Key messages
• Digital interventions may have small, short-term beneficial effects on fat mass, but their effects on other outcomes are unclear.
• No studies reported on the safety of interventions.
• Future studies should report their results by age, gender, race/ethnicity; include the full data; include adverse events and other outcomes; control for both diet and physical activity in their analyses; and include the behavioral theory informing their intervention.
Why is obesity in childhood a problem?
Childhood obesity is a worldwide public health problem that increases the risk of developing long-term diseases, such as diabetes and heart disease. Worldwide, more than 340 million children and adolescents aged 5 to 19 were living with overweight or obesity in 2016.
What are digital technologies, and how are they used in weight-loss management?
Researchers are exploring new ways of managing obesity in children and adolescents using digital technologies, including wearable devices, web-based interventions, text messages, mobile phone or tablet applications, 'exergaming' and active video gaming, and telehealth (seeing or talking to your doctor from home using your phone, computer, or tablet). The advantages of these technologies may include:
• being available at all times, helping to sustain a behavior over time;
• lower care costs;
• promoting health equity – that is, reducing unfair differences in health between different groups of people – as they are generally accessible and available to a large population.
What did we want to find out?
We wanted to know whether integrating digital technologies helps children and adolescents to lose weight, and if these tools are safe.
What did we do?
We searched for studies that explored digital technology, such as 'wearables' (a compact, portable electronic device that you wear on your body to track your diet, health, and/or fitness), web-based tools, texting, mobile apps, exergaming, or telehealth, in the management of obesity in children and adolescents aged up to 19 years. We grouped the studies into two comparisons:
• digital technology plus usual care versus usual care alone;
• digital technology alone versus usual care alone.
We compared and summarized the results of the studies and rated our confidence in the evidence, based on factors such as study methods and sizes.
What did we find?
We included 15 studies involving a total of 911 children and adolescents. Five studies included children from 0 to 19 years old. Ten studies included only those aged 10 to 19 years. Nine studies lasted less than six months (short-term studies); six studies lasted at least six months (long-term studies).
Eight studies compared a digital technology plus usual care to usual care alone. The digital technology approach may reduce body fat by an average of 2.63% at the end of the study. This is a small but important improvement. The effects on other outcomes were unclear.
Seven studies compared a digital intervention alone to usual care alone. The effects on the outcomes assessed were unclear.
No studies reported on the safety of these treatments.
What are the limitations of the evidence?
The long-term clinical meaning of the reduction in fat mass with a digital intervention combined with conventional care in this population is difficult to assess due to the limited evidence. Also, we have no evidence about the safety of these digital technologies, and there was not enough information to determine whether different age groups had different outcomes.
How current is this evidence?
This evidence is current to 14 April 2025.
Читать полную аннотацию (абстракт)
Childhood obesity is a worldwide public health problem that increases the risk of chronic diseases. In 2016, more than 340 million children and adolescents aged 5 to 19 years were living with overweight or obesity.
Задачи
To assess the effects and safety of interventions using digital technology – that is, interventions applied to achieve health objectives implemented within any digital application, communication, or system – for the integrated management of obesity in children and adolescents.
Specifically, to assess the effects of digital interventions in the management of obesity in children and adolescents when used:
- in combination with conventional care compared to conventional care alone; and
- alone compared to conventional care alone.
Методы поиска
We searched CENTRAL, MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and two major trials registers to identify the studies included in this review. The date of the last search was 14 April 2025. We did not apply any language restrictions.
Критерии отбора
We included randomized controlled trials conducted in children (0 to 9 years old) and adolescents (10 to 19 years old) living with obesity, as defined by World Health Organization (WHO) Growth References. We included trials using the following digital health interventions for managing obesity: 'wearable' or implantable devices, web-based interventions, text messages, mobile phone or tablet applications, 'exergaming' or active video gaming, and telehealth. Participants in the comparison groups received conventional care or an intervention without a digital/technological component.
Сбор и анализ данных
Working independently, two review authors extracted data, assessed the studies' risk of bias using Cochrane's original risk of bias tool, and evaluated the certainty of the evidence using GRADE criteria. The following outcomes were extracted: anthropometry (body mass index [BMI], weight, skinfolds, waist-to-hip ratio, waist circumference), adiposity, physical activity, physical and mental well-being, quality of life, blood pressure, adverse events associated with the interventions, presence of obesity co-existing complications, obesity-associated disability, hyperinsulinemia, insulin resistance, glycemia, lipid metabolism or adipogenesis, lipid hormones, alterations in hunger or satiety, reduced disability in any of the functionality domains, mortality, prevalence of obesity in adulthood, and access to health services.
Основные результаты
We included 15 studies involving 911 participants, conducted in the USA (five studies), Sweden (three studies), and one each in Canada, China, Ireland, Italy, South Korea, Switzerland, and Thailand. All studies involved participants aged 10 to 19 years old, with 10 exclusively focusing on this age group. Five studies also included younger children (0 to 9 years). Eight studies included both diet and physical activity components, four studies included only a physical activity component, and three included only a diet component. We classified nine studies as short duration (< six months) and six as long duration (six or more months). Nine trials did not specify the theoretical basis of their intervention.
We grouped the studies into two comparisons: (1) digital health technology plus conventional care versus conventional care alone; and (2) digital technology alone versus conventional care alone.
Digital interventions combined with conventional care versus conventional care alone (8 studies)
Digital interventions led to a slightly lower, but clinically meaningful, fat mass at the end of the study (mean difference -2.63%, 95% confidence interval -4.47 to -0.78; 3 studies, 203 participants; moderate-certainty evidence).
The effect of digital interventions plus conventional care on other important outcomes reported was unclear. No studies reported adverse event data.
Digital interventions alone compared to conventional care alone (7 studies)
The effect of digital interventions alone on any of the outcomes reported was unclear. No studies reported adverse event data.
Выводы авторов
Digital interventions plus conventional care may have a small, short-term beneficial effect on fat mass in children and adolescents compared to conventional care alone. The effect on other outcome measures is unclear. The long-term clinical benefit in children and adolescents is difficult to assess due to the limited number of studies with relatively small sample sizes included in this review.
Future studies should: report their results by age, gender, and race/ethnicity; report full data to better enable data extraction and analysis; assess other important outcomes, particularly adverse events; control for both diet and physical activity in their analyses; and report the behavioral theory informing their intervention.
