Creating an integrated care model for childhood obesity: a randomized pilot study utilizing telehealth in a community primary care setting

Abstract

Background In an integrated care model, involving primary care providers (PCPs) and obesity specialists, telehealth may be useful for overcoming barriers to treating childhood obesity. Objective To conduct a pilot study comparing BMI changes between two arms: 1) PCP in-person clinic visits plus obesity specialist tele-visits (PCP visits + Specialist tele-visits) and 2) PCP in-person clinic visits only (PCP visits only), with ongoing tele-consultation between PCPs and obesity specialists for both arms. Methods Patients (N=40, 10–17 years, BMI ≥95th percentile) were randomized to Group 1 or 2. Both groups had PCP visits every 3 months for 12 months. Using a cross-over protocol, Group 1 had PCP visits + Specialist tele-visits during the first 6 months and PCP visits only during the second 6 months, and Group 2 followed the opposite sequence. Each of 12 tele-visits was conducted by a dietitian or psychologist with a patient and parent. Results Retention rates were 90% at 6 months and 80% at 12 months. BMI (z-score) decreased more for Group 1 (started with PCP visits + Specialist tele-visits) vs. Group 2 (started with PCP visits only) at 3 months (−0.11 vs. −0.05, P=0.049), following frequent tele-visits. At 6 months (primary outcome), BMI was lower than baseline within Group 1 (−0.11, P=0.0006) but not Group 2 (−0.06, P=0.08); however, decrease in BMI at 6 months did not differ between groups. After cross-over, BMI remained lower than baseline for Group 1 and dropped below baseline for Group 2. Conclusion An integrated care model utilizing telehealth holds promise for treating children with obesity.

Fidelity and acceptability of a family-focused technology-based telehealth nutrition intervention for child weight management

“…24 A previous study of childhood obesity intervention using telehealth as a supplementary component to in-person clinic visits found that the majority of the parents ( n = 14 of 21) would choose to have a telehealth session over an in-person clinic visit with an obesity specialist. 25 Fifteen of 26 parents of the study also reported that they would not have seen any obesity specialist if telehealth was not available. 25 This technology-based approach appears to be a promising mode of intervention delivery for personalised nutrition care for families with children with overweight and obesity.…”

An addiction model‐based mobile health weight loss intervention in adolescents with obesity

“…However, the high prevalence impedes this as a practical strategy to combat obesity (8). Advances in mobile health technologies (mHealth) offer an opportunity to monitor various behaviours, and to deliver interventions in the adolescent's natural environment (10)(11)(12)(13). Thus, mHealth platforms may be a cost-saving alternative to an in-clinic intervention for paediatric weight management (14,15).…”

Telehealth and Impact on Pediatric Obesity

“…A randomized controlled study that was completed in 2016 looked at two groups of individuals, one group who saw a face-to-face health care provider for treatment, and another group who saw the face-to-face physician, with the addition of a telehealth visit. The authors analyzed the data at 3 months and found that the group also seeing the telehealth provider had notable decreases in BMI, versus the group who did not receive the telehealth visits (Fleischman et al, 2016). At the conclusion of the study (12 months), both groups experienced decreases in BMI, although they did not vary significantly from one group to the other.…”