Significantly greater relative weight loss
Our studies show that there is a significant difference in relative weight loss after one year of treatment with Evira compared to traditional treatment. The treatment with Evira is also less resource-intensive than the treatments that form the basis of the results presented under the USPSTF in the figure.
​
The figure below shows the reduction of overweight in BMI SDS during a first year of treatment in randomly selected patients. BMI SDS is a relative measure of obesity used for children.
Comparison between treatment results in BMI SDS after one year of treatment with Evira and traditional treatment according to the Child Obesity Register in Sweden (BORIS) as well as results presented in a meta-study for children who received at least 26 hours of professional support over a year compiled by USPSTF.
Significantly better
than traditional treatment
Evira has been validated in clinical studies and used in clinical practice for several years with very good results.
Happier families
In one of our studies, 78% of families were satisfied with the treatment results after one year of treatment with Evira compared to only 11% among parents in traditional treatment.
Fewer canceled visits
Among patients treated with Evira, the number of canceled visits decreased by 45% during a
six-month period, where only
40% of patients canceled at least one visit, compared to 85% with traditional treatment.
Lower cost
Evira has unmatched results in clinical studies for children where no drugs or surgery were used. Those who received treatment with Evira had, on average, twice as good a treatment effect compared to corresponding groups who received traditional treatment in Sweden.
Research about Evira
Evira has been clinically evaluated and studied in research settings in various forms over several years. Treatment with Evira yields, on average, twice the effect compared to traditional treatment.
One-year study in clinical practice
In our one-year study, that we carried out together with prominent researchers from Karolinska Institutet, the first 107 patients at the Martina Children's Hospital Center for Weight Health were able to use Evira's platform and treatment method for a year. A matched control group of 321 patients, who were randomly selected from the national quality register BORIS, received traditional childhood obesity treatment during the same time period. The intervention group using Evira had a relative weight loss of 0.30 BMI SDS units, compared to the control group which averaged 0.15 BMI SDS units.
Mean change in BMI SDS for Evira patients (dark gray) and the control group of BORIS patients (light gray) after 1 year of treatment divided by sex, age and degree of obesity in the 1-year study.
​
In addition to being able to see twice as good treatment results with Evira compared to traditional treatment, we were able to see a big effect on teenagers - a treatment group which traditionally has been very difficult to reach with traditional treatment.
​
Long-term effects of digital obesity treatment: Three-year follow-up study
This study from Karolinska Institutet, following up on our previous one-year study and based on the same cohort, shows that the relative weight reduction achieved by children and adolescents using the digital treatment tool Evira after one year of treatment was maintained for up to three years.
Patients treated with the digital tool experienced more than twice the reduction in BMI SDS (degree of overweight) and a higher proportion achieved remission from obesity compared to those receiving conventional standard care.
Mean change in BMI Z-score for patients in the digi-physical treatment group (dotted line) and the standard treatment group (dashed line) over three years, adjusted for sex, age, and degree of obesity at treatment initiation.
​
The three-year pragmatic clinical study, which followed 428 children and adolescents aged 4–17 years, compared two groups: one treated with the digital tool Evira (n=107) and a control group receiving conventional standard
care (n=321).
​
The prevalence of disordered eating behaviors and eating disorder diagnoses was examined in the group receiving digital treatment throughout the entire treatment period and for one year after completion. During follow-up, three patients showed signs of disordered eating behavior, all of whom were already in contact with specialist psychiatric care. No patient was diagnosed with an eating disorder during the study.
​
Key findings:
-
Patients using the digital tool lost twice as much relative weight as the control group after one year and maintained their weight loss for up to three years.
-
Those treated with the digital tool were 70% more likely to achieve remission, i.e reach a BMI below the obesity threshold, compared to those receiving standard treatment.
-
Treatment adherence was higher in the digital tool group, with significantly fewer patients dropping out compared to standard treatment.
-
No patient using the digital tool developed an eating disorder diagnosis during treatment or in the year that followed.
​​
Feasibility study
During Evira’s initial phase, the platform was tested in a small feasibility study at three clinics over a period of six months. The study showed a good treatment effect after six months compared to traditional treatment, and showed that patients and therapists were very satisfied with the platform.
.png)
Change in BMI SDS from baseline to follow-up at three and six months for intervention and control groups in the feasibility study.
​
Almost everyone in the intervention group who used Evira reported that Evira helped them reach their treatment goals, and that it was easier to get in touch with health care provider at the clinic. The families who used Evira were significantly more satisfied with the treatment results compared to the control group.
​
Doctoral thesis by Linnea Johansson
Linnea Johansson, Ph. D, has researched mobile health interventions with Evira as the main focus in her doctoral thesis. She brings up several important lessons about how to think about digital treatment and analyzes what worked and what didn't work during Evira's development period. She concludes by stating that digital health interventions together with clinical visits, such as Evira, provide a better treatment effect than behavioral treatment alone. Linnea also places great emphasis on the importance of technical maturity of digital systems, as well as the importance of teaching clinical staff how treatment with the help of digital support systems should be carried out.
Process Evaluation of an RCT – How Evira Evolved from Prototype to Scalable Treatment Tool
In 2018–2019, a randomized controlled trial (RCT) was conducted using an early-stage digital prototype designed to support the treatment of children with obesity – the first step in what would later become Evira. Following the RCT, a process evaluation was carried out to identify challenges and insights related to implementation and usage. These learnings have been central to the long-term, user-centered development that has shaped Evira into the treatment tool it is today. Since then, Evira has been further developed in close collaboration with healthcare professionals and patients, addressing both technical and pedagogical needs. The tool is now more intuitive, technologically mature, and offers real-time support as well as structured training for care providers. From an early prototype, Evira has grown into a scalable, evidence-based solution – built to function in real-world clinical practice. Both the RCT and the process evaluation were conducted by researchers at Karolinska Institutet.
Published research
Process Evaluation of a Randomized Controlled Trial With a Mobile Health Intervention for Children With Obesity. Linnea Hedin, Maria Hagströmer, Claude Marcus, Pernilla Danielsson, Sage Open Pediatrics, online 25 June 2025, doi: 10.1177/30502225251348292
​
Long-term results of a digital treatment tool as an add-on to pediatric obesity lifestyle treatment: a 3-year pragmatic clinical trial. Emilia Hagman, Louise Lindberg, Resthie R. Putri, Andreas Drangel, Claude Marcus, Pernilla Danielsson, International Journal of Obesity, online 12 March 2025, doi: 10.1038/s41366-025-01738-0.
​​
Effect of an interactive mobile health support system and daily weight measurements for pediatric obesity treatment, a one-year pragmatical clinical trial. Emilia Hagman, Linnea Johansson, Claude Kollin, Erik Marcus, Andreas Drangel, Love Marcus, Claude Marcus, Pernilla Danielsson, International Journal of Obesity, online 31 May 2022, doi: 10.1038/s41366-022-01146-8.
Mobile Health interventiopns and cardiorespiratory fitness in pediatric obesity.​ Linnea Johansson, Thesis for doctoral degree(Ph.D) 2022. Karolinska Institutet. ISBN: 978-91-8016-515-0
A novel interactive mobile health support system for pediatric obesity treatment: a randomized controlled feasibility trial. Linnea Johansson, Emilia Hagman, Pernilla Danielsson, BMC Pediatrics, online 23 September 2020, doi: 10.1186/s12887-020-02338-9
Ongoing Research
In addition to already published studies, there is a lot more happening at Evira. Below, you can read more about our ongoing research projects.
EurEvira - international multicenter study
EurEvira is an international multicenter study that is ongoing in several European countries to evaluate how Evira together with local childhood obesity treatment works in countries other than Sweden.
​​
The study is currently being conducted at the following sites in Europe:
Non-Inferiority Study in Abu Dhabi
Sheikh Shakhbout Medical City in Abu Dhabi has followed 60 patients treated with Evira over a 26-week period. The results have been compared to previously published data from Martina Vikthälsa. The aim was to investigate whether Evira’s treatment approach can achieve comparable outcomes in a different cultural context.
Status: The study has been completed and the article is currently under peer review.
Evira in Combination with Anti-Obesity Medication
A randomized, controlled, two-arm multicenter study is currently evaluating the effect of combining Evira with pharmacological treatment for obesity at clinics across Sweden. The primary outcome is to assess whether the combination improves treatment results compared to medication alone.
Status: The study is ongoing, and clinics are still being recruited. Please contact louise@evira.se if you are interested in participating.
Eating Disorders and Disordered Eating Behavior (ED & DEB)
Evira is involved in several ongoing studies related to eating disorders and disordered eating behaviors:
– A retrospective medical chart review of 315 children treated with Evira investigates whether the tool influences the prevalence of ED/DEB during or after treatment.
Status: Data analysis and manuscript preparation are ongoing.
– A comprehensive literature review is currently summarizing existing evidence on ED and DEB in the context of obesity treatment.
Status: Manuscript preparation is ongoing.
Family-Based Treatment Study
Karolinska Institutet is conducting a study in which at least one child and one parent with obesity are treated together using Evira within the primary care setting. The hypothesis is that care for families where both children and adults are affected by obesity can be streamlined and improved without compromising results when treated jointly with Evira. Furthermore, outcomes are expected to be more sustainable when the whole family is involved.
Status: Recruitment of study participants is ongoing.
Implementation Studies
Through several sub-studies (two of which are currently active), researchers are exploring how Evira is implemented at pediatric clinics that also handle a wide range of other diagnoses, and what results are achieved:
– The first sub-study focuses on the clinical reception of Evira, patient selection, and acceptance.
– The second sub-study is a retrospective cohort study comparing treatment outcomes in children aged 3–5 years treated with Evira versus a matched control group from the BORIS registry who received standard care.
