title: Developing a Web-Based Weight Management Program for Childhood Cancer Survivors: Rationale and Methods.
abstract: BACKGROUND
  Due to advances in the field of oncology, survival rates for children with cancer have improved significantly. However, these childhood cancer survivors are at a higher risk for obesity and cardiovascular diseases and for developing these conditions at an earlier age.
  
  
  OBJECTIVE
  In this paper, we describe the rationale, conceptual framework, development process, novel components, and delivery plan of a behavioral intervention program for preventing unhealthy weight gain in survivors of childhood acute lymphoblastic leukemia (ALL).
  
  
  METHODS
  A Web-based program, the Healthy Eating and Active Living (HEAL) program, was designed by a multidisciplinary team of researchers who first identified behaviors that are appropriate targets for weight management in childhood ALL survivors and subsequently developed the intervention components, following core behavioral change strategies grounded in social cognitive and self-determination theories.
  
  
  RESULTS
  The Web-based HEAL curriculum has 12 weekly self-guided sessions to increase parents' awareness of the potential impact of cancer treatment on weight and lifestyle habits and the importance of weight management in survivors' long-term health. It empowers parents with knowledge and skills on parenting, nutrition, and physical activity to help them facilitate healthy eating and active living soon after the child completes intensive cancer treatment. Based on social cognitive theory, the program is designed to increase behavioral skills (goal-setting, self-monitoring, and problem-solving) and self-efficacy and to provide positive reinforcement to sustain behavioral change.
  
  
  CONCLUSIONS
  Lifestyle interventions are a priority for preventing the early onset of obesity and cardiovascular risk factors in childhood cancer survivors. Intervention programs need to meet survivors' targeted behavioral needs, address specific barriers, and capture a sensitive window for behavioral change. In addition, they should be convenient, cost-effective and scalable. Future studies are needed to evaluate the feasibility of introducing weight management early in cancer care and the efficacy of early weight management on survivors' health outcomes.
authors.affiliation: Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States.
authors.forename: Fang Fang
authors.identifier: http://orcid.org/0000-0002-3130-0087
authors.initials: FF
authors.lastname: Zhang
authors.affiliation: Tufts Medical Center, Boston, MA, United States.
authors.forename: Susan
authors.identifier: http://orcid.org/0000-0001-6489-5729
authors.initials: S
authors.lastname: Meagher
authors.affiliation: Baylor College of Medicine, Houston, TX, United States.
authors.forename: Michael
authors.identifier: http://orcid.org/0000-0002-8379-6088
authors.initials: M
authors.lastname: Scheurer
authors.affiliation: Tufts University, Boston, MA, United States.
authors.forename: Sara
authors.identifier: http://orcid.org/0000-0002-4366-5622
authors.initials: S
authors.lastname: Folta
authors.affiliation: Tufts University, Boston, MA, United States.
authors.forename: Emily
authors.identifier: http://orcid.org/0000-0003-1174-2176
authors.initials: E
authors.lastname: Finnan
authors.affiliation: Tufts University, Boston, MA, United States.
authors.forename: Kerry
authors.identifier: http://orcid.org/0000-0002-0988-2834
authors.initials: K
authors.lastname: Criss
authors.affiliation: Tufts University, Boston, MA, United States.
authors.forename: Christina
authors.identifier: http://orcid.org/0000-0002-0410-5294
authors.initials: C
authors.lastname: Economos
authors.affiliation: Baylor College of Medicine, Houston, TX, United States.
authors.forename: ZoAnn
authors.identifier: http://orcid.org/0000-0001-5341-6171
authors.initials: Z
authors.lastname: Dreyer
authors.affiliation: Tufts Medical Center, Boston, MA, United States.
authors.forename: Michael
authors.identifier: http://orcid.org/0000-0003-4552-7546
authors.initials: M
authors.lastname: Kelly
keywords: Web-based; childhood cancer survivors; development; nutrition; obesity; physical activity; weight management