Pediatric Obesity Treatment via Telehealth: Current Evidence and Future Directions

Moorman, Erin; Koskela-Staples, Natalie; Mathai, Babetta B; Fedele, David A.; Janicke, David M.

doi:10.1007/s13679-021-00446-w

Cited by 12 publications

(3 citation statements)

References 49 publications

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“…The alarming rise underscores the importance of primary care management approaches. Telehealth is an approach to delivering care to children and their families that can improve access and participation in weight management programs (24,25). Studies prior to and during the pandemic have suggested that telehealth for pediatric weight management is acceptable to families, results in high satisfaction with care, improves show rates, and supports behavior changes (8, 26-29).…”

Section: Discussionmentioning

confidence: 99%

Adapting Connect for Health Pediatric Weight Management Program for Telehealth in Response to the COVID-19 Pandemic

Simione

Aschbrenner

Farrar-Muir

et al. 2023

Preprint

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Background: To address the evolving needs and context changes due to the COVID-19 pandemic, we adapted Connect for Health, an evidence-based, primary care, pediatric weight management intervention for telehealth. The objective of this study is to describe the systematic process we undertook to make adaptations and the results of stakeholder engagement to inform the adaptations to meet the needs of children and families at risk of poor access to care. Methods: Guided by adaptation frameworks, we identified the changing healthcare context during implementation due to the pandemic and adapted the program for telehealth. We surveyed parents of children with a BMI ³ 85th percentile and pediatric clinicians and examined their experiences using telehealth for pediatric weight management and needs and preferences. Using multivariable logistic regression, we examined the preferences of parents with limited English proficiency regarding key aspects of pediatric weight management. Results: We surveyed 200 parents and 43% had a primary language of Spanish. Parents wanted care to be a combination of in-person and virtual visits (80%). We found that parents with limited English proficiency had a higher odds ratio of affirming in-person visits are better than virtual visits for ensuring their child’s health concern can be taken care of (OR: 2.91; 95% CI: 1.36, 6.21), feeling comfortable when discussing personal information (OR: 3.91; 95% CI: 1.82, 8.43), talking about healthy behaviors and setting goals (OR: 3.09; 95% CI: 1.39, 6.90), and talking about mental health and overall well-being (OR: 4.02; 95% CI: 1.83, 8.87) than parents without limited English proficiency. We surveyed 75 clinicians and 60% felt telehealth was a useful tool to provide care for pediatric weight management. Clinicians felt virtual visits did not pose barriers to all aspects of care. We then adapted the core forms of Connect for Health to be used for telehealth and in-person to meet the needs of families at risk for poor access to care. Conclusions: By engaging stakeholders and adapting the program for telehealth, we optimized the program’s use and future sustainability. We have provided a real-world example of how clinical innovations can evolve and how to systematically plan adaptations. Trial registration: Clinicaltrials.gov (NCT04042493), Registered on August 2, 2019

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Section: Discussionmentioning

confidence: 99%

Adapting Connect for Health Pediatric Weight Management Program for Telehealth in Response to the COVID-19 Pandemic

Simione

Aschbrenner

Farrar-Muir

et al. 2023

Preprint

View full text Add to dashboard Cite

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“…These clinics were intensive and included extensive involvement of a multi-disciplinary team of health professionals including child psychologists, nurse practitioners/paediatricians, dietitians, and occupational therapists, Thus, the limited available information suggests that a CD may be effective for long-term weight loss in adolescents with ID when used in the framework of an intensive intervention, However, the burden and costs associated delivering an with ID (n = 120) who were randomized to an intervention using an eSLD (6 months weight loss, 12 months maintenance) delivered to the adult with ID and a caregiver/study partner during FTF home visits (À3.7%) or remotely using Zoom ® (À5.1%). 42 Some evidence in typically developing children and adolescents with overweight/obesity suggests that weight loss achieved with remotely delivered behavioural interventions is minimal (~0.10 change in BMI z-scores) 44 and that a combination of FTF and remotely delivered sessions may be required to elicit clinically relevant weight loss. 45,46 However, the significant weight loss across 12 months in both the RD/eSLD arm of the current trial in adolescents, and our on-going trial in adults with ID, suggests that remote delivery may be an effective strategy for long-term weight management in individuals with ID.…”

Section: Discussionmentioning

confidence: 99%

A randomized trial comparing diet and delivery strategies for weight management in adolescents with intellectual disabilities

et al. 2022

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Background: The literature evaluating multi-component interventions for long-term weight loss in adolescents with intellectual disabilities (ID) is extremely limited. Objectives: To compare the effectiveness of two delivery strategies, face-to-face (FTF) or remote delivery (RD), and two diets, enhanced Stop Light diet (eSLD) or conventional diet (CD) on weight change across 12 and 18 months. in response to an 18 months. weight management intervention (6 months Weight loss/12 months. Weight maintenance) in adolescents with ID.Methods: Adolescents with ID were randomized to one of three arms: FTF /CD, RD/CD, RD/eSLD and asked to attend individual education sessions with a health educator which were delivered during FTF home visits or remotely using video conferencing. The CD followed the US dietary guidelines. The eSLD utilized the Stop Light guide and was enhanced with portion-controlled meals. Participants were also asked to increase their physical activity (PA) and to self-monitor diet, PA and body weight across the 18-month. intervention.Results: Weight was obtained from 92(84%) and 89(81%) randomized adolescents at 12 and 18 months, respectively. Weight change across 12 months. Differed significantly by diet (RD/eSLD: À7.0% vs. RD/CD: À1.1%, p = 0.002) but not by delivery strategy (FTF/CD: +1.1% vs. RD/CD: À1.1%, p = 0.21). Weight change across

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“…Despite this, most published economic evaluations of telemedicine consider the perspectives of only the health care service/provider, as shown for cardiovascular disease management [ 28 ], obesity prevention [ 6 ], and eHealth more broadly [ 29 ]. It is important for researchers to assess delivery costs for future evaluations of digitally delivered pediatric weight management to build an evidence base for this population with unique care needs [ 30 ]. It is also vital that economic evaluations adopt a societal perspective to capture costs apart from direct health system costs.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Weight Management Through mHealth Compared to Face-to-Face Care: Cost Analysis of a Randomized Control Trial

Tully¹,

Sørensen²,

O’Malley³

2021

JMIR Mhealth Uhealth

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Background Mobile health (mHealth) may improve pediatric weight management capacity and the geographical reach of services, and overcome barriers to attending physical appointments using ubiquitous devices such as smartphones and tablets. This field remains an emerging research area with some evidence of its effectiveness; however, there is a scarcity of literature describing economic evaluations of mHealth interventions. Objective We aimed to assess the economic viability of using an mHealth approach as an alternative to standard multidisciplinary care by evaluating the direct costs incurred within treatment arms during a noninferiority randomized controlled trial (RCT). Methods A digitally delivered (via a smartphone app) maintenance phase of a pediatric weight management program was developed iteratively with patients and families using evidence-based approaches. We undertook a microcosting exercise and budget impact analysis to assess the costs of delivery from the perspective of the publicly funded health care system. Resource use was analyzed alongside the RCT, and we estimated the costs associated with the staff time and resources for service delivery per participant. Results In total, 109 adolescents participated in the trial, and 84 participants completed the trial (25 withdrew from the trial). We estimated the mean direct cost per adolescent attending usual care at €142 (SD 23.7), whereas the cost per adolescent in the mHealth group was €722 (SD 221.1), with variations depending on the number of weeks of treatment completion. The conversion rate for the reference year 2013 was $1=€0.7525. The costs incurred for those who withdrew from the study ranged from €35 to €681, depending on the point of dropout and study arm. The main driver of the costs in the mHealth arm was the need for health professional monitoring and support for patients on a weekly basis. The budget impact for offering the mHealth intervention to all newly referred patients in a 1-year period was estimated at €59,046 using the assessed approach. Conclusions This mHealth approach was substantially more expensive than usual care, although modifications to the intervention may offer opportunities to reduce the mHealth costs. The need for monitoring and support from health care professionals (HCPs) was not eliminated using this delivery model. Further research is needed to explore the cost-effectiveness and economic impact on families and from a wider societal perspective. Trial Registration ClinicalTrials.gov NCT01804855; https://clinicaltrials.gov/ct2/show/NCT01804855

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Pediatric Obesity Treatment via Telehealth: Current Evidence and Future Directions

Cited by 12 publications

References 49 publications

Adapting Connect for Health Pediatric Weight Management Program for Telehealth in Response to the COVID-19 Pandemic

Adapting Connect for Health Pediatric Weight Management Program for Telehealth in Response to the COVID-19 Pandemic

A randomized trial comparing diet and delivery strategies for weight management in adolescents with intellectual disabilities

Pediatric Weight Management Through mHealth Compared to Face-to-Face Care: Cost Analysis of a Randomized Control Trial

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