The Effect of Combined Internet Diet Behavior Intervention On School-Age Children

doi:10.21203/rs.3.rs-830260/v1

Background

With the development of the economy and the improvement of people's quality of life, the problem of children's eating behavior is a common phenomenon. The purpose of this study was to evaluate the effect of combined internet dietary behavior intervention on the dietary behavior of school-age children.

Methods

A randomized controlled trial (RCT) was conducted among school-age children aged 6–12 years and their parents. A total of 480 children participated, 240 in the experimental group and 240 in the control group. The children in the experimental group were given dietary behavior intervention for 2 months. The intervention was conducted through face-to-face lectures and WeChat; the children in the control group did not make any intervention. The school-age children’s eating behavior scale (CSCEBQ) was used to evaluate the eating behavior of all children at baseline and 2 months. The rank-sum test and X² test were used to analyze the data.

Results

At baseline, the experimental group and the control group had no significant differences in the scores of the six dimensions of food fussiness, food responsiveness, satiety responsiveness, unhealthy eating habits, external eating, craving for junk food (p > 0.05). After 2 months, in addition to the food preference dimension, the dietary behavior scores of the children in the experimental group were significantly lower than those in the control group in other dimensions (p ≤ 0.01).

Conclusions

Compared with the control group, the children in the experimental group improved in food fussiness, food responsiveness, unhealthy eating habits, external eating, dietary restriction, craving for junk food. This study increases the knowledge of using WeChat to intervene, and evaluated the impact of using CSCEBQ on children’s diet, and provides a more scientific and effective basis for the clinical intervention of children with eating behavior problems.

Health Economics & Outcomes Research

Infectious Diseases

Health Policy

School-age Children

Internet

Diet behavior intervention

Dietary behavior refers to a biological feature that meets growth and health needs, including preferences and choices for food. Children's dietary behavior includes children's eating behavior, feeding behavior, food choice, and other behaviors [1]. With the development of the economy and the improvement of people's quality of life, the problem of children's eating behavior is a common phenomenon. In recent years, domestic and foreign surveys have shown that children’s dietary behaviors have a high prevalence trend [2, 3]. Some foreign literature reports that the proportion of children with eating behavior problems can reach 25% [4]. In China, the incidence of children’s eating behavior problems reported in the literature can be as high as 60%[5, 6]. Studies have shown that children’s eating behaviors are affected by parental behaviors, and dietary habits are formed in childhood [7, 8]. Eating behaviors are closely related to the growth and development of children. Poor eating behaviors during childhood normally affect their nutritional status, leading to obesity, metabolic diseases, and other diseases [9, 10]. If children’s eating behavior problems can be identified as early as possible and intervened, it will not only improve children’s nutritional status but also have important significance for promoting their healthy growth and preventing chronic diseases.

Eating behavior intervention refers to changing the patient’s eating behavior and developing good eating habits through specific strategies and guidance [11]. Several investigators have demonstrated the effectiveness of dietary behavior intervention in reducing bad eating behavior and enhancing the well-being and quality of life in individuals in children [12, 13, 14]. However, the intervention may take a long time in the treatment process, the intervention method is single, the intervention effect is short, and the intervention plan is not systematic enough [15, 16, 17].

With the development of the Internet and smartphones, people now are accustomed to finding some ways to solve problems on the Internet. The Internet and smartphone technologies may be more effective as dietary interventions because they can be seamlessly integrated into daily activities [18, 19]. In recent years, relevant research has mainly focused on the dietary behavior and interventional research of preschool children, and there are few interventional studies on the dietary behavior of school-age children. Combining WeChat to intervene in school-age children’s eating behavior and analyze the characteristics of school-age children’s eating behavior is of great significance to the healthy growth of school-age children.

The purpose of this study is to explore the impact of face-to-face combined online dietary behavior intervention on school-age children's dietary behavior. This study hypothesizes that this intervention will lead to changes in children's eating behaviors, which are mainly manifested in eight types of eating behaviors: food fussiness, food responsiveness, satiety responsiveness, unhealthy eating habits, external eating, dietary restriction, food preference, craving for junk food.

Trial Design

This study was a multi-center,two-parallel-armed, 1:1 allocated RCT with 2 months follow-up. 480 children with eating behavior problems in 10 tutoring institutions were randomly assigned to the intervention group or the control group. The intervention group was given a two-month dietary behavior intervention, including concentrated lectures, establishing a WeChat group to send related videos, WeChat official account to push related dietary knowledge, and distributing brochures. The control group did not do any intervention.

Participants

The study was conducted from January 2021 to March 2021. Participants came from 10 tutoring institutions in Dezhou City, Shandong Province, Weifang City, Shandong Province, and Weihai City, Shandong Province, in eastern China. A total of 480 children aged 6–12 years were included in this study.
The inclusion criteria for participating in the study include: based on the caregiver's report, there are one or more of the eight types of eating behavior problems, and children aged 6–12 years without serious organic diseases. The eight types of eating behavior problems include:⑴Food fussiness, ⑵Food responsiveness, ⑶Satiety responsiveness, ⑷Unhealthy eating habits, ⑸External eating, ⑹Dietary restriction, ⑺Food preference, ⑻Craving for junk food.

Exclusion criteria: ⑴Can't operate a smartphone, can't use WeChat (a communication application that has been widely used in China) frequently (< 5 times per week), ⑵ Before registration Participate in other dietary behavior interventions within 3 months, ⑶ refuse to participate.

Procedure

Children with eating behavior problems were recruited from 10 tutoring institutions. First, the parents of children obtain informed consent for eating behavior intervention. Once agreed, participants will obtain the Chinese School-age Children Eating Behavior Questionnaire (CSCEBQ), including basic information about the child, basic information about the main caregiver, and eating behavior problems. According to the inclusion and exclusion criteria, the information of all participants is screened, and then within 1 week, the researcher will contact eligible participants via phone or WeChat and establish a WeChat group. 480 subjects were randomly assigned to the intervention group (n = 240) or the control group (n = 240). Participants were asked to perform two assessments with CSCEBQ at baseline and 2 months after the intervention.

Intervention

The establishment of a research team and the training of researchers before the formal intervention. The training content includes the establishment of WeChat official accounts and WeChat groups, and regular delivery of relevant intervention measures. The targets of intervention are 6–12 years old children and their parents. The intervention time is two months, once a week, 30 to 45 minutes each time, a total of 8 interventions. In the first month, the intervention was conducted through a lecture on dietary behavior and health, once a week, 4 interventions. After each lecture, a brochure was distributed to the participants and related children's dietary knowledge was pushed through the WeChat public account. In the second month, online video combined with WeChat public platform pushes were used to intervene 4 times. Children in the intervention group and their parents consolidate their knowledge of healthy eating by watching videos and online contests with prizes. The intervention included lectures on children's dietary behavior and health, brochures on healthy eating, videos of children's dietary behaviors shared by WeChat groups, and WeChat official accounts to push related dietary health knowledge. Details on the dietary behavior intervention are provided in Table 1.

Table 1

The specific content of eating behavior intervention
Week	Subject	Purpose	Main content	Follow-up content
1	Food fussiness	Understand the food fussiness concept	1.Establish a good relationship with the respondent and fill out the questionnaire after obtaining informed consent 2.Hold lectures on food fussiness 3.Push articles about food fussiness on the WeChat public account. For example, the pictures and texts show to parents and describe in detail the definition, harms, and solutions of food fussiness.	1.Follow up via WeChat or phone to answer questions raised by respondents during the intervention process at any time 2.Encourage everyone to actively post their photos about eating behavior in the WeChat group
2	Food responsiveness	Understand the food responsiveness concept	1.Hold lectures on food responsiveness 2.Push articles about food responsiveness on the WeChat public account. For example, the pictures and texts show to parents and describe in detail the definition, hazards, and the solutions of food response.	1.Follow up via WeChat or phone to answer questions raised by respondents during the intervention process at any time 2.Encourage everyone to actively post their photos about eating behavior in the WeChat group
3	Satiety responsiveness	Understand the satiety responsiveness concept	1.Hold lectures on satiety responsiveness 2.Push articles about satiety responsiveness on the WeChat public account. For example, the pictures and texts show to parents and describe in detail the definition, hazards, and the most important solutions and expected effects of the Satiety responsiveness.	1.Follow up via WeChat or phone to answer questions raised by respondents during the intervention process at any time 2.Encourage everyone to actively post their photos about eating behavior in the WeChat group
4	Unhealthy eating habits	Understand the unhealthy eating habits concept	1.Hold lectures on unhealthy eating habits 2.Push articles about unhealthy eating habits on the WeChat public account. For example, the pictures and texts show parents the specific content, harms, and solutions of unhealthy eating habits.	1.Follow up via WeChat or phone to answer questions raised by respondents during the intervention process at any time 2.Encourage everyone to actively post their photos about eating behavior in the WeChat group
5	External eating	Understand the external eating concept	1.Push a video about external eating in the WeChat group 2.Encourage everyone to post corresponding questions after watching the video 3.Those who answer correctly can get a separate WeChat push 4.Push articles about external eating on the WeChat public account.	1.Follow up via WeChat or phone to answer questions raised by respondents during the intervention process at any time 2.Encourage everyone to actively post their photos about eating behavior in the WeChat group
6	Dietary restriction	Understand the dietary restriction concept	1.Push a video about dietary restriction in the WeChat group 2.Encourage everyone to post corresponding questions after watching the video 3.Those who answer correctly can get a separate WeChat push 4.Push articles about the dietary restriction on the WeChat public account.	1.Follow up via WeChat or phone to answer questions raised by respondents during the intervention process at any time 2.Encourage everyone to actively post their photos about eating behavior in the WeChat group
7	Food preference	Understand the food preference concept	1.Push a video about food preference in the WeChat group 2.Encourage everyone to post corresponding questions after watching the video 3.Those who answer correctly can get a separate WeChat push 4.Push articles about food preference on the WeChat public account.	1.Follow up via WeChat or phone to answer questions raised by respondents during the intervention process at any time 2.Encourage everyone to actively post their photos about eating behavior in the WeChat group
8	Craving for junk food	Understand the craving for junk food concept	1.Push a video about craving for junk food in the WeChat group 2.Encourage everyone to post corresponding questions after watching the video 3.Those who answer correctly can get a separate WeChat push 4.Push articles about craving for junk food on the WeChat public account. For example, the pictures and texts show to parents and describe in detail the types, harms, and solutions of junk food.	1.Follow up via WeChat or phone to answer questions raised by respondents during the intervention process at any time 2.Encourage everyone to actively post their photos about eating behavior in the WeChat group

No guidance to participants in the control group. After the study was completed, these participants were introduced to the research plan and provided videos and materials for the intervention.

Measures

Chinese School-age Children Eating Behavior Questionnaire (CSCEBQ) is used to measure children's bad eating behavior [20]. CSCEBQ is composed of eight dimensions: food fussiness, food responsiveness, satiety responsiveness, unhealthy eating habits, external eating, dietary restriction, food preference, and craving for junk food. There are 4 to 8 items in each dimension, containing 46 items in total, and the score for each item ranges from 1 (never) to 5 (always). The total score of CSCEBQ ranges from 46 to 230. The higher the score, the more serious the eating problem. This scale can objectively and comprehensively reflect the eating behavior problems and characteristics of Chinese school-age children. Compared with related scales at home and abroad, it contains common dimensions such as food fussiness, food responsiveness, satiety responsiveness, external eating, and food preference. CSCEBQ has prominent reliability and validity. The correlation coefficient between the scores of each dimension is 0.08ཞ0.48, the correlation coefficient between the scores of each dimension and the total score of the questionnaire is 0.51ཞ0.72, the Cronbach’s α coefficient of the scale is 0.89, the Guttman split-half reliability is 0.71, and the test-retest reliability coefficient is 0.73.

Sample Size

Considering the reliability and validity of CSCEBQ, the sample size is calculated as 230 persons according to 5 times the number of entries in this scale. Considering the attrition rate, in the end, 240 people were included in each group.

Randomization

The randomization of the trial is a simple random method. The random number sequence was generated by a researcher who was not involved in this study using the random number generator function in SPSS 23.0(IBM Corporation). The randomization process was carried out by an independent researcher.

Statistical Analysis

The data of this study adopts SPSS 23.0(IBM Corporation) for statistical analysis. Categorical variables are described by counts and proportions. Due to the non-normal distribution of continuous variables, the median and quartile of related items are used for description. A two-sample rank-sum test or X² test was used to analyze and compare the differences in baseline characteristics and outcome variables between the two groups. The paired rank-sum test was used to compare and analyze the effects before and after an intervention. The significance level was set to α = 0.05. When p ≤ 0.05, the null hypothesis was rejected.

A total of 500 children were screened. Four hundred eighty children completed the baseline questionnaires and received a randomized allocation, so they were included in the intention-to-treat analysis. 240 participants were randomized to the experimental group, 240 participants completed the final evaluation after the intervention. 240 participants were randomized to a control group, and 240 patients completed the final evaluation after the intervention. The study design flow chart is shown in Fig. 1. Participants are children from 6 to 12 years old. The demographic characteristics of the two samples are shown in Table 2.

Table 2

Characteristics of participating parents and children
Characteristic	Experimental group	Control Group
	(n = 240)	(n = 240)
Sex,n(%)
Male	127.00(52.90%)	121.00(50.40%)
Female	113.00(47.10%)	119.00(49.60%)
Age,[M(IQR)]	10.00(9.00,11.00)	11.00(9.00,11.00)
left behind children,n(%)
Yes	21.00(8.80%)	10.00(4.20%)
No	219.00(91.30%)	230.00(95.80%)
Place,n(%)
City	121.00(50.40%)	126.00(52.50%)
Rural area	119.00(49.60%)	114.00(47.50%)
Height,[M(IQR)]	145.00(135.00,152.00)	150.00(140.00,155.75)
Weight,[M(IQR)]	37.50(30.00,42.00)	40.00(36.00,43.00)
Caregiver,n(%)
Parents	218.00(90.80%)	219.00(91.30%)
Grandparents	15.00(6.30%)	20.00(8.30%)
Other	7.00(2.90%)	1.00(0.40%)
Age of caregiver,[M(IQR)]	37.00(34.00,40.00)	40.00(37.00,42.00)
Caregiver occupation,n(%)
Worker	55.00(22.90%)	52.00(21.70%)
Farmer	59.00(24.60%)	45.00(18.80%)
Housework or unemployed	31.00(12.90%)	26.00(10.80%)
Government agencies	7.00(2.90%)	15.00(6.30%)
Teacher or medical worker	6.00(2.50%)	2.00(0.80%)
Business services	63.00(26.30%)	88.00(36.70%)
Other	19.00(7.90%)	10.00(4.20%)
Educational level of caregiver,n(%)
Below junior high school	117.00(48.80%)	101.00(42.10%)
High school	96.00(40.00%)	115.00(47.90%)
Undergraduate	26.00(10.80%)	23.00(9.60%)
Postgraduate	1.00(0.40%)	1.00(0.40%)
Per capita monthly income,n(%)
< 3000RMB	61.00(25.40%)	62.00(25.80%)
3000 ~ 5000RMB	129.00(53.80%)	122.00(50.80%)
5000 ~ 10000RMB	46.00(19.20%)	52.00(21.70%)
> 10000RMB	4.00(1.70%)	4.00(1.70%)
family structure,n(%)
Nuclear family (father, mother, child)	154.00(64.20%)	183.00(76.30%)
Three generations live together	81.00(33.80%)	47.00(19.60%)
one-parent family	5.00(2.10%)	10.00(4.20%)

Compare the scores of 8 dietary behavior problems before and after intervention in each group. After the intervention, the experimental group's scores in the food preference dimension increased, while the scores in other dimensions decreased; After the intervention, the scores of the control group in the three dimensions of food responsiveness, satiety responsiveness, and craving for junk food did not change substantially, and the scores in other dimensions increased. Compared with the pre-intervention, the experimental group after intervention food preference scores rose and there was a statistically significant difference (p < 0.01); After the intervention of the experimental group, the scores of the eight dimensions of food fussiness, food responsiveness, satiety responsiveness, unhealthy eating habits, external eating, dietary restriction, craving for junk food, and total eating behavior score decreased, and there were statistical differences (p < 0.01). After the intervention of the control group, there were statistical differences in the distribution of six dimensions of food fussiness, food responsiveness, unhealthy eating habits, food preference, craving for junk food, and total eating behavior score (p < 0.05); There was no statistical difference in the distribution of scores in the three dimensions of satiety responsiveness, external eating, and dietary restriction in the control group after intervention (p > 0.05). The eating behavior of the control group after the intervention was worse than baseline. The above results can be obtained from Table 3, Fig. 2.

Table 3

Comparison of scores in various dimensions of the experimental group before and after intervention
	Group	Baseline Median (range)	Post-Intervention Median(range)	z	p
Food fussiness	Experimental group	18.00(15.00,20.00)	14.00(12.00,15.00)	-10.28	0.001^***
Food responsiveness	Experimental group	15.00(12.00,17.00)	11.00(9.00,12.00)	-10.75	0.001^***
Satiety responsiveness	Experimental group	11.00(10.00,12.00)	11.00(9.25,12.00)	-2.69	0.007^**
Unhealthy eating habits	Experimental group	20.00(14.00,24.00)	14.00(12.00,16.00)	-10.41	0.001^***
External eating	Experimental group	23.50(17.00,27.00)	19.00(16.00,21.75)	-6.57	0.001^***
Dietary restriction	Experimental group	10.00(7.00,13.00)	6.50(4.00,9.00)	-10.98	0.001^***
Food preference	Experimental group	16.00(14.00,18.00)	19.00(14.00,22.00)	-3.51	0.001^***
Craving for junk food	Experimental group	23.00(19.00,26.00)	14.00(12.00,16.00)	-12.57	0.001^***
Total Eating Behavior Score	Experimental group	135.00(112.00,155.00)	109.00(97.25,117.00)	-11.11	0.001^***
^P < 0.05,^*P < 0.01.

Compare the baseline and post-intervention dietary behavior scores between the two groups. The results in Table 4 show that among the eight types of eating behavior problems, the three highest-scoring dimensions in the two groups are External eating, Craving for junk food, and Unhealthy eating habits. Before the intervention, the two groups had no statistically significant differences in the seven dimensions of food fussiness, food responsiveness, satiety responsiveness, unhealthy eating habits, external eating, craving for junk food, and total eating behavior score(p > 0.05); However, there was a statistically significant difference in the two dimensions of dietary restriction and food preference (p < 0.05). After the intervention, the experimental group and the control group had statistically significant differences in the scores of the nine dimensions of food fussiness, food responsiveness, satiety responsiveness, unhealthy eating habits, external eating, dietary restriction, food preference, craving for junk food, and total eating behavior score(p < 0.05). Figure 3 shows that in addition to the food preference dimension, the dietary behavior scores of children in the intervention group were significantly lower than those in the control group in other dimensions (p ≤ 0.01).

Table 4

Changes in the results of each dimension between the two groups
	Group	Experimental group	Control Group	z	p
Food fussiness	Baseline Median (range)	18.00(15.00,20.00)	17.00(14.00,20.00)	-1.05	0.29
	Post-Intervention Median(range)	14.00(12.00,15.00)	18.00(14.00,21.00)	-8.77	0.001^***
Food responsiveness	Baseline Median (range)	15.00(12.00,17.00)	15.00(11.00,17.75)	-0.05	0.96
	Post-Intervention Median(range)	11.00(9.00,12.00)	15.00(11.00,18.00)	-10.13	0.001^***
Satiety responsiveness	Baseline Median (range)	11.00(10.00,12.00)	11.00(10.00,12.00)	-1.04	0.30
	Post-Intervention Median(range)	11.00(9.25,12.00)	11.00(10.00,13.00)	-2.63	0.01^**
Unhealthy eating habits	Baseline Median (range)	20.00(14.00,24.00)	18.00(15.00,24.00)	-0.44	0.66
	Post-Intervention Median(range)	14.00(12.00,16.00)	20.00(15.00,25.00)	-9.46	0.001^***
External eating	Baseline Median (range)	23.50(17.00,27.00)	21.50(18.00,27.00)	-0.53	0.60
	Post-Intervention Median(range)	19.00(16.00,21.75)	23.00(17.00,28.00)	-5.85	0.001^***
Dietary restriction	Baseline Median (range)	10.00(7.00,13.00)	12.00(8.00,15.00)	-4.25	0.001^***
	Post-Intervention Median(range)	6.50(4.00,9.00)	13.00(8.00,15.00)	-12.53	0.001^***
Food preference	Baseline Median (range)	16.00(14.00,18.00)	15.00(14.00,17.00)	-3.01	0.003^**
	Post-Intervention Median(range)	19.00(14.00,22.00)	16.00(14.00,18.00)	-5.45	0.001^***
Craving for junk food	Baseline Median (range)	23.00(19.00,26.00)	23.00(19.00,26.00)	-0.05	0.96
	Post-Intervention Median(range)	14.00(12.00,16.00)	23.00(18.25,27.00)	-14.08	0.001^***
Total Eating Behavior Score	Baseline Median (range)	135.00(112.00,155.00)	129.00(115.00,154.00)	-0.37	0.71
	Post-Intervention Median(range)	109.00(97.25,117.00)	131.00(112.25,159.00)	-10.17	0.001^***
^P < 0.05,^*P < 0.01.

The dietary behavior score improvement of the experimental group and the control group was compared, and the difference between the scores of various dietary behaviors after the intervention and the baseline was calculated. The larger the difference, the more obvious the improvement of dietary behavior. The results in Table 5 show that after 2 months of follow-up intervention, the dietary behavior scores of the children in the experimental group showed a downward trend, while the dietary behavior scores of the children in the control group did not decrease but increased. Among them, the degree of improvement in the two dimensions of Satiety responsiveness and Food preference of the intervention group was not obvious, and the degree of improvement in the scores of other dimensions was significantly better than that of the control group (P < 0.001).

Table 5

Comparison of score difference between the two groups before and after intervention
	Group	Experimental group	Control Group	z	p
Food fussiness	Difference Median (range)	3.00(1.00,6.00)	0.00(-1.00,0.00)	-12.6	0.001***
Food responsiveness	Difference Median (range)	4.00(1.00,6.00)	0.00(-1.00,0.00)	-11.8	0.001***
Satiety responsiveness	Difference Median (range)	0.00(-1.00,3.00)	0.00(-1.00,0.00)	-3.454	0.001***
Unhealthy eating habits	Difference Median (range)	5.00(1.00,8.00)	0.00(-1.00,0.00)	-11.528	0.001***
External eating	Difference Median (range)	4.00(0.00,7.00)	0.00(-1.00,1.00)	-8.419	0.001***
Dietary restriction	Difference Median (range)	3.00(0.25,5.00)	0.00(-1.00,1.00)	-11.312	0.001***
Food preference	Difference Median (range)	-1.00(-5.00,2.00)	0.00(-2.00,0.00)	-2.002	0.05**
Craving for junk food	Difference Median (range)	7.00(4.00,11.00)	0.00(-2.00,0.00)	-15.439	0.001***
Total Eating Behavior Score	Difference Median (range)	27.00(8.00,42.00)	-1.00(-6.00,1.00)	-12.36	0.001***

To the best of our knowledge, this is the first RCT article on dietary behavior intervention on the dietary behavior of Chinese school-age children. The current study found that after dietary behavior intervention, the dietary behavior problems of children in the experimental group were lower than those of the control group.

In this study, through lectures and the establishment of a WeChat public account to push videos and articles related to healthy eating for school-age children, a good intervention effect was obtained, which is consistent with the previous literature [21]. A review wrote that by intervening in children through dietary behavior intervention guided by scientific theories, the intervention effect is more significant [22]. In this study, through the intervention of school-age children, their eating behavior has been improved. Previous studies have shown that health-related dietary behavior interventions for children can effectively improve the quality of children’s diet [23, 24] and reduce children’s dietary behavior problems [25]. And some studies have shown that children's eating behavior can lead to obesity, metabolic syndrome, type 2 diabetes, and other diseases [8, 26, 27, 28, 29]. However, so far, there is still a lack of research to evaluate the changes in children's dietary behaviors after intervention and the impact of an intervention to change children's dietary behaviors on childhood obesity. This study is a Randomized Controlled Trial (RCT) on the dietary behavior intervention of school-age children through the joint Internet to explore the changes in children's dietary behavior after the intervention. The results of the current study show that there are improvements in the six aspects of food fussiness, food responsiveness, unhealthy eating habits, external eating, dietary restriction, and craving for junk food.

In this study, children in the intervention group increased their scores on the food preference dimension. The reason for the analysis may be related to the influence of genetic factors or the gradual increase in self-awareness of school-age children and the desire to eat when hungry [30]. This study did not find any significant changes in the ability to satiety responsiveness, which is consistent with the results of Ahmad et al. [25]. In general, this study provides evidence that the instruction of healthy eating interventions for school-age children and their parents is related to the moderate improvement of children's eating behaviors. These healthy eating behaviors may lay the foundation for long-term healthy eating habits and reduce the risk of obesity in the future [31, 32, 33]. In future studies, it is necessary to continue to explore new interventions that can improve dietary behaviors and the impact of interventions on obesity, to observe clinically significant changes in children's dietary behaviors.

This study explored the effect of joint Internet intervention on the dietary behavior of school-age children. Keep in touch with the subjects and their parents through WeChat groups and WeChat official accounts. The delivery model of the online health intervention includes videos and related tweets to convey educational information and exercises. Intervention on the dietary behavior of school-age children through the United Internet may have the following benefits: ⑴Due to most Chinese people now have the habit of using smartphones to communicate via WeChat, this increases the possibility of such interventions; ⑵Some participants may be inconvenient to reach the experimental activity site, and the joint Internet intervention has added a lot of convenience to the participants; ⑶It can reduce the cost of treatment, because face-to-face intervention may require more economic and manpower [18, 19, 34, 35]. The development of the Internet provides a good condition for children's dietary behavior intervention, and many applications that help children improve their dietary behaviors are constantly being developed and used [29].

However, the current research still has some limitations that deserve our attention. First, at present, there are few pieces of research on children's diet intervention based on applications in China [36], and there are more applications on children's healthy diet developed abroad [29]. Second, so far, fewer RCTs are using CSCEBQ to evaluate the eating behavior of school-age children, so the scope of comparison is relatively limited. Third, the participants in this study are from tutoring institutions in certain cities in Shandong, and can’t be regarded as representing all children with eating behavior problems in China, which may limit the effectiveness of the intervention. Fourth, this article discusses the effect of dietary behavior intervention and doesn’t involve the degree of maintenance of the intervention effect during the follow-up process. Next, it is necessary to further develop applications to help children improve their diet, expand the sample size, extend the follow-up time, and provide more effective intervention measures to provide a solid foundation for the healthy diet of Chinese school-age children and the health of adulthood.

The results of this RCT show that after intervening in the dietary behavior of school-age children through the joint Internet, the children in the experimental group have improved in food fussiness, food responsiveness, unhealthy eating habits, external eating, dietary restriction, and craving for junk food. This was an interventional study combining face-to-face conference lectures and WeChat. It was also the first RCT that using the CSCEBQ to assess changes in school-age children's dietary behaviors. The results of this study increase the understanding of intervention studies on poor diets for school-age children and provide a more scientific and effective method for clinical interventions for children with eating behavior problems.

CSCEBQ

Chinese School-age Children Eating Behavior Questionnaire; RCT:Randomized controlled trial

Acknowledgements

Not Applicable.

Authors’ contributions

Conception and study design (XYZ and XML), data collection or acquisition (XYZ and XRL), statistical analysis (XYZ and LG), interpretation of results (XYZ, and XML), drafting the manuscript work or revising it critically for important intellectual content (XYZ, XRL and LG) and approval of final version to be published and agreement to be accountable for the integrity and accuracy of all aspects of the work (All authors).

Funding

The study was supported by Shandong Social Science Popularization and Application Key Project (grant number 2020-SKZZ-34). The funder had no role in the design of the study, data collection and analysis, interpretation of data and in writing the manuscript.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Ethics approval and consent to participate

Informed consent was obtained from parents or legal guardians of all subjects. The study was approved by the Ethics Committee of Binzhou Medical University. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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No competing interests reported.

The Effect of Combined Internet Diet Behavior Intervention On School-Age Children

Status:

Version 1

Abstract

Background

Methods

Results

Conclusions

Figures

Background

Methods

Trial Design

Participants

Procedure

Intervention

Measures

Sample Size

Randomization

Statistical Analysis

Results

Discussion

Conclusion

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1