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Gary Glissman, RN, BS, who has logged more than 25 years in the home care trenches and is currently a information systems manager of I-trax Health Management Solutions, Inc., a disease management firm, addresses the obesity and technology challenge before us...and touches on these questions:

Do you think working with the obese population in usual home healthcare programs is do-able?
What about if a home care agency already has started a tele-monitoring program-- do you think it's much of a stretch to use some of the same tools (weight scale, telephone, diet planners, etc.) for an obese or more likely co-morbid patient population?
What types of patients do you think are more likely to succeed in losing weight (or otherwise doing more self management) with more frequent contact?

There's no question that targeting obesity in the plan of care for existing HH patients would produce results, for a number of reasons:

Patients are being monitored for change and improvement
They are more likely to respond to professional guidance and intervention
Their daily activities (eating and exercise) can be more closely managed/guided
There is an opportunity to develop a comprehensive plan with input from a physician, dietician, social worker, nursing and PT that would be very specific to the patient's situation and needs
It could allow for daily contact/reinforcement to follow a plan (especially if telehealth services were available)
Timely changes in the plan could be introduced if improvements were not occurring.

That's the positive side. The challenges with making this happen are also an issue:

HHA's are under severe pressure to treat, train and transition the most obvious conditions that qualify the patient for home care. Obesity is seldom (probably never) identified as the primary or even secondary problem. Therefore, little if any attention is given to it.
Agencies are not reimbursed for providing comprehensive treatment plans, therefore asking for nutrition consults, PT services or even physician input rarely happens.
The patient is not motivated to address obesity issues, and may not feel this is the right time to begin a weight loss program. They may feel overwhelmed with information and priorities.
Agencies may be limiting their patient contact to personal intermittent visits, and are only treating the primary problem (even though it may often be the result of a chronic obesity cause).

In general, the existing home care population would be excellent candidates for a telehealth obesity program, but it would require a paradigm shift in thinking by agencies, physicians and insurance plans. The key here is education, discussion and commitment on the part of all involved. If an agency were already using telehealth services, I would think it would be much easier to initiate an effective tele-obesity program....the tools are there, they just need to expand their use to this area of concern.

Existing research and experience clearly demonstrates that positive outcomes are often directly linked to the frequency and quality of personal contact. The benefits of this have been well documented in numerous studies involving more traditional telehealth disease management programs. In the area of obesity treatment, frequent contact has been a hallmark of some of the commercial weight loss programs (Jenny Craig, Weight Watchers, etc) where people have an opportunity to share their challenges, results and successes with other people on a scheduled basis. This serves as a continuous motivator for many individuals, and encourages them to adopt and continue behavior changes. It also provides an excellent opportunity for ongoing education. These two factors (education and motivation) are instrumental in helping people develop and maintain new behaviors.

The ability to provide frequent contact and dialogue with individuals without relying on them to commit time and resources to attend meetings would then intuitively seem to create possibilities of effectively reaching large numbers of people. Regular phone contact and Internet communications (daily e-mails, personalized messaging, individually designed educational materials and other resources) would produce the ability to reach out to individuals to create an electronic relationship, and to provide that extra element of education and motivation that can be so instrumental in the long-term success of treatment interventions.

With obesity treatment, it would seem important to establish an initial plan that is based on an individual's unique situation (age, weight, activity level, culture, wellness, other health conditions, socioeconomic factors, motivation, etc). Once that has been identified, a realistic communication plan designed for that individual could be designed. This might involve initial daily menus and activity schedules, the provision of educational materials relative to the person and situation, daily phone contact for a period of several weeks, and scheduled weight reports. It could also include motivational videos, conference calls with other professionals or patients, and a wide variety of additional materials that would serve as constant encouragement. The number of creative interventions that would be appropriate in this type of program is unlimited.

The characteristics of patients that would likely be successful in a program of this nature are very diverse. It would be advisable to have only a few prerequisites initially since patients that may have "failed" in the past using more traditional techniques could very well be more successful in a program of this nature. The ability to engage in telephone discussions and/or access an Internet connection is really the only criteria necessary. Even if the patient is cognitively impaired, a dedicated caregiver could be used to implement a successful program. It would seem reasonable to begin a program with liberal entrance criteria, and refine future enrollment based on direct experience.