For youth dealing with obesity who need extra help losing weight, experts suggest a multidisciplinary approach in which care is provided by several health specialists. However, the logistics of traveling to multiple appointments, even if just across town, can be a barrier to receiving care, especially for low-income families.
UCLA researchers who work with this patient population set up a pilot program using telehealth technology — a secure system that allowed patients to see and speak with their health care providers at UCLA over a computer from their local health clinic — to evaluate if such a system could be an effective strategy to help overcome these issues.
Their study of the program found that the great majority of pediatric patients — approximately 80 percent — were satisfied with their telehealth appointment, saying it was just as good as talking to the doctor in person, that it was easier to go to the local clinic than to the UCLA campus in Westwood, that they felt comfortable and that their privacy was protected.
In addition, 80 percent said they would participate in a telehealth appointment again. Responses from the health care providers were similarly positive.
The results of the project were presented at the Southern California Public Health Association Conference on Dec. 9.
"One surprise was how natural it was to talk with each other through the telehelath system, even though we never met the patients in person," said lead author Dr. Wendy Slusser, medical director of the Fit for Healthy Weight program at Mattel Children's Hospital UCLA and director of pediatric wellness programs at the Venice Family Clinic. "The interaction was very much like being in the same room together. Some kids even thought it was fun to see themselves on the screen."
To conduct the study, researchers with the Fit for Healthy Weight program worked with UCLA colleagues, the Venice Family Clinic and the Los Angeles Unified School District to implement a telehealth system that met a high standard of encryption and was compliant with national regulations to ensure patient privacy.
Forty-five patients, whose average age was 10, visited their regular local clinic, either the Venice Family Clinic's Simms/Mann Health and Wellness Center in Santa Monica or the LAUSD's San Miguel Healthy Start Clinic in South Gate. There, they and their parents checked in with an on-site medical assistant and a primary care physician who took their vital signs, including height, weight and blood pressure and performed lab work.
The patient and a parent then sat in front of a telehealth computer and talked "face-to-face" with specialists from the UCLA Fit for Healthy Weight clinic located at the 200 UCLA Medical Plaza building in Westwood, including a pediatrician, a psychologist and/or a dietitian
During the telehealth appointment, the UCLA providers reviewed the patients' vitals and blood test results, asked questions about the patient's health and lifestyle, and worked with the family to set healthy lifestyle goals and addressed the patient's health issues.
To study the effectiveness of this care, satisfaction questionnaires were provided to both the young patients — or to the parent if a child was too young — and the primary care providers at the local clinic after the telehealth appointment. Researchers also reviewed patients' charts to see how their body mass index evolved, tracking their BMI before, during and a few months after their appointment.
Of the patients, 52 percent were male, and the average baseline BMI was in the 98th percentile. Over time, 86 percent of the 25 patients who were followed after their telehealth appointments either stabilized or decreased their BMI scores, and three of the four patients with high blood pressure normalized their blood pressure.
The other positive outcome was the relative ease with which the Fit for Healthy Weight program was able to implment and adapt the technology.
"Although there were a few technological challenges in the beginning, we learned some valuable lessons in implementing a telehealth program," said Margaret Whitley, project manager of the Fit for Healthy Weight program.
The next phase of this project is a pilot home telehealth so that patients can talk to their doctor from home. This will eliminate the need for patients to travel to a local clinic, which can be especially beneficial for patients with mobility limitations. In addition, researchers are also helping the LAUSD develop a "teledietitian" project.
"Pediatric obesity is a serious epidemic that can lead to long-lasting health problems as children grow into adulthood," Slusser said. "We urgently need to find new ways to overcome barriers, and telehealth is a promising tool."
The program's research efforts are part of the Children's Discovery and Innovation Institute at Mattel Children's Hospital UCLA.
This project was funded by UniHealth Foundation. Funds from California Proposition 1D were used to provide telehealth equipment.
In addition to Slusser and Whitley, UCLA co-authors included Nilufar Izadpanah, Dr. Alma Guerro, Dr. Debra Lotstein, Dr. Daniel DeUgarte and Don Ponturo.
The authors have no financial ties to disclose.
The mission of the Fit for Healthy Weight Program at Mattel Children's Hospital UCLA is to provide comprehensive promotion of healthy eating, physical activity, psychosocial well-being (psychological, social, familial and educational) and overall wellness for children and adolescents and their families. For more information, please visit www.fitprogram.ucla.edu.