Smartphone use health outcomes in children and adolescents: A systematic review of behavioral, developmental, and environmental risk pathways

Table 10 Use of smartphones to reduce risk of obesity (digital health approaches)

Ref.	Country	Age group	Design	Sample	Digital intervention	Physical activity outcome	BMI outcome	Primary bias considerations	Risk of Bias (JBI)
Vajravelu et al[80], 2022	United States	12-18 years (prediabetes/T2D)	Qualitative formative study	20	SMS reminders + incentives	High acceptability for PA promotion	Not evaluated	High bias regarding clinical outcomes, as they were not evaluated; excellent end-user feedback	N/A (formative)
Ruiz-Hermosa et al[81], 2024 (EUMOVE)	Europe	Primary and secondary school	Program implementation	Multi-country	School-based app + active resources	Promotes active commuting & PA	Preventive framework	Descriptive study of project phases; effectiveness not yet reported in this publication	N/A (descriptive)
Umano et al[82], 2024	Italy	Pediatric obesity	RCT	75	Lifestyle counseling app	Improved engagement; lower dropout	No significant BMI Z-score difference	Randomized controlled design; objective BMI measurements at 6 months and 12 months	Low
Kassari et al[84], 2026 (BigO)	Europe	Mean 12.6 years	Prospective cohort	1727	Smartphone + smartwatch objective monitoring	Behavioral tracking & lifestyle intervention	Decreased obesity proportion	Large prospective sample; used objective sensors (GPS/inertial) for behavioral monitoring	Low
Vaidya et al[83], 2026	India	8-15 years	Pilot clinical trial	26	App-based counseling + yoga	Increased PA duration	Significant BMI reduction (P < 0.001)	Small pilot sample size; lacks a formal control group for the pre-post comparison	Moderate to high

Risk of Bias assessment has been performed using the Joanna Briggs Institute checklist for analytical cross-sectional studies and ergonomic assessments. PA: Physical activity; BMI: Body mass index; JBI: Joanna Briggs Institute; T2D: Type 2 diabetes; RCT: Randomized controlled trial; N/A: Not applicable.