A telehealth pediatric weight management program that takes into account equitable access may aid in the efforts against childhood obesity during the time of the coronavirus disease 2019 (COVID-19) pandemic, as effective interventions that can be delivered remotely may have an important role in supporting vulnerable populations, according to a perspective published in Obesity.
While obesity, hypertension, and diabetes are associated with increased COVID-19-related morbidity and mortality, the necessary closures imposed on educational, healthcare, and community settings may increase the burden of obesity and its health complications. Furthermore, nonbehavioral obesity risk factors may also be on the rise during the pandemic, including poverty, food insecurity, and stress.
There have been previous reports in support of the use of telehealth or mobile health interventions focused on pediatric weight management, but the efficacy and effectiveness of these care modalities are unclear.
In March 2020, the pediatric weight management programs at the New York-Presbyterian, Columbia, and Weill Cornell medical centers in New York, New York, fully transitioned to telehealth weight management. In response to the COVID-19 outbreak, they developed a cross-campus partnership and implemented virtual nutrition, physical activity, and mental health support.
The rapid transition to telehealth weight management in these settings was possible in light of several advancements, including the use of a common electronic health record and ability of multiple providers to access telehealth visits simultaneously, changes to telehealth billing rules, and widespread use of mobile technology. Furthermore, the use of remote care alleviated some of the previous barriers common in vulnerable populations, including the need for long-distance travel and childcare.
After the implementation of this telehealth program, the show rate for telehealth visits has been 76% to 89% across the pediatric weight management program between the end of March and April 16, 2020. This high show rate supports the potential importance of telehealth for these vulnerable children.
However, there are some important challenges to telehealth and efforts that should be taken to reduce the potential for digital technology disparities. These include addressing linguistic barriers and social needs, such as food insecurity; identifying platforms that safeguard security and meet regulations for patient privacy; overcoming reimbursement challenges; and identifying effective ways to deliver virtual interventions that promote retention, adherence, and healthy weight in children.
“Without effective interventions that can reach all children, the inter-generational cycle of obesity disparities will continue to widen, leaving children in disproportionately burdened populations at continued higher risk for morbidity and mortality throughout the current COVID-19 pandemic, and in future public health crises,” concluded the perspective authors.
Woo Baidal JA, Chang J, Hulse E, Turetsky R, Parkinson K, Rausch JC. Zooming towards a telehealth solution for vulnerable children with obesity during COVID-19 [published online April 30, 2020]. Obesity (Silver Spring). doi:10.1002/oby.22860