ESPE Abstracts

Background: The integration of mobile health technology with a limited number of physical visits shows promising treatment outcomes, but long-term evidence is lacking. Additionally, concerns about eating disorders following obesity treatment are common among families and caregivers, although data on this matter are scarce for children and adolescents. This study evaluates three-year weight outcomes for patients using a digi-physical treatment tool and reviews the occurrence of eating disorders.  

Methods: Patients who initiated obesity treatment between 2018 and 2019 using the treatment tool Evira were included. The Evira tool encompasses a digitless body scale for daily home-weighing, a mobile application showing continuous BMI Z-score changes as a moving average, and a clinic interface that facilitates weekly communication between families and clinics. The control group consisted of children matched by sex and age who received standard paediatric obesity treatment. Data were extracted from the Swedish Childhood Obesity Treatment Register (BORIS). The primary outcome, change in BMI Z-score, was analysed using a mixed model, adjusted for sex, age, and degree of obesity at treatment initiation. Diagnoses and symptoms of eating disorders were obtained from patient records in the digi-physical treatment group and reviewed throughout the entire treatment period and for one additional year after the trial period. Data on eating disorders were not available for the control group.  

Results: A total of 428 patients (67% male), aged 4.1-17.4 years, were included. Among these, 107 received digi-physical treatment using the Evira tool, and 321 patients received standard treatment. The mean (SD) BMI Z-score at treatment initiation was 2.81 (0.36) and 2.77 (0.38), respectively (P = 0.38). After three years of continuous treatment, the digi-physical treatment group showed a significantly greater improvement in BMI Z-score compared to the standard treatment group; the adjusted average (95% Cl) change in BMI Z-score was -0.29 (-0.40 to -0.18) versus -0.12 (-0.21 to -0.03), P = 0.02. During the follow-up period, three patients in the digi-physical treatment group reported disturbed eating behaviour (loss of control in one patient and anxiety related to eating in two patients), but no diagnosis of an eating disorder was established. All three patients were under specialist psychiatric care for other conditions, such as trauma or mental health conditions.

Conclusion: Over a three-year period, the digi-physical treatment generated a superior treatment effect compared to standard treatment. No patient treated with the Evira tool received an eating disorder diagnosis.