Digital Support Can Help to Optimize Pediatric Obesity Treatments

Pernilla Danielsson Liljeqvist, RN, PhD

New research from a clinic based in Stockholm, Sweden provides insight into the effects of using an interactive mobile health support system for treatment of pediatric obesity compared with standard care.

A 1-year pragmatic clinical trial enrolling more than 425 children with obesity, results of the trial demonstrate incorporation of a digital support system personalized to an individual’s weight loss target was more effective and had a lower attrition rate than standard care.

“This is the first app whereby healthcare professionals, and the family can monitor the child's weight development in real-time,” said senior investigator Pernilla Danielsson Liljeqvist, RN, PhD, a researcher at the Department of Clinical Science, Intervention and Technology at Karolinska Institutet, in a statement. “It was particularly gratifying that it worked so well for adolescents, who we otherwise have not been able to reach with behavior-changing therapy. The app provides more support through continuous feedback, which creates clarity with regard to the treatment. We could not note any side effects associated with the treatment, for example in the form of eating disorders.”

Although obesity has ballooned into an epidemic that has continued to grow in recent years, the prospect of digital interventions playing a role in mitigating the impact of the obesity epidemic has grown as well. As such, numerous trials have been conducted in recent years estimating the potential benefit of these interventions in various patient populations, including use of smartphone applications. The mobile health application used in the current study was developed by Evira AB designed to leverage daily home measurements of weight to calculate BMI Z-score, which was presented graphically with an individualized weight loss target curve.

For the purpose of the trial, investigators recruited 156 children referred for a first visit to a clinic in Stockholm, Sweden. Of these, 135 attended the first visit and 109 met criteria for being considered to have obesity. From this group, 107 agreed to use of the mobile health support system. Inclusion criteria for the study required participants to be 4.0-17.9 years of age and to have been referred to Martina Children’s Hospital between August 2018-March 2019. For the purpose of analysis, an age- and sex-matched control group was identified from the Swedish childhood obesity treatment register, which yielded an overall cohort of 107 patients receiving the digital intervention and 321 controls who received standard care.

The primary outcome of interest for the study was the treatment effect on relative weight, which was assessed as change in BMI Z-score, the proportion of patients reaching a clinically relevant weight loss, and the number of patients in obesity remission. Investigators noted age was categorized as 4-12 years and 12-18 years while the degree of obesity was defined as obesity or severe obesity.

Upon analysis, results indicated the attrition rate during the trial was 36% with the digital intervention and 46% with standard care (P=.08). At the conclusion of the trial period, the mean change in BMI Z-score was greater in the digital intervention arm (-0.30±0.39) than in the standard care arm (-0.15±0.28) (P=.0002). In subgroup analyses, results suggested there were no significant differences observed based on patient sex or age, with a greater treatment effect observed in all subgroups with the digital intervention.

“We know that the pediatric obesity treatment in Sweden is focused on behavioral change and the control group's results are in line with BORIS' annual report and major international reviews,” Danielsson Liljeqvist added. “A calculation of the cost of the treatment was also not included. We must first know that it works.”

This study, “Effect of an interactive mobile health support system and daily weight measurements for pediatric obesity treatment, a 1-year pragmatical clinical trial,” was published in the International Journal of Obesity.