# Telehealth Secure Solution to Provide Childhood Obesity Monitoring
## 3 Family-Based Weight Management for Children  
Childhood obesity, overweight, and their comorbidities can be prevented by carrying out continuous monitoring of children's growth charts and documenting deviations from them [23; 24; 25], as an important part of a multi-faceted approach for successful treatment to reduce childhood obesity. Monitoring and evaluation are two points that can help raise awareness of the problem and are necessary to evaluate progress in the development, implementation and effectiveness of interventions. It is important to promote a healthy lifestyle early in childhood for many reasons, including to help promote a healthy weight, so as to limit the possibility of the development of obesity, as the effects of the implemented actions are likely to be long-lasting [26]. Given the high prevalence of childhood obesity and its potential deleterious, long-lasting consequences for those who present this condition, the use of telehealth solutions could provide intensive, family-based pediatric weight management that includes psychological attention, and in cases where psychological help is needed, it can be performed remotely [27]. To define which risk factors contribute to the early onset of childhood obesity and overweight and which data from these will be sent by our scheme, literature reviews in the field were taken into account, seeking further categorization, as well as cut-off points for some parameters that determine the risk or prevalence of childhood obesity and overweight. The chosen parameters were anthropometric data, physical activity, and hours of sleep. However, the system can be extended to more categories of data that are also valuable in determining the risk of childhood obesity, such as diet, which was not included at this stage due the difficulties in the accurate assessment of dietary intake. The data and their categorizations that are to be sent to health professionals are shown in Figures 1 and 2a,b. Body measurements (waist, arm, and calf circumference) are taken by the parents, for which they will receive a basic manual with simple instructions. This manual will be based on the recommendations of recognized health organizations in the region where the proposed scheme will be implemented. Additionally, the parent will weigh the child, and enter the data into an application on their cell phone. From the previous data, the mobile application will first validate the data entered by the parent to verify that there are no significant variations with previous data (if any). If so, it will inform the parent to rectify the measurements. With the data provided, the mobile application will calculate the waist-to-height ratio (WHtR) and the body mass index (BMI) and send this data to the health professionals through the platform. It should be mentioned that three key  
Figure 1: Anthropometric Data. Figure 2: Kinds of data obtained by non-intrusive device: (**a**) Data of physical activity and (**b**) hours of sleep. anthropometric indicators of childhood obesity and overweight were considered: Two of them can be obtained from the body measurements (WHtR and BMI) and the third, body fat, will be used only when the parents have the digital scales to obtain these data. Although the accuracy of digital scales (or smart scales) for estimating body composition, including body fat, is poor, a recent study found that such a method to obtain body fat allows the participants significant weight loss for several months [28]. For the WHtR, which is used to determine the prevalence of abdominal obesity, the cut-off point considered as the boundary value to assess risk is 0.5 [24; 25]. This indicator is recommended for the evaluation and follow-up of obese and overweight children [26].