Addressing disparities: A systematic review of digital health equity for adolescent obesity prevention and management interventions.

Adolescence is a high-risk life stage for obesity. Digital strategies are needed to prevent and manage obesity among adolescents. We assessed if digital health interventions are contributing to disparities in obesity outcomes and assessed the adequacy of reporting of digital health equity criteria across four levels of influence within the digital environment. The systematic search was conducted on 10 major electronic databases and limited to randomized controlled trials (RCTs) or cluster-RCTs for prevention or management of obesity among 10-19 year olds. Primary outcome was mean body mass index (BMI), or BMI z-score change. The Adapted Digital Health Equity Assessment Framework was applied to all studies. Thirty-three articles (27 unique studies with 8483 participants) were identified, with only eight studies targeting adolescents from disadvantaged populations. Post-intervention, only three studies reported significantly lower BMI outcomes in the intervention compared to control. Of the 432 digital health equity criteria assessed across 27 studies, 82% of criteria were "not addressed." Studies are not addressing digital health equity criteria or inadequately reporting information to assess if digital health interventions are contributing to disparities in obesity outcomes. Enhanced reporting is needed to inform decision-makers and support the development of equitable interventions to prevent and manage obesity among adolescents.