedentary in this pandemic. There is an urgent need to move face-to-face interventions to online interventions as it is important to be active in this period. Childhood obesity threatens the health of US and Singapore populations. In the US, 30% of children are overweight, 17% have obesity, and 8% have severe obesity. In Singapore, 13% of children have obesity, and approximately half of all overweight children live in Asia. In both countries the prevalence is increasing, especially amongst the lower income populations, and is associated with future cardiovascular and metabolic disease. In US, obesity is most prevalent in Black and Hispanic populations and in Singapore, obesity affects Malays and Indians disproportionately. The underlying drivers and potential solutions thus share many common factors. The current evidence shows a clear dose-response effect with increasing number of hours of treatment, with a threshold for effectiveness at > 25 hours over a 6-month period. A key gap in delivering this recommendation is meeting the intensity, and delivering comprehensive treatment that is culturally relevant, engaging to families, and integrated within the community context. The study is an online pilot randomised controlled trial among children aged 4-7 with obesity, in Singapore, to test a novel school-clinic-community online intervention, the KK Hospital (KKH) Sports Singapore program, for child obesity treatment with usual care. The primary outcome is intensity of treatment as measured by hours of exposure to intervention. The online KKH Sports Singapore program involves 4-6 weekly online sessions of physical activity and nutrition lessons for children and parents.
Through this trial, the investigators will address the following aims:
1. To demonstrate implementation feasibility and fidelity of the Duke community-based
intervention model into an online model. The investigators hypothesise that the
evidence-based implementation strategy tested in the US with Parks and Recreation will
be adaptable for use at Duke-National University Singapore (NUS) with Singapore Sport,
leading to online implementation within a 3-month period, and children in the
intervention will receive up to 60 minutes of moderate-to-vigorous physical activity per
session.
2. To meet current recommendations for intensity of obesity treatment. As compared with
usual care, the investigators hypothesise that children in the online intervention will
be more likely to receive >25 hours over 6 months of treatment.
3. To estimate the effectiveness of the online intervention. Children who participate in
the online intervention, as compared with usual care, will demonstrate improvements in
health outcomes at 6-months, including cardiorespiratory fitness, weight-related quality
of life and stabilisation or reduction in BMI at 6 months.
Behavioral: Usual Care
Participants will receive standard care which consist of the following:
a lifestyle counseling visit
educational materials
goal-setting by a healthcare professional, and
information about general weight management resources.
weighing scale and measuring tape with instructions to use
fitness tracker
Behavioral: online KKH Sports Singapore Program with Usual Care
Participants will receive standard care and basic sports equipment and cooking materials for the online programme.
The online programme will be available up to 4 days per week (Weekdays evenings and Weekends mornings or early afternoons) and all household family members are invited to participate. The majority of the programming will be run by trained research coordinator and volunteers from KKH and Sports Singapore coaches. A regular rotation of comprehensive programming is provided, which includes online fitness, cooking, nutrition, and peer support classes. Every session includes up to 60 minutes of exercise and/or active play, and each session has an additional special 'theme.' For example, one to two sessions per week includes nutrition related programming (e.g., cooking classes), parent specific activities (e.g., a yoga class), peer support sessions (e.g., small group discussions around issues such as weight stigmatization), and fitness classes (e.g., soccer classes).
Inclusion Criteria:
Subject must meet all of the inclusion criteria to participate in this study.
- Overweight as defined by BMI percentile of above 90th percentile
- Age 4-7 years old in the year of referral
- Ability to provide informed consent
Exclusion Criteria:
- Patients with secondary causes of obesity especially genetic syndromes e.g. Trisomy
21, Prader-Willi
- Currently participating in a weight management program
- Unable to understand and speak English sufficiently to give informed consent and
complete the research assessments.
KK Women's and Children's Hospital
Singapore, Singapore
Elaine Chu Shan Chew, MBBS, Principal Investigator
KK Women's and Children's Hospital