Treating Rural Pediatric Obesity through Telemedicine: Baseline Data from a Randomized Controlled Trial

Nearly one-third of the children between 2 and 19 years of age in the US are overweight or obese (Ogden, Carroll, & Curtin, 2010). Childhood obesity is linked to an increased risk of mortality (Neovius, Sundstrom, & Rasmussen, 2009) and other medical comorbidities such as cardiovascular disease (Freedman et al., 2008; Baker, Olsen, & Sorensen 2007), musculoskeletal problems (Taylor et al., 2006; Krul, van der Wouden, Schellecis, van Suijlekom-Smit, & Koes, 2009), and impaired glucose tolerance (Sinha et al., 2002). Children who are obese have lower self-esteem, more negative self-perceptions of physical competence (Braet, Mervielde, & Vandereycken, 1997), and more behavioral and emotional difficulties than children who are not obese (Braet, Mervielde, & Vandereycken, 1997). Children in rural areas are more likely to be overweight and obese than children who live in urban areas (Joens-Matre et al., 2008). For instance, between 4% (Montgomery-Reagan et al., 2009) and 25% (Lutfiyya, Lipsky, Wisdom-Behounek, & Inpanbutr-Martinkus, 2007) more rural children are obese compared to their city-dwelling peers. In addition, higher prevalence rates in rural areas are not explained by demographic factors such as ethnicity, gender, or grade level (Davis, Flickinger, et al., 2005). More data are needed to determine the reasons rural children are at higher risk for obesity, but different dietary and activity patterns likely contribute. For example, high numbers of overweight children have been found in predominantly rural states, and lower physical activity is hypothesized to be a contributing factor (Davis, Boles, et al., 2008). Residents in suburban areas are nearly twice as likely to meet physical activity requirements as rural residents (Cherry, Huggins, & Gilmore, 2007), and rural children are less likely than their suburban and urban counterparts to engage in adequate amounts of daily physical activity (Lutfiyya, Lipsky, Wisdom-Behounek, & Inpanbutr-Martinkus, 2007). Interventions targeting obesity in rural children exist, but none have utilized telemedicine (interactive televideo) technology. Gombosi and colleagues (Gombosi, Olasin, & Bittle, 2007) instituted a comprehensive primary prevention program in rural Pennsylvania, which intervened at the school, family, community, industry, and restaurant levels. The prevention program, however, showed little impact on obesity rates over a 5-year period. Dennison and colleagues (Dennison, Yin, Kibbe, Burns, & Trowbridge, 2008) also developed a direct-contact intervention, which trained health care workers to manage overweight adolescents in rural primary care settings. Findings demonstrated the feasibility of training health care workers to appropriately and comprehensively assess adolescents for obesity risk factors. Janicke and colleagues (Janicke et al., 2008) facilitated Project STORY, a randomized clinical trial comparing parent-only and family-based interventions. Findings from Project STORY suggested potential feasibility and efficacy of rural pediatric obesity interventions, but did not explore the technological possibilities offered by telemedicine. One of the greatest benefits of using telemedicine technology in rural settings is that it allows for specialized professionals in urban settings to provide interventions to all corners of the state. There have been some randomized controlled trials using telemedicine to treat obesity in adults (Goulis et al., 2004; Frisch et al., 2009), and in both studies the intervention groups were fairly compliant and, relative to comparison groups, saw greater improvements in cardiovascular risk factors and weight loss. However, to date there are no telemedicine interventions (TM) specifically targeting rural pediatric obesity. The objective of this article is to report on the methodology and baseline characteristics of a randomized controlled trial comparing telemedicine to usual care (UC) for the treatment of pediatric obesity in rural children.