P1023 - Telehealth as an alternative to in-person visits for pediatric weight management: evaluating anthropometric and laboratory results.

Background/Purpose:

Telehealth has the ability to expand quality care to patients unable to access specialty health services, such as expertise on weight management. This is especially critical in rural settings where the prevalence of pediatric obesity is generally higher than in urban areas. The objective of this study was to compare quantitative results from patients visiting a weight management clinic to those participating in similar care remotely via a more recently established telehealth alternative, predominately in rural areas where access to these services would not previously have existed. This included an analysis of laboratory results associated with obesity comorbidities, on which there has been little telehealth literature to date.

Methods:

We examined data from subjects enrolled in a nutrition and lifestyle program for overweight and obese children 2 to 22 years old from January 2017 to September 2019. Subjects were enrolled in either in-person visits in an established weight management clinic or in remote telehealth visits. We utilized de-identified electronic health record data. Descriptive statistics for each group included age, sex, gender, and average baseline body mass index (BMI). Change in BMI, BMI Z-score, Low Density Lipoprotein (LDL), Alanine Aminotransferase (ALT) and glycated hemoglobin (HbA1C) levels were measured from each patient’s initial to final visit. Patients were excluded if they had bariatric surgery, were not in the program for at least 30 days, or did not have at least one follow up visit with labs or weight recorded.

Results:

1201 patients provided data, and after exclusions, we evaluated 1019 of 1126 (90.5%) in-person visits and 58 of 75 (77.3%) of telehealth clinic visits. The mean initial BMI in the in-person population was 32.2 and was 32.6 in the telehealth cohort (p= 0.36).The mean decrease in BMI z-score from first to last visit was 0.044 in the in-person group and 0.032 in the telehealth group (p= 0.64). The change in mean HbA1C was an increase of 0.009 in the in-person group and 0.067 in the telehealth group (p=0.59). There was decrease in mean LDL of 2.3 in the in-person group and 2.0 in the telehealth group (p=0.93), and a mean increase in ALT of 0.27 in the clinic and 48.63 in the telehealth groups respectively (p=0.09).

Conclusion(s):

These results show a small decrease in BMI percentile and Z-score in both in-person and telehealth visits, and no significant difference in the change in BMI between the two groups. There was also no significant difference in LDL, ALT, and HbA1C found between groups. In order to expand on this comparison, further research on retention rates between the two groups, as well as differences in behavioral and lifestyle changes, should be undertaken.