Effect of an interactive mobile health support system and daily weight measurements for pediatric obesity treatment, a 1-year pragmatical clinical trial

Abstract

Background: Pediatric obesity lifestyle treatment is not always successful. Frequent clinical visits are of major importance to certify sufficient effect but are difficult due to the associated costs and the great demands on families. We hypothesized that an interactive digital support may reduce the need for frequent physical visits. The aim of the study was to assess 1-year weight outcome for patients using a digital support system compared with standard care.

Methods: An obesity lifestyle treatment with a digital support system was implemented in one clinic in Stockholm, Sweden. Measurements from a custom-made body scale without digits for daily home measurement of weights were transferred via Bluetooth to a mobile application, where BMI Z-score was calculated and presented graphically with an individualized weight loss target curve. An automatic transfer of data to the web-based clinic interface enables a close monitoring of treatment progress, and frequent written communication between the clinical staff and families via the application. One-year outcome was compared with a randomly retrieved, age and sex matched control group from the Swedish childhood obesity treatment register (BORIS), which received standard treatment at other clinics. Main outcome was change in BMI Z-score and missing data was imputed.

Results: 107 children were consecutively included to digi-physical treatment and 321 children to standard care. Age range 4.1-17.4 years (67% males). The attrition rate was 36% and 46% respectively, p = 0.08. After 1 year, the mean ± SD change in BMI Z-score in the treatment group was -0.30 ± 0.39 BMI Z-score units and in the standard care group -0.15 ± 0.28, p = 0.0002. The outcome was better for both sexes and all age groups in the digi-physical treated group.

Conclusion: A digital support system with a personalized weight-loss target curve and daily weight measurements shared by the family and the clinic is more effective than a standard care childhood obesity treatment.

Gov id: NCT04323215.

Conflict of interest statement

EH: None. LJ: PhD student with CM as co-supervisor. CK: Director of and stockholder of Martina Children’s Hospital AB. EM: Advisor for Evira AB. AD: Employed by and shareholder of Evira AB. LM: Employed by and shareholder of Evira AB. CM: Board member and shareholder of Evira AB. PD: None.

© 2022. The Author(s).

Figures

Fig. 1. Flowchart of the children treated with digital support and children in standard care.

* I.e. patients not meeting the criterion for obesity at treatment initiation. ** BORIS—the Swedish Childhood Obesity Treatment Register.

Fig. 2. Illustration of the digital support system.

Family interface in mobile application shows graphic presentation of child’s individual target curve and progress. Clinic interface shows child’s absolute measures and progress in BMI Z-score and weight. Custom made scale, with hidden digits, transfer weight through Bluetooth.

Fig. 3. Treatment outcome.

Dark gray show outcome for the digital support group and light gray bars indicates standard care. Whiskers indicate standard error. A Mean BMI Z-score and standard error at baseline and 1 year. B Mean change in BMI Z-score, 1-year post treatment initiation, stratified for sex, age, and degree of obesity.

Fig. 4. Process measures for individuals receiving digital support.

Dark gray line indicates individuals remaining in treatment (left axis) and light gray line show average numbers of weekly weight measurements (right axis).