Childhood obesity is today considered a severe disease with markedly increased mortality and morbidity. In addition to the well-established cardiovascular and metabolic comorbidities, hypertension, fatty liver disease and type 2 diabetes, childhood obesity is also associated with increased risk for several cancers and autoimmune diseases such as multiple sclerosis, thyroiditis, arthritis and type 1 diabetes.¹ The most important causative factor is probably the low grade inflammation which appears already early in life in children with obesity. To prevent inflammatory-induced diseases, a normalization of the weight already before puberty is required¹ and this requires an early and intensified lifestyle treatment.

It is well established that successful lifestyle treatment requires continuous support and frequent visits, at least every other week.² As this is difficult to realize both for families and the health care system a digital support system, Evira, has been developed.³ Evira consists of a scale for daily home weight measurements. The scale does not present any data to reduce measurement stress. Instead, data is transferred to a mobile application in the parent’s smart phones. There, the degree of overweight is presented graphically as BMI z-score. The system can, with high accuracy, predict the height velocity required for BMI z-score calculation for children with obesity. Degree of obesity, height at clinical visits, age and gender are used and the calculation is based on height velocity data for obese children.⁴ BMI z-score data is in turn transformed into a database and presented to the clinical staff which communicate weekly with the families via a chat.

The system has been evaluated in several studies in Sweden. The one-year results are twice as good as conventional treatment and the dropout rate is lower.^{3 5} Also, after three years the treatment effect is significantly better than conventional treatment. The system has now been implemented at 12 ordinary pediatric clinics and preliminary one-year data indicates that similar results are obtained there. Based on these results Evira is now implemented via NHS in the UK and also evaluated in an ongoing study in Abu Dhabi.

In conclusion, weight loss early in life is required to reduce severe obesity-induced morbidity and mortality. Evira is a digital support system which makes high-intensity lifestyle treatment effective and affordable. The number of physical visits can be reduced from 26 to 4 visits per year with remaining excellent weight loss for a large number of children. Evira is also good in combination with pharmacological treatment

References

1. Marcus C, Danielsson P, Hagman E. Pediatric obesity-Long-term consequences and effect of weight loss. J Intern Med 2022;292(6):870-891.

2. O’Connor EA, et al. Screening for obesity and intervention for weight management in children and adolescents: evidence report and systematic review for the US preventive services task force. JAMA 2017;317(23):2427-2444.

3. Hagman E, et al. Effect of an interactive mobile health support system and daily weight measurements for pediatric obesity treatment, a 1-year pragmatical clinical trial. Int J Obes (Lond) 2022;46(8):1527-1533.

4. Putri RR, et al. Height and growth velocity in children and adolescents undergoing obesity treatment: A prospective cohort study. J Clin Endocrinol Metab 2023.

5. Johansson L, Hagman E, Danielsson P. A novel interactive mobile health support system for pediatric obesity treatment: a randomized controlled feasibility trial. BMC Pediatr 2020;20(1):447.