Digitally-Delivered Healthcare for Children and Adolescents with Obesity

Aim: This PhD aimed to explore the usefulness, feasibility and economic viability of integrating telemedicine to child and adolescent weight management services.  

Methods and results: Four studies were carried out to meet the aims of this PhD. Study one consisted of a systematic scoping review of research assessing mHealth for childhood obesity treatment. Forty two eligible papers were identified assessing acceptability, usability, feasibility or pilot studies, treatment effect, and fidelity. Most of the identified published literature was focussed on developing and piloting such interventions. Change in BMI z-scores or percentiles was most commonly used effect measure. Study two was a retrospective chart review for 322 children with obesity, to assess their hospital service utilisationand costs over a four year period. A micro-costing approach and negative binomial regression analyses were used. Participants had a mean of 27 (IQR 16-33, SD 15.06) episodes of hospital care at a mean cost of €2590 per child. Children with a co-morbid condition were associated with more frequent attendances and higher costs. A rapid mixed-methods review was carried out in study three to aid the decision-making process on delivering paediatric healthcare during the COVID-19 pandemic. Twenty seven eligible studies were identified. Important challenges highlighted from the perspective of healthcare providers were issues with information and communication technology (ICT)proficiency and quality, legal concerns, and fear of reliance on subjective descriptions. Facilitators included clear dissemination of the aims of ICT services, involvement of staff throughout implementation, sufficient training, and cultivation of telemedicine champions. Finally, study four assessed the costs of delivering treatment to two groups of adolescents with severe obesity via smartphone app versus face-to-face in a randomised controlled trial (RCT). The analyses estimated the mean cost per adolescent attending usual care at €142 (SD 23.7) while the cost per adolescent in the mHealth group was €722 (SD 221.1). The national budget impact for implementing this approach was estimated at €59,046. The main driver of costs in the mobile health arm was the need for health professional support for patients.  

Conclusion: This PhD generated valuable knowledge and emphasises that innovative ways of delivering childhood obesity treatment and increasing accessibility to care are necessary. The PhD provides insight related to the need for collaborative planning and robust evaluation of acceptability and cost-effectiveness of digital obesity interventions.