Effectiveness of home-centered care through telemedicine applications for overweight and obese patients: a randomized controlled trial

OBJECTIVE: To determine if home-centered monitoring through telemedicine has an impact on clinical characteristics, metabolic profile and quality of life in overweight and obese patients. DESIGN: Randomized controlled trial, 6-month duration. SETTING: Tertiary care academic hospital. SUBJECTS: A total of 122 patients were eligible to participate as they met the inclusion criteria of increased body mass index (BMI>25 kg/m(2)), age >18 and <70 y and ability to operate electronic microdevices. INTERVENTIONS: All patients in the control group ( n = 77) received standard hospital care. Patients in the intervention group ( n = 45), additionally, measured three times a week, for 6 months, their blood pressure and body weight and transmitted them to an automated call center. These values were not shared with the patients' physician or dietician. MAIN OUTCOME MEASURES: Clinical ( body weight, BMI, blood pressure), laboratory ( fasting plasma glucose, triglycerides, HDL-cholesterol, total cholesterol) and quality of life parameters (SF-36(R), Visual Analog Scale of European Quality-5 Dimensions, Obesity Assessment Survey). Data were analyzed in an intention-to-treat-way ( last observation carried forward). RESULTS: Drop-out rate was similar in the control and intervention groups: 12 vs 11 percent, respectively, P = NS. There were no significant differences at baseline between intervention and control groups in all main outcome parameters. There were significant decreases for patients in the intervention group in body weight ( from 101.6 +/- 22.4 to 89.2 +/- 14.7 kg, P = 0.002, P = 0.05 vs controls at 6 months), total cholesterol ( from 247.6 +/- 42.0 to 220.7 +/- 42.6 mg/dl, P = 0.002, P = 0.05 vs controls at 6 months) and triglycerides ( from 148.4 +/- 35.0 to 122.3 +/- 31.4 mg/dl, P = 0.001, P = 0.01 vs controls at 6 months). Intervention group patients made a total of 1997 phone contacts. The number of phone contacts was correlated positively with Social Functioning (SF), Vitality (VT) and Mental Health (MH) scores of SF-36(R) at baseline ( r = 0.48, r = 0.41, r = 0.41, respectively, P = 0.05) but not with weight loss. CONCLUSIONS: Home-centered, intense treatment through the use of telemedicine can be effective in improving short-term obesity outcomes.