AI Chatbot Helpful for Teens with Obesity in Weight-Loss Program

Samara Rosenfeld
MAY 20, 2019
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An artificial intelligence (AI) behavioral coach is a feasible and useful approach for behavioral counseling for adolescent patients enrolled in a weight management program, according to research published in the journal Translational Behavioral Medicine.

Researchers at Nemours Children’s Health System found that the teenagers had positive reactions and showed willingness to engage in short message service text conversations with chatbot technology that simulates human interactions. Participants found 96% of the interactions to be helpful.

Over the course of the study, participants exchanged more than 4,000 messages with the chatbot in 270 conversations. The chatbot initiated 73% of the conversations providing a total of 55 hours and 45 minutes of support. Almost 18% of the conversations happened outside of typical office hours. The average conversation lasted about 12.5 minutes.

Nemours already uses telemedicine health coaching and text reminds to help patients and families achieve their weight-loss goals.

“A natural next step was adding an AI behavioral coach to allow more frequent and shorter interactions to keep patients engaged on the path toward healthier behaviors, as well as provide an extra layer of care outside of office hours,” said Lloyd Werk, M.D., MPH, director of the Healthy Choices Clinic at Nemours Children Hospital is Orlando.

The researchers collaborated with X2ai, a company that uses AI for psychological coaching, to build the behavioral coach, Tess.

The team spent two years pre-populating Tess with hundreds of prompts and responses to counsel adolescents with obesity and pre-diabetes, including empathetic and compassionate expressions to support those struggling. Tess could be customized to interact with the goals of specific individuals.

For example, a girl who shared her interest in cooking could get messages from Tess about health food choices.

Nemours’ Healthy Choices Clinic enrolled 23 patients between the ages of 9 and 18 years old with obesity symptoms to test the feasibility of adding an AI component to complement existing treatment.

“Everyone is used to AI technology, it’s like Siri on your iPhone so texting with a chatbot isn’t that weird. The difference with Tess is that you can actually text her about what you need to achieve or improve your goals and she’s encouraging… Tess would ask me, ‘Did you meet that goal?’ and then give me ways to improve or encourage me to continue working on that goal.” – Laura Hernandez, study participant from Davenport, Florida


The researchers said that the two reasons parents stop taking their children to weight-loss programs is the inconvenience and cost of travelling for clinic visits. Tess provided participants with 24/7 on-demand services to allow participants to engage during off-hours at their own frequency. The chatbot also allowed for anonymity, which could help decrease the stigma of seeking behavioral support.

Psychologists screened conversations regularly to detect potential behavioral warnings. But the researchers wrote that reading and responding to more than 4,000 texts would have taken as much as 137 staff hours. The team estimated that the chatbot provided almost $9,000 in savings.

As patients and doctors continue to use AI and telehealth services, the research team found feasibility with the chatbot for teenagers with obesity.

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