Telehealth Vs. Face-to-Face Treatment for Children and Adolescents With Obesity: A Randomized Controlled Trial

Telemedicine (TELE) may improve accessibility to paediatric obesity treatment, yet its effectiveness relative to face-to-face (FTF) care remains uncertain.

To compare the effects of a high-intensity, multidisciplinary TELE intervention with standard FTF care in children and adolescents with obesity.

Participants aged 10-18 years with obesity [body mass index (BMI) ≥ 2 standard deviations] were randomized to a 6-month TELE or FTF program in a tertiary-care centre paediatric obesity clinic. The TELE group received 30 weekly remote multidisciplinary consultations and a gamified step-monitoring application, along with three in-person visits. The FTF group attended six monthly in-clinic visits. The primary outcome was BMI z-score changes. Secondary outcomes included body composition, weight-related-quality-of-life (QOL), adherence, and satisfaction.

One hundred participants were randomized 1:1 to TELE or FTF, of whom 65 completed the intervention (TELE n = 32; FTF n = 33). Baseline BMI z-scores were similar between groups (2.11 ± 0.32 vs. 2.11 ± 0.29). The reduction in BMI z-score was significantly greater in FTF than TELE (-0.16 ± 0.14 vs. -0.05 ± 0.15; p = 0.002), and any reduction was observed among 85% of FTF participants compared with 56% in TELE (p = 0.015). Body composition and QOL improved similarly in both groups, whereas satisfaction was higher in FTF.

TELE-based care was less effective than FTF in reducing BMI z-score in children with obesity. Hybrid models integrating TELE with FTF visits warrant further investigation.

ClinicalTrials.gov identifier: NCT05700409.