Exploring the feasibility of an mHealth intervention delivered by an exercise physiologist within a UK Complications from Excess Weight service: qualitative findings from a randomised controlled trial- MOTIVATE-CEW

For many young people living with severe obesity, the path to better health is blocked by more than just biology; it is often blocked by the way they are treated. When medical advice focuses almost exclusively on the number on a scale, it can feel shaming and discouraging. This is particularly true for physical activity, where the fear of judgment or the sheer physical difficulty of moving a heavy body can make exercise feel impossible. In the United Kingdom, the National Health Service has established specialized clinics called Complications from Excess Weight services to help these young people manage the serious health risks associated with their condition, such as diabetes and heart disease. While doctors know that moving the body is essential for health, the best way to get these specific young people to start and, more importantly, to keep moving has remained unclear. The challenge is not just telling them to exercise, but designing a system that fits their unique lives, respects their autonomy, and helps them find a reason to move that goes beyond weight loss.

A team of researchers set out to test a new approach to this problem, creating a program called MOTIVATE-CEW. They wanted to see if a combination of human support and modern technology could help young people build a lasting habit of exercise. The program was led by an exercise physiologist, a specialist in how the body moves and adapts, rather than a general doctor. This specialist worked with each young person to create a custom plan that started where they were and slowly grew stronger over time. To keep the young people connected and accountable, the team used mobile health technology, which included a wrist-worn fitness watch and a smartphone app. This technology tracked their heart rate and movement, sending the data back to the specialist who could then offer encouragement and advice through video calls and text messages. The goal was to see if this blend of personal attention and digital tools could make exercise feel less like a chore and more like a manageable part of daily life.

The researchers recruited twelve young people, aged twelve to eighteen, who were already receiving care at a children's hospital in Liverpool. These participants, along with their parents or guardians, agreed to try the three-month program. After the program finished, the researchers did not just look at the numbers on the fitness watches; they wanted to hear the stories. They held small group discussions and one-on-one interviews with the young people and their families, and they also sent out a written survey. They asked simple, direct questions: Did you enjoy the plan? Did the technology help or hinder you? Did you feel supported? The aim was to understand the human experience behind the data, to find out what worked, what didn't, and how the program could be improved for the future.

The conversations revealed that the most powerful part of the program was the shift in focus. At the beginning, many families were fixated on losing weight as the only measure of success. However, the exercise physiologist steered the conversation toward how movement made them feel. The young people began to notice improvements in their mood, their confidence, and their overall energy levels. One parent noted that for the first time, someone was talking about health without making the young person feel like their weight was the only thing that mattered. This change in perspective seemed to unlock a new kind of motivation. When the young people realized that exercise could make them feel better mentally, not just change their appearance, they were more willing to try.

Another key finding was the importance of having a plan that was truly theirs. The program did not force everyone to run on a treadmill or follow a rigid schedule. Instead, the young people worked with the specialist to choose activities they actually liked. If a young person hated running, they could choose fast walking or swimming. If they had a busy week, the plan could be adjusted to fit their schedule. This flexibility was crucial. One participant explained that when they told the specialist they were struggling with the length of a workout, the specialist listened and changed the plan to something more manageable. This ability to adapt the program to real life, rather than forcing life to fit the program, made the difference between giving up and sticking with it.

The technology played a supporting but vital role. The fitness watch provided immediate feedback, showing the young people their heart rate in real time. This helped them understand how hard they were working without having to guess. They could see that they were in a safe, effective zone, which built their confidence. The app allowed them to track their progress and see their own history of completed workouts. For many, seeing a record of their own effort was a source of pride. It turned an abstract idea of "being active" into something concrete they could look at and say, "I did this." The technology did not replace the human connection; instead, it gave the specialist the information they needed to offer specific, timely encouragement.

Perhaps the most significant element of the program was the relationship with the exercise physiologist. The young people and their families consistently described the specialist as friendly, approachable, and genuinely interested in their well-being. Unlike the pressure some felt from parents or other family members to exercise, the feedback from the specialist felt supportive rather than controlling. One young person noted that they listened more to the specialist than to their own parents because the specialist understood their needs and spoke to them on their level. The regular messages and video calls created a sense of accountability that was positive, not punitive. It felt like someone was on their team, cheering them on and helping them navigate the obstacles that arose during the week.

Despite these successes, the study also highlighted areas where the program could be stronger. The young people and their families felt that three months was not long enough to fully establish a new habit. They suggested that a longer duration would give them more time to settle into a routine that could last after the program ended. There were also discussions about the value of bringing young people together. While the individual support was excellent, some parents felt that having a group of peers to share experiences with could provide an extra layer of encouragement. However, the researchers noted that this would need to be handled carefully, as not every young person would want to be in a group setting.

The study concluded that the combination of a personalized plan, clear instructions, and regular, supportive feedback from a specialist was a promising way to help young people with severe obesity engage in physical activity. The approach worked because it treated the young people as individuals with unique preferences and challenges, rather than a group to be managed with a one-size-fits-all solution. The technology served as a bridge, connecting the young people to the specialist and providing the data needed to make informed decisions. While the program showed that engagement was possible, the researchers emphasized that maintaining that engagement over the long term requires ongoing support and perhaps a longer timeline. The findings suggest that when young people feel heard, supported, and empowered to choose their own path, they are much more likely to find the strength to move.