Beyond BMI: A Systematic Review and Meta-Analysis of mHealth Interventions for Pediatric Obesity Management

Background: Pediatric obesity (PO) is a chronic disease requiring multidisciplinary management. Recent clinical guidelines emphasize the need for accessible, patient-centered solutions, positioning mHealth interventions as vital "clinical extenders" in modern practice. Objective: This systematic review and meta-analysis evaluate the efficacy and evolution of mHealth interventions for PO management between 2020 and 2026. Methods: A systematic search of electronic databases identified randomized controlled trials (RCTs) investigating mHealth for PO. Quality was assessed using the Cochrane RoB 2 tool, and a meta-analysis was performed on a subset of studies reporting zBMI data. Results: Twenty-three RCTs met the inclusion criteria, of which six were included in the quantitative synthesis. The meta-analysis demonstrated a statistically significant reduction in BMI z-score (MD = -0.20; 95% CI: -0.36 to -0.04; p = 0.02), with moderate heterogeneity (I² = 60%; Q = 13.5, p = 0.019). Beyond anthropometric outcomes, mHealth interventions consistently improved behavioral parameters, including dietary quality and sedentary time. However, engagement declined over time in standalone digital interventions ("mHealth fade-out"), whereas hybrid models integrating human support demonstrated improved retention and sustained effects. Anthropometric and behavioral outcomes showed partially divergent trajectories, with behavioral improvements often preceding measurable changes in BMI, and data on body composition were rarely reported, limiting a more precise understanding of changes in adiposity beyond BMI. Conclusions: mHealth is an effective catalyst for obesity management when integrated into a multidisciplinary framework. Future protocols must prioritize developmental tailoring-targeting parental empowerment in early childhood and encouraging adolescent autonomy-to ensure sustained engagement and a clinical focus that looks beyond BMI.