The authors concluded that childhood obesity studies showed promise for telemedicine to expand treatment access and for electronic health records to assist adherence to screening guidelines. The effect on weight loss and behaviour change remained understudied and inconsistent. Given the potential for review bias and the limitations of the evidence, the authors' conclusions regarding treatment benefit may be overstated.

To assess the effects of health information technology on patient outcomes and care processes in the management of child obesity.

MEDLINE, EMBASE and Cochrane Central Registry of Controlled Trials (CENTRAL) were searched from 2006 to April 2012 for articles in English. Search terms were reported. Reference lists of relevant articles were screened manually.

Eligible studies were randomised controlled trials (RCTs), controlled trials, before-and-after studies and cross-sectional studies that used information technology to deliver obesity screening or treatment to children aged two to 18 years. Information technology interventions had to be clinic-based or involve data communication with child-health professionals. Outcomes of interest included patient outcomes (body mass index, dietary or physical activity behaviour change and treatment adherence) or care processes (body mass index screening, comorbidity testing, diet or physical activity counselling).

Most of the included studies were conducted in USA; two were in Canada or Australia. Health information technology included electronic health records or computerised decision support, telemedicine (as defined in the review), text messages and telephone support. Interventions were provided as group or individual treatment.

Two reviewers independently screened studies for inclusion. Disagreements were resolved through consensus.

Study quality was assessed using a previously published tool that was developed for health information technology studies. The 10-point scale included criteria on allocation units and methods, similar baseline characteristics between treatment groups, subjective or objective outcomes and drop-out rates. Before-and-after studies could score a maximum of 4 and cross-sectional studies a maximum of 3.

Two reviewers independently assessed study quality. Any disagreements were resolved through consensus.

Improvements in patient outcomes or care processes were extracted based on statistically significant results (p<0.05).

Two reviewers independently performed the data extraction.

Findings were presented as a narrative synthesis by type of information technology applied (electronic health records, telemedicine and text message or telephone support).

A random-effects model was used to pool odds ratios (OR) and 95% confidence intervals (CI) for the proportion of children who underwent body mass index screening (where reported or calculable). Statistical heterogeneity was assessed using the I² statistic.

Thirteen studies (66,588 participants, range 17 to 60,711) were included in the review: four RCTs, five before-and-after studies and four health care professional surveys. RCTs scored between 5 and 10 on the 10-point quality scale. Before-and-after studies scored between 2 and 4 (out of a maximum score of 4) and cross-sectional studies scored 1 or 2 (out of a maximum score of 2).

Electronic health records: One RCT that used electronic health records reported no significant differences between intervention and control groups in body mass index or nutritional intake but reported a slightly greater decrease in television viewing at one year follow-up (-0.36 hours viewing per day, 95% CI -0.64 to -0.09). The eight studies that assessed impact on care processes reported inconsistent findings but indicated that health professionals who used electronic health records were more than twice as likely to screen for body mass index compared to health professionals who did not use electronic health records (OR 2.53, 95% CI 1.39 to 4.62; four surveys). However, there was evidence of statistical heterogeneity (I²=79%).

Telemedicine: One RCT and one before-and-after study reported no statistically significant differences in patient outcomes using telemedicine.

Text message and telephone support: One of three RCTs reported significantly greater decreases in body mass index z-score at one year in children/families who received counselling and telephone support compared to children/families who received only group counselling. No other differences in patient outcomes were statistically significant.

Studies in childhood obesity showed promise for telemedicine to expand treatment access and for electronic health records to assist physicians in adhering to clinical guidelines for screening. The effect on weight loss and behaviour change remained understudied and inconsistent.

The review question and supporting inclusion criteria were clearly stated. Three electronic databases were searched. The search was restricted to articles in English so language bias could not be ruled out. Study quality was assessed and indicated that most studies were of poor quality. Each stage of the review process was undertaken in duplicate and this reduced potential for reviewer error and bias.

Few patient and study characteristics were reported in the review. Given the differences between the included studies, it was appropriate that the authors presented most outcomes as a narrative synthesis. Outcome details were sparse and confidence intervals for pooled effects were wide, which reduced the reliability of the findings. The authors acknowledged some limitations of the included studies including the potential for over- or under-estimation of screening and counselling rates using electronic health records. They also acknowledged that most studies were small.

Given the potential for bias in the review, poor quality of the included studies and limited evidence synthesis, the authors' conclusions regarding treatment access and adherence to guidelines may be overstated.

Practice: The authors did not state any implications for practice.

Research: The authors stated that further higher quality research was needed to evaluate whether changes in care processes affect clinical outcomes and whether additional information technology applications could enhance the quality and availability of screening and treatment. The authors highlighted that there were seven ongoing RCTs.

No external funding.

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.