Multi‐profile hidden Markov model for mood,dietary intake,and physical activity in an intervention study of childhood obesity

Motivated by an application to childhood obesity data in a clinical trial, this paper describes a multi‐profile hidden Markov model (HMM) that uses several temporal chains of measures respectively related to psychosocial attributes, dietary intake, and energy expenditure behaviors of adolescents in a school setting. Using these psychological and behavioral profiles, the model delineates health states from the longitudinal data set. Furthermore, a two‐level regression model that takes into account the clustering effects of students within school is used to assess the effects of school‐based and community‐based interventions and other risk factors on the transition between health states over time. The results from our study suggest that female students tend to decrease their physical activities despite a high level of anxiety about weight. The finding is consistent across intervention and control arms. Copyright © 2013 John Wiley & Sons, Ltd.