Effectiveness of telemedicine applications for weight management : a meta-analysis of randomized controlled trials

Abstract

Background The telemedicine application has great potential to address the prevalence of overweight and obesity, a severe the public healthcare burden in the 21st century. However, no exiting systematic review has been investigated the effectiveness of telemedicine application of weight reduction. The absence of quantitative evaluations and relatively rigorous qualitative assessments explains the carry-out of the present systematic review with a meta-analysis. Objectives The objectives are to determine the aggregated effect of thetelemedicine application to the management of overweight and obesity, in particular to investigate the effect of thetelemedicine application on reducing body weight, and to evaluate major contributable factors to commit a successful telemedicine intervention in body weight lowering. Methods This meta-analysis is guided by the PRISMA statement, with the automatic and manual searching by input keywords in the main databases. Only RCTs with absolute reduction of body weight as outcome measure, comparing the effect of the telemedicine application interventions with other stated interventions in reducing human body weightare potentially to be included. The selected RCTs are subject to the Jaded scale and the CONSORT for quality assessment. The studies identification and the data extraction were performed by two independent reviewers separately.The heterogeneity across the selected RCTs was assessed by Cochran Q test and I-square statistic. The meta-analysis was conducted with random-effect models and sensitivity analyses were performed by eliminating studies with extreme outcome values. Publication bias was examined through visual inspection of funnel plots and statistical assessments of the Begg‟s rank correlation test and the fail-safe N. Results 723 studies were identified from the preliminary database searches, 32 full-text articles were retrieved to review, after which, 12 RCTs were subject to the quality assessment process. Only 10 RCTs of high quality were selected into the meta-analysis. The generalizability of the meta-analysis is great since the patients subgroups were broadly from different geographical and cultural settings with the age ranging from 18 to 70, and no comorbidity conditions were excluded. The single element, the telemedicine application intervention, contributed to a significant extra 4.17 kg absolute reduction of human body weight in the average time period of 42 weeks. The outcome of the sensitivity analysis excluding the studies with extreme outcome measures was also consistent with the finding, which means the telemedicine application intervention contributed to a significant extra 2.58 kg absolute reduction of human body weight in the average time period of 46.5 weeks. Conclusions The telemedicine application is an effective public health intervention with broad generalizability for weight reduction in the future. Further studies to assess the effect of the telemedicine intervention among the populations of the developing countries, especially the large Chinese population, and to evaluate the confounding effect of the Hawthorne effect are critically important to support the international guideline on the promotion of the telemedicine intervention.