A telehealth intervention for ensuring continuity of care of pediatric obesity during the CoVid-19 lockdown in Italy

A scoping review of physical activity-based interventions for obesity management in children and adolescents during the COVID-19 pandemic

Overweight and obesity have emerged as global health issues among children and adolescents. Restrictions related to the COVID-19 pandemic have aggravated the threat of paediatric obesity due to the prevalent reduction in physical activity (PA) in children and adolescents. However, this has also created an opportunity for healthcare professionals to explore new strategies to address this persistent problem. A systematically conducted scoping review was performed on 15 online databases to summarise and analyse the design, efficacy, and feasibility of PA-based weight management interventions for children and adolescents during the pandemic. Finally, we reviewed 23 eligible studies that were published between 2021 and 2023. The included interventions were presented to 1938 children and adolescents and 355 parents using a virtual or virtually blended face-to-face approach during the pandemic. The intervention design included a basic PA programme with three optional components (nutritional education, sociopsychological counselling, and medication consultations). Implementation generally resulted in favourable changes in body mass index (BMI) and/or body size or composition (primary outcomes), as well as health behaviours, physical health or fitness, and individual well-being (secondary outcomes). A longer duration of exposure to the intervention, female sex, and older age were associated with a higher efficacy of the included interventions. Moreover, the interventions showed high feasibility, with medium-high participant attendance, high acceptance/satisfaction in both children and adolescents and their parents and teachers, and strong participant engagement. This may be related to the high accessibility of health information, timely social support, and enhanced self-efficacy. In conclusion, both the virtual and blended delivery of well-planned weight management interventions during the pandemic show promise for the treatment and control of paediatric obesity. The lessons learned from the pandemic may help improve the design of future interventions and inform the proper integration of new technologies that have emerged in the post-pandemic world.

The Ongoing Impact of COVID-19 on Pediatric Obesity

In the developed world, pediatric obesity (PO) has been a major health concern since the last century, and this condition may lead to detrimental life-long physical and mental comorbidities. Currently, its prevalence has increased in low- and middle-income countries and in many high-income countries. Thus, the provision of effective and tailored care for children and their families has become vital. The social consequences of the COVID-19 pandemic are known everywhere, and among these, it has been argued that the COVID-19 pandemic has had a major impact on PO. Overall, the growth of PO over the last decade has been enhanced by the pandemic. During the COVID-19 pandemic, children, adolescents and young adults gained weight as the pediatric population dealt with sedentary lifestyles and changes in food habits. In this review, we want to highlight the impact that the COVID-19 pandemic had on PO.

Pediatric Obesity Care via Telemedicine: Expanding the Path Forward-A Review

PURPOSE OF REVIEW

Review latest data regarding the intersection of pediatric obesity epidemic with telemedicine expansion to meet the need of equitable obesity care in children.

RECENT FINDINGS

Prevalence of pediatric obesity in the USA continues to worsen particularly in rural, underserved areas. Although there is an increasing number of obesity medicine specialists over the last decade, availability varies by geographic location. Pre-pandemic centers were limited, rarely located in rural areas, and required in-person visits for reimbursement. Telemedicine changes, responding to pandemic needs, provided increase in telemedicine utilization and acceptance with similar or improved obesity care outcomes. Given pediatric obesity prevalence and need for chronic, effective obesity care, leveraging telemedicine to expand reach and decrease access barriers provides a critical and creative remedy. Data cites similar outcomes between telemedicine and in-person care. The time to reimagine a full spectrum of care delivery for pediatric obesity is now.

The Efficacy of Internet-Based Interventions in Family-Centered Empowerment Among Children with Chronic Diseases: A Mixed-Methods Systematic Review

Background

The incidence of chronic diseases in children is increasing worldwide, which can disrupt the quality of life. Family empowerment (FE) is one approach to strengthen family care among children with chronic diseases. In addition, internet has the potential in healthcare service interventions for families.

Purpose

This study aimed to determine the efficacy of internet-based family empowerment interventions among children with chronic diseases.

Methods

The study used a mixed-methods systematic review. A literature review was conducted following PRISMA guidelines using the PubMed, Scopus, ScienceDirect, and CINAHL databases. We used the PCC framework: chronic diseases (Population), family empowerment (Concept), and internet-based intervention (Context). Studies were eligible if published between 2013 and 2023, full-text, original study design, and focused on family empowerment in children with chronic diseases. Studies would be excluded if they were not in English or if the population was adults. The quality of the studies was assessed using the Mixed Methods Appraisal Tool (MMAT) version 2018. The study analysis used Sequential Explanatory Synthesis, which is a quantitative study (QUAN) synthesis followed by a qualitative study (QUAL) synthesis, then integrated using the QUAL data transformation technique.

Results

We highlight the quantitative study findings that an internet-based family empowerment intervention positively impacted family members' ability to care for children with chronic diseases with a mean Family Empowerment Scale (FES) total score of 4.13. We analyzed six study and identified four themes regarding efficacy of internet-based interventions in empowering families with children with chronic diseases: knowledge; availability of resources and time-saving; connectedness and communication; and family management and self-confidence.

Conclusion

Our study highlights that online-based interventions in family empowerment positively impact enhancing all domains of empowerment. This findings suggest that internet-based family interventions need to be adopted to fulfill the care needs of children with chronic diseases sustainably.

Exploring the Effect of the Dynamics of Behavioral Phenotypes on Health Outcomes in an mHealth Intervention for Childhood Obesity: Longitudinal Observational Study

BACKGROUND

Advancements in mobile health technologies and machine learning approaches have expanded the framework of behavioral phenotypes in obesity treatment to explore the dynamics of temporal changes.

OBJECTIVE

This study aimed to investigate the dynamics of behavioral changes during obesity intervention and identify behavioral phenotypes associated with weight change using a hybrid machine learning approach.

METHODS

In total, 88 children and adolescents (ages 8-16 years; 62/88, 71% male) with age- and sex-specific BMI ≥85th percentile participated in the study. Behavioral phenotypes were identified using a hybrid 2-stage procedure based on the temporal dynamics of adherence to the 5 behavioral goals during the intervention. Functional principal component analysis was used to determine behavioral phenotypes by extracting principal component factors from the functional data of each participant. Elastic net regression was used to investigate the association between behavioral phenotypes and weight change.

RESULTS

Functional principal component analysis identified 2 distinctive behavioral phenotypes, which were named the high or low adherence level and late or early behavior change. The first phenotype explained 47% to 69% of each factor, whereas the second phenotype explained 11% to 17% of the total behavioral dynamics. High or low adherence level was associated with weight change for adherence to screen time (β=-.0766, 95% CI -.1245 to -.0312), fruit and vegetable intake (β=.1770, 95% CI .0642-.2561), exercise (β=-.0711, 95% CI -.0892 to -.0363), drinking water (β=-.0203, 95% CI -.0218 to -.0123), and sleep duration. Late or early behavioral changes were significantly associated with weight loss for changes in screen time (β=.0440, 95% CI .0186-.0550), fruit and vegetable intake (β=-.1177, 95% CI -.1441 to -.0680), and sleep duration (β=-.0991, 95% CI -.1254 to -.0597).

CONCLUSIONS

Overall level of adherence, or the high or low adherence level, and a gradual improvement or deterioration in health-related behaviors, or the late or early behavior change, were differently associated with weight loss for distinctive obesity-related lifestyle behaviors. A large proportion of health-related behaviors remained stable throughout the intervention, which indicates that health care professionals should closely monitor changes made during the early stages of the intervention.

TRIAL REGISTRATION

Clinical Research Information Science KCT0004137; https://tinyurl.com/ytxr83ay.

Introducing Telemedicine in Italy: Citizens' Awareness of a New Healthcare Resource

In recent years, especially during the COVID-19 pandemic, new technologies have emerged as useful resources in healthcare. Telemedicine services may decrease opportunities for contagion by limiting direct medical contacts; they can lead to greater access to and better quality of care, especially for the elderly and chronically ill patients. However, there are still some difficulties in their widespread use, such as lack of knowledge about the effectiveness and safety of telemedicine; lack of awareness of its existence; privacy issues; and lack of computer literacy. The aim of this study is to assess the awareness of and attitude toward telemedicine in the Italian adult population, considering sociodemographic characteristics and territorial differences in telemedicine service implementation. A questionnaire was administered to Italian citizens from October 2022 to February 2023 using communication and social media in order to collect sociodemographic and health characteristics and data on awareness and use of telemedicine services. Less than half of the respondents (n = 1002) were aware of telemedicine services in their region; most of them did not use the available services due to a preference for in-person visits or lack of need. More than 90% of participants who used these services were satisfied with them. A negative attitude toward telemedicine was found in a higher proportion of older adults. This study demonstrated that, although telemedicine services are active in Italy, a large part of the population ignores its availability. Therefore, further efforts should be made to increase citizens' awareness and the use of telemedicine in our country.

Rising NAFLD and metabolic severity during the Sars-CoV-2 pandemic among children with obesity in the United States

OBJECTIVE

Nonalcoholic fatty liver disease (NAFLD), the most common liver disease among youth with obesity, precedes more severe metabolic and liver diseases. However, the impact of the Sars-CoV-2 global pandemic on the prevalence and severity of NAFLD and the associated metabolic phenotype among youth with obesity is unknown.

METHODS

Participants were recruited from the Yale Pediatric Obesity Clinic during the Sars-CoV-2 global pandemic (August 2020 to May 2022) and were compared with a frequency-matched control group of youth with obesity studied before the Sars-CoV-2 global pandemic (January 2017 to November 2019). Glucose metabolism differences were assessed during an extended 180-minute oral glucose tolerance test. Magnetic resonance imaging-derived proton density fat fraction (PDFF) was used to determine intrahepatic fat content in those with NAFLD (PDFF ≥ 5.5).

RESULTS

NAFLD prevalence increased in participants prior to (36.2%) versus during the Sars-CoV-2 pandemic (60.9%), with higher PDFF values observed in participants with NAFLD (PDFF ≥ 5.5%) during versus before the pandemic. An increase in visceral adipose tissue and a hyperresponsiveness in insulin secretion during the oral glucose tolerance test were also observed.

CONCLUSIONS

Hepatic health differences were likely exacerbated by environmental and behavioral changes associated with the pandemic, which are critically important for clinicians to consider when engaging in patient care to help minimize the future risk for metabolic perturbations.

The effect of phone and video counselling given to participants living with obesity on weight loss and quality of life during the COVID-19 pandemic: a randomised controlled trial

BACKGROUND

Although remote dietary counselling practices have increased in the COVID-19 pandemic, it is not known which method is more effective. This study aimed to determine the effect of diet counselling by phone or video on weight loss and to compare it with the traditional follow-up method.

METHODS

Forty-six participants living with obesity were randomised into the phone counselling (n = 15), video counselling (n = 15), and traditional follow-up groups (n = 16), and were followed for 10 weeks. The anthropometric measurements, quality-of-life questionnaire (SF-36) scores and total calorie/macronutrient intakes were recorded and compared at baseline and at the end of the study.

RESULTS

In the phone counselling, video counselling and traditional follow-up groups body weight (-4.8 ± 0.9, -5.7 ± 1.8 and -3.3 ± 0.8 kg, respectively) and SF-36 general health scores (14.2 ± 4.2, 15.9 ± 3.6 and 10.2 ± 3.7, respectively) of the participants changed significantly compared to baseline (group × time interaction, p < 0.05). The change in the body weight and SF-36 general health score was more in the phone counselling and video counselling groups relative to the traditional follow-up group (group × time interaction, p < 0.01). The highest decrease in total calorie (-301.4 ± 112.2 kcal) and carbohydrate (-26.6 ± 11.2 g) intake was in the video counselling group compared to the other groups (group × time interaction, p < 0.01).

CONCLUSION

Video counselling and phone counselling were effective in weight loss in the COVID-19 pandemic. It is important to maintain remote dietary counselling practices to support weight management when face-to-face meetings are not possible.

Telehealth als Therapieoption in der juvenilen Adipositasprävention

Übergewicht und Adipositas im Kindes- und Jugendalter gehen nicht nur mit ausgeprägten medizinischen und psychologischen Begleit- und Folgeerkrankungen einher, sondern stellen auch aus ökonomischer Sicht eine der größten Herausforderungen für das Gesundheitssystem dar. Die Beschränkungen im Rahmen der weltweiten COVID-19-Pandemie (COVID-19: „coronavirus disease 2019“) führten zu einer weiteren Aggravierung der vorbestehend hohen Prävalenz an juvenilem Übergewicht. Da pharmakologische Behandlungsmöglichkeiten im Kindes‑/Jugendalter im Allgemeinen nicht zugelassen sind und daher keine Option darstellen, spielt die Lebensstilveränderung aus therapeutischer Sicht eine gesonderte Rolle. Dabei haben multimodale Beschulungskonzepte mit Beratungen durch Mitarbeitende verschiedener Fachbereiche (beispielsweise Psychologie, Ernährung, Sport, Medizin) aktuell die besten Erfolgsaussichten. Durch den gezielten Transfer dieser Schulungsprogramme in telemedizinische Konzepte könnten deren Wirkungsgrad nachhaltig verbessert und dabei Ressourcen sowohl auf therapeutischer Seite als auch der der Betroffenen geschont werden.

Medical treatment of weight loss in children and adolescents with obesity

Obesity remains one of the biggest health problems both in adults and children. Lifestyle modification, including diet and exercise, continues to be the mainstay of obesity prevention and treatment. Unfortunately, lifestyle modifications are often unsuccessful. Pharmacological treatment of obesity in pediatric patients can be applied in selected cases, and not before evidence of failure of the multidisciplinary lifestyle intervention. In this narrative review, we revised the most up-to-date evidence on medical treatment of weight loss in children and adolescents with obesity, including FDA- or EMA-approved and -experimented, not approved, drugs for pediatric population. Multidisciplinary treatment of childhood obesity, regulation of appetite control, energy balance and body weight were also discussed, in order to clarify the indications and mechanism action of drugs. Despite a substantial number of medications used for the treatment of obesity in adults, a limited number of drugs are approved by the drug regulatory agencies for pediatric population. Further research is needed to evaluate the efficacy and safety of novel pharmacological approaches for treatment of pediatric obesity in order to optimize weight management for children and adolescents and limit the development obesity-related comorbidities.

Current evidence on the impact of the COVID-19 pandemic on paediatric endocrine conditions

Severe acute respiratory coronavirus 2 (SARS-CoV-2) interacts with the host cells through its spike protein by binding to the membrane enzyme angiotensin-converting enzyme 2 (ACE2) and it can have a direct effect on endocrine function as ACE2 is expressed in many glands and organs with endocrine function. Furthermore, several endocrine conditions have features that might increase the risk of SARS-CoV-2 infection and the severity and course of the infection, as obesity for the underlying chronic increased inflammatory status and metabolic derangement, and for the possible changes in thyroid function. Vitamin D has immunomodulatory effects, and its deficiency has negative effects. Adrenal insufficiency and excess glucocorticoids affect immune conditions also besides metabolism. This review aims to analyze the rationale for the fear of direct effects of SARS-Cov-2 on endocrinological disorders, to study the influence of pre-existing endocrine disorders on the course of the infection, and the actual data in childhood. Currently, data concerning endocrine function during the pandemic are scarce in childhood and for many aspects definite conclusions cannot be drawn, however, data on properly managed patients with adrenal insufficiency at present are re-assuring. Too little attention has been paid to thyroid function and further studies may be helpful. The available data support a need for adequate vitamin D supplementation, caution in obese patients, monitoring of thyroid function in hospitalized patients, and confirm the need for an awareness campaign for the increased frequency of precocious puberty, rapidly progressive puberty and precocious menarche. The changes in lifestyle, the increased incidence of overweight and the change in the timing of puberty lead also to hypothesize that there might be an increase in ovarian dysfunction, as for example polycystic ovarian disease, and metabolic derangements in the next years, and in the future we might be facing fertility problems. This prompts to be cautious and maintain further surveillance.

Multidisciplinary Treatment for Childhood Obesity: A Two-Year Experience in the Province of Naples, Italy

Childhood obesity must be faced through an integrated multi-level preventive approach. This study was aimed at assessing the adherence and the outcomes of an outpatient service for childhood obesity treatment activated in the province of Naples, Italy, throughout a 2-year follow-up period. At first visit (T0), weight, height, waist circumference, and body composition of children were assessed, together with sociodemographic features and physical activity levels of children and parents. Anthropometric and body composition parameters of children were measured at 6 ± 3 months (T1) and 12 ± 3 months (T2). A total of 451 non-related children who accessed the service were analyzed: 220 (48.7%) of them returned at least once (attrition rate 51.3%). Returner outpatients showed higher age (p = 0.046) and father’s educational level (p = 0.041) than non-returner ones. Adherence to the treatment was found to be related to father’s (Rho = 0.140, p = 0.005) and mother’s (Rho = 0.109, p = 0.026) educational level. All the outcomes improved between T0 and T1 (p < 0.001), while only body mass index (BMI) decreased significantly at T2. Changes in BMI-SDS were associated with baseline value (OR 0.158, 95%CI 0.017−0.298, p = 0.029). The multidisciplinary approach seems to be promising to treat childhood obesity in this geographic context. Lower parents’ educational level should be considered as an attrition determinant.

Impact of Covid-19 Pandemic on the Effectiveness of Outpatient Counseling in Childhood Obesity Management

The Covid-19 pandemic drastically modified social life and lifestyle, in particular, among children and adolescents, promoting sedentary behaviors and unhealthy eating habits. The aims of this study were to assess the rate and the factors associated with outpatient drop-out in childhood obesity management, and to evaluate how the Covid-19 pandemic influenced weight status and lifestyle of children and adolescents with obesity. One hundred and forty-five children and adolescents with obesity were identified, including 80 subjects evaluated before the Covid-19 pandemic (group A) and 65 subjects in the period straddling the Covid-19 pandemic (group B). Anamnestic (family history of obesity, dietary habits, physical activity, screen time), socio-cultural (economic status, employment and schooling of parents, household composition, place of living) and clinical (weight, height, BMI, waist circumference) data were retrospectively analyzed for each subject in both groups at baseline (V0) and 12-months (V1) at in-person assessment. Glycemic and lipid profiles were assessed at V0. Drop-out rate did not differ significantly between the two groups. BMI SDS at V0 (OR=2.52; p=0.004), female sex (OR=0.41; p=0.035), and the presence of a single parent in the household (OR=5.74; p=0.033) significantly influenced drop-out in both groups. Weight loss between V0 and V1 was significantly greater among group A patients compared to group B (p=0.031). In group B, hours spent in physical activity significantly decreased from V0 to V1, being significantly lower than group A at V1; on the contrary, screen time significantly increased in the same period. The consumption of sugary drinks and snacks was significantly greater in group B than group A at V1. Our study documented that the Covid-19 pandemic, although not affecting the drop-out rate of obese children in a follow-up program, negatively influenced lifestyle and reduced the effectiveness of outpatient counseling in childhood obesity treatment.