The Journal of eHealth Nursing

This Month's Featured Online Article 

Overweight In Childhood Internet Intervention System

Interviews presented in this section are intended for informational purposes only. The views expressed in this interview are not necessarily those of Carol M. Stock & Associates nor does Carol M. Stock & Associates support or endorse any particular product or company. 

Robert A. Pretlow, MD, President of eHealth International, an eHealth monitoring and interactive healthcare website company, has developed an unique interactive Internet intervention system for overweight children and teens.  For more information about eHealth International you can visit their website at   You can also visit several of their interactive disease management websites at and This month will focus on eHealth International's Overweight In Childhood Internet Intervention System  .

Dr. Pretlow, you've focused lately on overweight kids and teens.  Why is that?

Overweight in childhood is at epidemic level.  Two recent remarks caused me to pause, wonder, and ask myself, "How did we get to this point," and, "Why isn't something more being done to prevent such an outcome."  To quote Dr. William Klish, (member of the National Institutes of Health Expert Committee on Overweight In Childhood, and Director, Childhood Obesity Center, Baylor Univ. Med. Center), "Because of the current overweight epidemic in children and teens, for the first time in recent history, the current generation of kids has a life expectancy less than that of their parents."  

The second quote from Dr. Heather Dean, professor of pediatrics at the University of Manitoba, Winnipeg, Canada at the annual meeting of The American Diabetes Association, 2002, "Ten years ago people were concerned about overweight in children and teens causing overweight in adults and disease in adult life.  What's changed is that overweight in children and teens causes disease in childhood and teenage years and complications in young adults."  I find these statements alarming.  

Today we are seeing Type 2 diabetes, high blood pressure, clogged arteries, sleep apnea, and joint and bone problems occurring in overweight children and teens.  Complications occurring in young adulthood include blindness, kidney failure, limb amputations, miscarriages, heart attacks, strokes and even death.  Overweight African Americans, Asian Americans, Mexican Americans, and Native Americans are at highest risk for these diseases in childhood and adolescence and complications in young adulthood.  We never saw such health conditions in children and teens 20 years ago.  

The causes of childhood obesity and the large number of children and teens that are overweight have received enormous media coverage as of late.  In your view, why hasn't the medical community done more to recognize this problem and intervene?

That's a great question.  Unfortunately, I think the medical community has failed for two reasons.  First, health care providers are not reimbursed to manage and treat overweight children.  Second, many providers recognize overweight children in their practice but do little to help them because physicians historically are not trained in nutrition or weight management.  In addition, the physician might refer the child to a dietitian who might prescribe a complicated diet the child cannot or will not follow.  Weight management is also frustrating for many reasons.  Often times children and parents deny there is an overweight problem or don't want to talk about it.

A recent poll we conducted ( revealed that 69% of overweight children and teens are too embarrassed to ask for help from their healthcare provider in regard to their weight problem.  Another poll showed that even when an overweight child or teen saw their provider, 38% did not tell the child he/she was overweight and only 35% suggested ways to lose weight. (  Embarrassment coupled with provider lack of nutrition knowledge and lack of insurance reimbursement for weight management complicate treatment for overweight children and teens.  

How did you perceive a need for an Overweight Internet Intervention system?

The management of overweight children in the medical office is not being met.  Others agree.  Dr. Bart Schmidt, Professor of Pediatrics at the University of Colorado and a proponent of self-care ( agrees with me that "we have over-medicalized obesity and we don't have the resources or funding to treat all these children and adults in a medical setting." That is why I think the Internet is ideal for helping overweight children and teens.  The Internet is anonymous and eliminates much of the stigma and embarrassment factors, and the Internet is cheap.  If we could get insurance reimbursement for weight management in children that would be a big step forward.  

What is the Overweight in Childhood Internet Intervention System (R) and how does it work?

The Overweight in Childhood Internet Intervention System is designed for overweight kids and teens.  The system utilizes an interactive website at, which is currently used by approximately 80,000 children and teens per month (as of 2005) from all over the world.  The website and intervention tools facilitate both health behavior change and self-monitoring and self-management of overweight by children and teens.  The website allows overweight children and teens to learn about the causes and health risks of overweight, set their weight goals, post their weights to online secure charts, and interact in an online support community with other overweight children and teens. In addition, the site allows interactive support from a child's healthcare provider.  

How does self-management of  one's overweight work with the Overweight in Childhood Internet Intervention System?  Does Internet self management really work?

A recent study of 1830 children revealed that 42% of children and teens discontinue self-monitoring and self-management without interactive support from their healthcare provider (  However, 1% continue to self-monitor and manage themselves indefinitely.  Some children on our site have been self managing themselves for over  4 years.  I think this goes to show how dedicated children and teens can be to weight loss and how readily they take to Internet Intervention.  They desperately want health care providers to interact with them utilizing the Internet medium but we as healthcare providers are failing them.  I think we as providers are missing a wonderful opportunity to help overweight children. 

If I am an overweight kid, how do I get involved in this system?

It's pretty simple.  The child accesses the website,, which is free at this point.  Children set their own weight goals and weight loss rate per week.  The website provides guidelines for weight loss, per current medical literature.  A software robot provides interactive feedback to the children on their progress.  A child may use a specially designed digital scale called an "eScale", which connects to the child's computer and automatically sends his/her weight and comments to the child's individual weight chart on the website.  Or the child may post his/her weight manually. The weight chart results may be viewed at anytime (via password) by the child/parents or by the child's healthcare provider, if the child/parent has authorized such.  The advantage of the eScale is that it renders the child "electronically accountable" in that the weight value cannot be erroneously entered or changed.  Their weight chart can be printed out and taken to their provider's office for review.  

The secure eCare Area of the site allows self-monitoring and self-management of weight by the child.  If a child or teen's healthcare provider wishes, they may follow and interactively support their overweight pediatric clients via the eCare area on the website and in a personal "eCare Room" for each child.  Digital photographs of the child and the provider personalize these interactions. 

Does the Blubberbusters website or the Intervention system give medical advice?

The site does not do individualized weight management or offer medical advice but offers general suggestions and tips.  For example, the website has a school area which teaches children and teens about why they become overweight, what are the health risks, and what is safe weight loss  .  There are general tips to help parents and children change their eating and activity behaviors.   In addition, an online community of several thousand overweight children and teens provides interaction and support, including bulletin boards, chat rooms, and a community "weigh-in" page.  The interactivity is substantial and is accessible anytime day or night.  That's what kids like about it and that is why I think it works. 

What problems have you seen or do you see in utilizing Internet Intervention for overweight children?

1. Insurance reimbursement - Not until more outcome studies and data support the cost savings (weight loss, decrease in chronic conditions associated with overweight), will insurance companies reimburse for provider directed weight loss treatment and prevention programs. More pilot studies need to be done and data published to convince insurance companies that Internet intervention for overweight children is a good idea. 

2. Lack of health care providers trained in the use of eHealth technology in practice.  More medical and nursing schools need to implement eHealth courses in their curriculums to train health care providers for the future.  I am convinced that we could train nurses to mange and follow overweight children utilizing such an Overweight Internet Intervention system as this one.  More pilot studies utilizing this system with physician groups are needed to demonstrate that Internet Intervention is a viable tool in combating overweight in children and teens.

What other problems do you see?

1. Lack of school intervention.  School health and fitness programs need to be more involved and more committed in the fight to combat the overweight crisis of school aged children and teens.  Community awareness is there but community involvement is not.  School intervention programs have focused on feeding children but not on what we feed the children.  Physical activity also needs to be more strongly encouraged.

2. There is an acute need for a public awareness campaign on the serious health risks associated with childhood obesity.  67% of adults are overweight in the U.S.  Unfortunately, adults do not want to give up the high fat, high sugar foods that are used for entertainment, comfort, and as a stress coping mechanism.

Thank you Dr. Pretlow for your time and insight into such an important topic. 

For more information about eHealth International you can visit their website at You can also visit several of their interactive disease management websites at and  If you are a health care facility or provider interested in piloting a study utilizing the Overweight in Childhood Internet Intervention System
  contact Dr. Pretlow at or 425-827-3719.

(c) Copyright 2005, Carol M. Stock & Associates. All rights reserved.