The evidence base for telehealth and telemedicine in the management of obesity

Susan Royer

Can a telehealth programme help in maintaining weight loss? 

Publication:  This article was taken from the Whole Systems Demonstrator Action Research Network (WSDAN) database

Obesity has become an increasingly prevalent long-term condition, and is now one of the major health issues in the West. While weight loss programmes are fairly common, facilities for weight loss maintenance are less so. A quasi-experimental study carried out in the United States examined the influence of telehealth in a weight loss maintenance programme. [1] Eighty-seven individuals who had participated in the ‘Colorado Weigh’ weight loss programme were involved in the study, which sought to answer this question: could a telehealth programme, undertaken following successful completion of a behavioural weight loss course, help in maintaining weight loss?

Researchers chose a quasi-experimental rather than a randomised study design so that individuals could choose to participate in a weight loss maintenance programme that was either telehealth-based or classroom-based, or to opt out completely. All those involved met both selection criteria of having previously taken part in a weight loss programme and having achieved at least 7 per cent weight loss.

Thirty-one participants selected the telehealth programme, 31 selected the classroom or 'traditional' programme, and 25 chose not to be involved with formalised weight loss maintenance.

The telehealth programme comprised computer software, email, and remote advice and coaching. Participants used the technology to record their weight-related activities, and to interact with a registered dietician once a fortnight over a 24-week period. Dieticians had access to the activity logs and telephoned participants where they felt that this added contact would be useful.

Those who opted for the traditional programme attended classes every fortnight for 24 weeks. Sessions were led by a registered dietician who was available before and after the class for individual queries. Attendees were required to complete a daily, paper-based log recording calorie and fat intake and physical activity.

Given that participants had chosen their method of weight loss maintenance, researchers wanted to find out user satisfaction levels for each of the programmes, as well as their effectiveness in weight loss maintenance terms.

Weight change for the telehealth and traditional groups was similar. Over the research period, the telehealth group lost 0.6 ± 2.5kg while the traditional group lost 0.5 ± 4.3kg. Within the same timeframe, the group that did not take part in either programme gained 1.7 ± 3.0kg.

These results indicate that some form of weight loss maintenance programme is more effective in the avoidance of weight gain than no programme at all. However, the traditional programme appears to have performed broadly as effectively as the telehealth one.

User surveys of convenience and satisfaction were undertaken. These found similar satisfaction levels between the telehealth and traditional groups, but the telehealth group was rated as the more convenient of the two.

The researchers point out that participants in the telehealth group were 'highly educated' and had above-average access to and proficiency with the internet, which will have influenced their decision to choose the telehealth option. A randomised group would have produced different, perhaps less positive, results.

In terms of time-cost for the professionals involved, the telehealth programme initially required more time than the traditional programme. However, by the end of the study, the traditional programme had a greater time requirement.

The study concluded that a telehealth option, such as that described above, can be an effective tool in weight loss management for people who wish to avoid physically attending classes, possess the required technology and are equipped to use it.

Telehealth evidence database

The telehealth evidence database currently holds seven research summaries on obesity. These include three randomised controlled trials (RCTs), as well as other study designs.

One RCT, undertaken in Greece, used telemedicine over a six-month period to allow participants to record and transmit their own blood pressure and body weight readings. [2] One hundred and twenty-two patients aged between 18 and 70, and with a body mass index (BMI) greater than 25kg/m2, took part in the study. The control group comprised 77 patients who received standard hospital care. The remaining 45 also used electronic devices for the readings mentioned above. Outcome measures included body weight, BMI, blood pressure and quality of life.

The study recorded greater weight loss among those in the intervention group compared with the control group, alongside high levels of satisfaction with the telemedicine. Quality of life measurements were similar for both the intervention and control groups.

Another six-month RCT looked at self-reported weight for a group of obese employees. [3] Telephone coaching and 'interactive telemonitoring' were available to an intervention group, in addition to daily self-weighing. Both the intervention and control groups under-reported their weight, but the intervention group’s under-reporting was the less significant. This might be attributed to the telemedicine and telemonitoring employed during the study.

The potential of a person’s obesity to impact on other chronic conditions was highlighted by researchers who investigated the accuracy of home blood pressure readings. [4] The study focused on the size of sphygmomanometer cuffs used by patients and found that, for some obese individuals, the cuff circumference was too small for precise home readings to be taken. It concluded that patients need better information about appropriate cuff sizes for their arms to improve their blood pressure management.

Numerous studies have been undertaken on obesity among children and adolescents. One such study looked at the feasibility and acceptability of a telemedicine intervention for family-based paediatric obesity. [5] Seventeen families were involved, including children with a mean age of 9.9 years. The control group received a single physician visit during the study, while the intervention group took part in four one-hour videoconference sessions with health professionals over an eight-week period. Families began the sessions together, before the parents spoke separately with a psychologist over the video link. BMI measurements did not change significantly for either group. Parents recorded high satisfaction with the telemedicine, as did the health professionals involved, who had access to patients across a wide geographical area without travelling to numerous locations.

Another RCT involved 8-12-year-old children and their parents. Over one year, some parents received 'interactive voice response counseling'. [6] Sustained BMI decreases were recorded for children whose parents regularly accessed the counselling service, compared with parents who were using other methods. Researchers concluded that the interactive facility could successfully support parents in reducing their children’s weight.

It is clear that telehealth and telemedicine can be used in the treatment of obesity, whether by facilitating patients' and health professionals' monitoring of the condition or by providing additional, remote guidance and support. Patient satisfaction with these methods tends to be high and, from the provider perspective, delivery savings in time and cost are achievable after initial set-up.

References

[1] Haugen H, Tran Z, Wyatt H, Barry M, Hill J (2007). 'Using telehealth to increase participation in weight maintenance programs'. Obesity, vol 15, pp 3067–77. Available at: www.nature.com/oby/journal/v15/n12/abs/oby2007365a.html (accessed on 19 July 2011).

[2] Goulis D, Giaglis G, Boren S, Lekka I, Bontis E, Balas E, Maglaveras N, Avramides A (2004). 'Effectiveness of home-centred care through telemedicine applications for overweight and obese patients: a randomized controlled trial'. International Journal of Obesity, vol 28, pp 1391–98. Available at: www.nature.com/ijo/journal/v28/n11/full/0802773a.html (accessed on 19 July 2011).

[3] Pronk N, Crain A, VanWormer J, Martinson B, Boucher J, Cosentino D (2011). 'The use of telehealth technology in assessing the accuracy of self-reported weight and the impact of a daily immediate-feedback intervention among obese employees'. International Journal of Telemedicine and Applications, vol 2011, 6 pages. Available at: www.hindawi.com/journals/ijta/2011/909248/ (accessed on 19 July 2011).

[4] Akpolat T (2010). 'Obesity, hypertension and home sphygmomanometer cuffs'. European Journal of Internal Medicine, vol 21, no 4, pp 338–40. Available at: www.ejinme.com/article/S0953-6205(10)00090-7/abstract (accessed on 19 July 2011).

[5] McGrath Davis A, James R, Boles R, Goetz J, Belmont J, Malone B (2010). 'The use of telemedicine in the treatment of paediatric obesity: feasibility and acceptability'. Maternal & Child Nutrition, vol 7, no 1, pp 71–9. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1740-8709.2010.00248.x/pdf (accessed on 19 July 2011).

[6] Estabrooks P, Shoup J, Gattshall M, Dandamudi P, Shetterly S, Xu S (2009). 'Automated telephone counseling for parents of overweight children: a randomized controlled trial'. American Journal of Preventive Medicine, vol 36, no 1, pp 35–42. Available at: www.ajpmonline.org/article/S0749-3797(08)00837-4/abstract (accessed on 19 July 2011).

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