Telemedicine and mHealth in pediatric obesity management: current effectiveness and future directions

R. De Giuseppe,¹ F. Loperfido,¹ I. Bianco,¹ F. Sottotetti,¹ D. El Masri,¹ C. Ferrara,¹ B. Maccarini,¹ M. V. Conti,¹ C. Breda,¹ N. Madini,¹ H. Cena^1,2 | ¹Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia; ²Unit of Clinical Nutrition, ICS Maugeri IRCCS, Pavia, Italy

The landscape of pediatric obesity management is undergoing a profound transformation, moving from the four walls of the clinic into the daily digital lives of families. While traditional, face-to-face, multidisciplinary care remains the gold standard, it often faces insurmountable barriers of geography, time, and accessibility.¹ Today, telemedicine and mHealth are no longer just futuristic concepts but essential facilitators that bridge the gap between clinical guidelines and real-world implementation.² Current evidence suggests that the digital path offers a promising, if nuanced, journey. Indeed, it has been demonstrated that while digital lifestyle interventions (including apps, web platforms, and wearable devices) produce modest reductions in body mass index (BMI) and body weight (standardized mean difference [SMD] 0.19 and 0.15, respectively),³ their most consistent impact is seen in the transformation of daily habits. These tools reliably empower children to eat more fruit and vegetables while cutting down on sugar-sweetened beverages,⁴ even when the numbers on the scale shift more slowly.⁵ The success of this digital voyage depends largely on the traveller. For instance, for younger children (ages 5-11), eHealth is most effective when it focuses on parents as the primary agents of change, allowing them to reprogram the home environment through continuous remote support.^6,7 For adolescents, the journey is fuelled by engagement and motivation; they respond best to multi-domain digital programs that blend nutritional advice with psychological support and “serious games”.⁸ Notably, research highlights that “clinic-based telehealth” is not a mere substitute but a non-inferior alternative to traditional visits, provided the intensity of care is preserved.¹ However, the human touch remains irreplaceable for physical activity, where face-to-face interaction still offers a significant advantage for long-term success.⁹ Ultimately, telemedicine acts as a social equaliser, bringing specialised care to rural and underserved areas and reducing the logistical burden on families. Yet, we must remain vigilant of the digital divide, ensuring that these advancements promote health equity rather than leaving the most vulnerable behind, particularly in younger groups where data is still emerging.^10,11 Digital health is best understood as a satellite navigator: it does not replace the driver or the destination, but it provides the real-time guidance and constant support needed to make the long road toward a healthier future less lonely and more achievable.