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BACKGROUND Aim2Be is a gamified lifestyle app designed to promote lifestyle behavior changes among Canadian adolescents and their families. OBJECTIVE The primary aim was to test the efficacy of the Aim2Be app with support from a live coach to reduce weight outcomes (BMI Z score [zBMI]) and improve lifestyle behaviors among adolescents with overweight and obesity and their parents versus a waitlist control group over 3 months. The secondary aim was to compare health trajectories among waitlist control participants over 6 months (before and after receiving access to the app), assess whether support from a live coach enhanced intervention impact, and evaluate whether the app use influenced changes among intervention participants. METHODS A 2-arm parallel randomized controlled trial was conducted from November 2018 to June 2020. Adolescents aged 10 to 17 years with overweight or obesity and their parents were randomized into an intervention group (Aim2Be with a live coach for 6 months) or a waitlist control group (Aim2Be with no live coach; accessed after 3 months). Adolescents’ assessments at baseline and at 3 and 6 months included measured height and weight, 24-hour dietary recalls, and daily step counts measured with a Fitbit. Data on self-reported physical activity, screen time, fruit and vegetable intake, and sugary beverage intake of adolescents and parents were also collected. RESULTS A total of 214 parent-child participants were randomized. In our primary analyses, there were no significant differences in zBMI or any of the health behaviors between the intervention and control groups at 3 months. In our secondary analyses, among waitlist control participants, zBMI (P=.02), discretionary calories (P=.03), and physical activity outside of school (P=.001) declined, whereas daily screen time increased (PP=.001). App use did not modify any changes in outcomes among adolescents in the intervention group. CONCLUSIONS The Aim2Be intervention did not improve zBMI and lifestyle behaviors in adolescents with overweight and obesity compared with the waitlist control group over 3 months. Future studies should explore the potential mediators of changes in zBMI and lifestyle behaviors as well as predictors of engagement. CLINICALTRIAL ClinicalTrials.gov NCT03651284; https://clinicaltrials.gov/ct2/show/study/NCT03651284 INTERNATIONAL REGISTERED REPORT RR2-10.1186/s13063-020-4080-2

British Columbia is the epicentre of the opioid crisis in North America. Illicit drug toxicity is now one of the top 3 causes of death for adolescents in British Columbia. Evidence informed treatment is available but adolescents rarely receive it. Non-fatal toxicity can provide an opportunity to intervene. Since 2018, paediatricians in British Columbia have been offering admission, involuntary if necessary, to adolescents presenting to hospital after a life-threatening illicit drug toxicity. This brief stay, termed “stabilization care,” offers medical and psychiatric assessments, withdrawal management and initiation of opioid agonist therapy and discharge planning. Hospital policies, procedures and protocols were revised to support the unique needs of this population. Early experience with 17 adolescents shows relatively high attachment to treatment services and opioid agonist treatment, suggesting that paediatric interdisciplinary teams, working strategically, can improve care for adolescents in the face of the opioid epidemic.

Background The Mind, Exercise, Nutrition…Do it! (MEND) childhood obesity intervention was implemented in British Columbia (B.C.), Canada from April 2013 to June 2017. The study objective was: a) to describe and explore program reach, attendance, satisfaction, acceptability, fidelity, and facilitators and challenges to implementation during scale-up and implementation of MEND in B.C. while b) monitoring program effectiveness in improving children’s body mass index (BMI) z-score, waist circumference, dietary and physical activity behaviours, and psychological well-being.Methods This prospective, pragmatic implementation evaluation (Hybrid Type 3 design) recruited families with children aged 7-13 with a BMI ≥ 85th percentile for age and sex. The 10-week MEND B.C. program was delivered in 27 sites, throughout all five B.C. health regions (Northern, Interior, Island, Fraser, and Vancouver Coastal) over four years. A mixed-method approach was used to collect and analyze the data. Evaluation measures included: program reach, attendance, fidelity, acceptability, satisfaction, facilitators and challenges to implementation, and effectiveness (change in children’s BMI z-score, physical activity, screen-time, eating behaviours, self-esteem and emotional distress).Results 136 MEND B.C. programs were delivered over four years. The program reached 987 eligible children. 755 (76.5%) children completed the program. The average program attendance was 81.5%. Parents reported the program content was easy to understand, culturally suitable for their family, respectful of their family's financial situation and provided adequate information to build a healthy lifestyle. Children achieved significant positive changes across all four evaluation years in BMI z-score, nutrition behaviours, physical activity levels, hours of screen time per week and emotional distress (p

Background The prevalence of overweight and obesity remains high in Canada, and the current standard for the treatment of childhood obesity is in-person, family-based, multidisciplinary interventions that target lifestyle behaviors (e.g., diet, physical activity, and sedentary behaviors). These programs are costly to operate, have limited success, and report recruitment and retention challenges. With recent advances in technology, mobile health or mHealth has been presented as a viable alternative to in-person interventions for behavior change, especially with teens. Purpose The primary aim of this study is to test the efficacy of Aim2Be, a gamified app based on behavior change theory with health coaching to improve weight outcomes (i.e., decrease in standardized body mass index (zBMI)) and lifestyle behaviors (i.e., improve dietary quality, increase fruit and vegetable intake, reduce sugar-sweetened beverage intake, increase physical activity, and reduce screen time) among children 10- to 17-years old with overweight or obesity versus their peers randomized into a waitlist control condition. The secondary aims of this study are to 1) test whether supplementing the Aim2Be program with health coaching increases adherence and 2) examine the mediators and moderators of adherence to the Aim2Be intervention. Methods We will employ a randomized controlled trial design and recruit 200 child and parent dyads to participate in the study (2019–2020). Participants will be recruited from Canadian pediatric weight management clinics and through online advertisements. Child participants must be between the ages of 10 and 17 years, have overweight or obesity, be able to read English at least at a grade 5 level, and have a mobile phone or home computer with internet access. Following baseline data collection, participants will be randomized into intervention and waitlist control groups. Intervention participants will receive access to Aim2Be, with access to health coaching. After having their data collected for 3 months, the control group will gain access to Aim2Be, with no access to health coaching. Participants will control their frequency and duration of app usage to promote autonomy. Discussion Findings from this study will determine the efficacy of using Aim2Be in improving child weight outcomes and lifestyle behaviors and guide future mHealth interventions for pediatric weight management. Trial registration ClinicalTrials.gov, NCT03651284. Registered 29 August 2018.

Opiate overdose is now the leading cause of death in Canada and the United States for adults under age 55. Adolescents, in particular homeless adolescents, who have presented to the emergency department (ED) with overdose have a greatly increased risk of dying from a subsequent overdose within the next year. Homeless adolescents have much higher risk of experiencing opiate overdose than housed youth and have fewer available family or social supports. Presentation to the ED is an opportunity for assertive intervention including mandated hospital admission for stabilization; initiation of treatment, potentially including opioid agonist therapy or detoxification; assessment of medical complications, evaluation of mental health; optimization of family engagement and community resources; and evaluation for placement in secure care for residential treatment. These steps offer a model of intervention to prevent long-term addiction and later risk of death. The ethical dilemmas of mandated care for adolescents are explored.

Currently, there is a dangerous inconsistency between our current understanding of adolescent development and the effects of drugs on cognition when compared to our collective approach to youth who present in the emergency department with an opioid overdose. We call upon practitioners to embrace a new paradigm and we ask the Canadian Pediatric Society (CPS) to spearhead the development of guidelines to advise on best practices to manage youth who present to the emergency department with an illicit drug overdose.

Background: The prevalence of overweight and obesity remains high in Canada, and the current standard for the treatment of childhood obesity is in-person family-based multidisciplinary interventions that target lifestyle behaviours (e.g. diet, physical activity, and sedentary behaviours). These programs are costly to operate, have limited success, and report recruitment and retention challenges. With recent advances in technology, mobile health or mHealth has presented as a viable alternative to in-person interventions for behavior change, especially with teens. Purpose: The primary aim of this study is to test the efficacy of Aim2Be, a gamified app based on behavior change theory with health coaching at improving weight outcomes (i.e., decrease in zBMI) and lifestyle behaviours (i.e. improve dietary quality, increase fruit and vegetable intake, reduce sugar-sweetened beverage intake, increase physical activity, and reduce screen time) among 10-17 year old children with overweight or obesity versus their peers randomized into a waitlist control condition. The secondary aims of this study are to: 1) test whether supplementing the Aim2Be program with health coaching increases adherence; and 2) examine the mediators and moderators of adherence to the Aim2Be intervention. Methods: We will employ a randomized controlled trial design and recruit 200 child and parent dyads to participate in the study (2019-2020). Participants will be recruited from Canadian pediatric weight management clinics, and through online advertisements. Child participants must be between the ages of 10-17 years, have overweight or obesity, be able to read English at a grade 5 level, and have a mobile phone or home computer with internet access. Following baseline data collection, participants will be randomized into intervention and waitlist control groups. Intervention participants will receive access to Aim2Be, with access to health coaching. Following 3-month data collection, the control group will gain access to Aim2Be; with no access to health coaching. Participants will control their frequency and duration of app usage to promote autonomy. Discussion: Findings from this study will determine the efficacy of using Aim2Be in improving child weight outcomes and lifestyle behaviours and guide future mHealth interventions for pediatric weight management.

In their analysis about taxation on sugar-sweetened beverages, Riediger and Bombak correctly point out that we must consider the potential effects of such a tax on weight stigma, Indigenous populations and health inequities.[1][1] They also call to our attention the lessons learned from tobacco

British Columbia (BC) is the epicentre of the illicit drug overdose crisis in Canada. There were 1422 deaths from overdose in 2017; 23 of these deaths occurred in children (aged 10–18 yr).[1][1] Rates of death from illicit drug use in this age group doubled between 2015 and 2016, and doubled again

Objective To conduct a process evaluation of the Living Green, Healthy and Thrifty (LiGHT) program, a novel virtual child obesity management program that combines health promotion with ecology and economy (Phase 1). Methods We carried out a mixed methods process evaluation involving qualitative and quantitative data collection in 3 phases: among 3 child–parent units, (group 1) that informed program development; 9 child–parent units (group 2) that tested the draft program and further aided program refinement; and 17 child–parent units (group 3) for a 4-week pilot of the program. In the program pilot, we assessed participants' knowledge and readiness to change pre- and postintervention and explored perceptions of the program. Results Participants generally felt that the online format for program delivery was convenient and accessible, the content was practical, and the integration of health-environment-economy was well received. Many parents also appreciated the involvement of the family. However, the lack of visual appeal and overabundance of text was identified as a challenge, and children/youth in particular requested assurance that their personal information (e.g. weight) was not seen by their parents. The online method of program delivery holds the unique challenge of requiring special efforts to create a sense of personal connection and community. The presence of a “Way-finder” to assist participants and discussion boards/forums are potential solutions. Conclusion The LiGHT online weight management program offers an accessible, convenient weight management resource that children and families appreciate for its availability, broader educational scope, and practicality. Outcome evaluation of LiGHT will be carried out in Phase 2 of the project.