Listen to the science

Our studies show that there is a significant difference in relative weight loss after one year of treatment with Evira compared to traditional treatment. Furthermore, treatment with Evira is less resource-intensive than the treatments that form the basis of the results presented under USPSTF in the figure.

The figure below shows the reduction in overweight in BMI SDS during the first year of treatment for randomly selected patients. BMI SDS is a relative measure of obesity used for children.

Evira has been evaluated clinically and in research contexts in various forms for several years. Treatment with Evira provides on average twice as good an effect compared to traditional treatment.

One-year study in clinical practice

In our one-year study together with prominent researchers from Karolinska Institutet, the first 107 patients at Martina Barnsjukhus Centrum för Vikthälsa used Evira’s platform and treatment method for one year. A matched control group of 321 patients was randomly selected from the national quality register BORIS who received traditional childhood obesity treatment during the same period. The intervention group using Evira had a relative weight loss of 0.30 BMI SDS units, compared to the control group who on average gained 0.15 BMI SDS units.

In addition to seeing twice as good treatment results with Evira compared to traditional treatment, we observed a significant effect on teenagers – a treatment group that has historically been very difficult to reach with traditional treatment.

Long-term effects of digital treatment for obesity: Three-year follow-up

This study from Karolinska Institutet, which is a follow-up to our previous one-year study and is based on the same cohort, shows that the relative weight loss achieved by children and young people with the digital treatment tool Evira after one year of treatment was maintained for up to three years.

Patients treated with the digital tool had more than twice the reduction in BMI SDS (degree of overweight) and a higher proportion reached below the obesity threshold compared to a group receiving conventional standard treatment.

The three-year pragmatic clinical study, which followed 428 children and young people aged 4–17 years, compared two groups: one treated with the digital tool Evira (n=107) and a control group receiving conventional standard treatment (n=321).

The prevalence of disordered eating behaviour and eating disorder diagnoses was investigated in the group receiving digital treatment throughout the treatment period and one year after treatment completion. During follow-up, three patients showed signs of disordered eating behaviour, all with pre-existing contact with specialist psychiatric care. No patient received an eating disorder diagnosis during the study.

Key results

• The relative weight loss, which was twice as large at one year compared to the control group, was maintained for up to three years in patients treated with the digital tool.
• Patients treated with the digital tool had a 70% higher chance of achieving remission, i.e. reaching below the obesity threshold, compared to patients receiving standard treatment.
• Adherence to treatment was higher in the group treated with the digital tool, where a significantly lower proportion discontinued treatment compared to patients in standard treatment.
• No patient treated with the digital tool developed an eating disorder diagnosis during treatment or the subsequent year.

Feasibility study

In Evira’s early stages, the platform was tested in a small feasibility study at three clinics over six months. The study showed good treatment efficacy after six months compared to traditional treatment, and also showed that patients and healthcare professionals were very satisfied with the platform.

Almost all in the intervention group using Evira reported that Evira helped them achieve their treatment goals, and that it was easier to get in touch with healthcare professionals at the clinic. Families using Evira were significantly more satisfied with the treatment outcomes compared to the control group.

Doctoral thesis by Linnea Johansson

Linnea Johansson, Ph. D, has in her doctoral thesis researched, among other things, mobile health interventions with Evira as the main focus. She highlights several important lessons learned about how to approach digital treatment and analyses what has and has not worked during Evira's development period. She concludes by stating that digital health interventions together with clinical visits, such as Evira, provide better treatment efficacy than behavioural treatment alone. Linnea also places great emphasis on the importance of the technical maturity of digital systems, and the importance of educating clinic staff on how clinical treatment with the help of digital support systems should be conducted.

Process evaluation of an RCT – how Evira went from prototype to scalable treatment tool

Between 2018–2019, a randomised controlled study was conducted using an early digital prototype tool for the treatment of children with obesity – a first step in the development of what is today Evira. Following the RCT, a process evaluation was carried out to identify challenges and insights related to implementation and use. These learnings have been central to the long-term, user-centred development work that has shaped Evira into the treatment tool it is today. Evira has since been further developed in close collaboration with healthcare professionals and patients to meet needs – both technically and pedagogically. Evira is now more intuitive, technically mature, and offers real-time support as well as structured training for healthcare providers. From an initial prototype, Evira has grown into an evidence-based, scalable tool – developed to work in practice.

Both the RCT and the process evaluation were conducted by researchers at Karolinska Institutet.

In addition to already published studies, we have a lot of other things in progress at Evira. Below you can read more about ongoing studies.

EurEvira is an international multicentre study 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 ongoing at the following locations in Europe:

Non-inferiority study in Abu Dhabi

Sheikh Shakhbout Medical City in Abu Dhabi has followed 60 patients treated with Evira for 26 weeks. The results have been compared with previously published data from Martina Vikthälsa. The aim was to investigate whether Evira's treatment method can achieve comparable results in a different cultural context.

Status: The study is completed and the article is under review.

Study Evira together with medication

In a randomised, controlled two-arm multicentre study, the effect of combining Evira with medication for obesity will be evaluated at clinics in Sweden. The primary outcome is to assess whether the combination improves treatment results compared to treatment with medication alone.

Status: The study is ongoing and continues to recruit clinics. Contact us louise@evira.se if you are interested in participating.

The medication study is ongoing at the following clinics:

Eating disorders and disordered eating behaviour (ED & DEB)

Evira has several ongoing studies concerning eating disorders and disordered eating behaviours.

– A retrospective review of patient records for 315 children treated with Evira examines whether Evira affects the prevalence of ED/DEB during or after treatment.

Status: Data analysis and article writing are in progress.

– A comprehensive literature review is currently compiling existing evidence for ED and DEB in obesity treatment.

Status: Article writing is in progress.

Family treatment study

Karolinska Institutet is conducting a study where at least one child and one parent with obesity are treated together with Evira in primary care. The hypothesis is that care for families where both children and adults have obesity can be facilitated and made more efficient without compromising results if they are treated jointly with Evira, and that the results will be more lasting when the entire family is involved.

Status: Study completed. Data analysis is in progress.

Implementation studies

Through several sub-studies (two ongoing ones are listed below), it is being investigated how Evira has been implemented in paediatric clinics that simultaneously treat many other diagnoses and what results are achieved:

– The first sub-study focuses on the reception of Evira at clinics, 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 compared to a matched control group from BORIS who received standard treatment.

Status: Article under review.