Transforming Health Through Virtual Weight Loss Programs

Summary: How Telehealth Helps Patients Overcome the Challenges of Obesity Treatment

• US Obesity Rates Are Skyrocketing: Obesity is a chronic, complex, relapsing disease that affects millions of people in the US. Telehealth helps patients overcome the challenges present with traditional treatment. 
• Reduces Physical Barriers to Care: Patients can access their healthcare team remotely, avoiding long-distance travel.
• Improves Access to a Multi-disciplinary Care Team: Telemedicine connects patients with physicians, dietitians, behavioral counselors, and other care team members who may not be available locally.
• Enhances Patient Engagement: Remote wearable devices, virtual peer group support, mobile health apps, and Just-In-Time adaptive interventions help patients feel more engaged in their care.
• Provides Cost Savings: Virtual care can lower out-of-pocket patient costs for visits and medications. 
• Addresses Weight Stigma and Privacy Concerns: Patients can receive care from the comfort and privacy of their homes if they have concerns about social weight stigma.
• Improves Patient Adherence: Telehealth supports long-term weight loss through ongoing interventions, such as regular check-ins with their care team and lifestyle adjustments when needed. 

Introduction

Over the past 3 decades, the prevalence of obesity has skyrocketed. The obesity epidemic in the US contributes substantially to rising chronic disease rates, early mortality, and exorbitant healthcare costs. 

I’m an obesity medicine specialist who treats patients in a rural community that has one of the highest obesity rates in the country. Obesity is a challenging disease to manage — successful long-term weight loss requires a comprehensive team approach. In my community, there are no nutritionists or behavioral counselors who are experienced in obesity treatment. The closest weight management clinic is 2 hours away. In addition, many can’t afford the out-of-pocket costs of in-person visits.  My patients aren’t able to get the care they need in a traditional brick-and-mortar setting. Enter telehealth. 

Telemedicine helps people overcome some of the barriers to successful weight loss. It offers those suffering from obesity the opportunity to develop a personalized, comprehensive treatment plan with a multi-disciplinary team of healthcare providers from the comfort of their homes.

The evidence is clear. A 2024 systematic review of telemedicine’s effectiveness in obesity treatment, published in The Journal of Telemedicine and Telecare, found that telemedicine is an effective modality for managing weight loss. The authors of the study concluded:

“Customized telemedicine strategies have the potential to combat the obesity epidemic among older adults in the United States, offering guidance to healthcare professionals aiming to reduce health risks and enhance overall well-being.”

Telemedicine is at the forefront of the effort to decrease the rates of obesity and chronic disease. Virtual technology has the inherent ability to overcome the challenges that people with obesity face.

How problematic is obesity in the US?

Obesity is one of the most serious health crises of our time. Almost 75% of US adults are either overweight or obese; by 2050, that number is expected to grow to around 82%. The economic impact of obesity is astounding— the current cost exceeds $1.4 trillion a year. 

Obesity is linked to over 200 diseases, including diabetes, heart disease, cancer, and high blood pressure. It has been designated as a chronic disease by the American Medical Association, and research is ongoing to develop effective treatment options.

Obesity is a chronic, relapsing, lifelong disease that requires ongoing treatment and continuous support. However, less than 1% of people suffering from obesity currently receive treatment. In addition, only around 1% of US physicians are certified in obesity medicine. 

Many challenges exist in treating obesity in the current healthcare system. Telehealth can help bridge the gap between people suffering from obesity and access to evidence-based obesity treatment programs.

What are the four pillars of obesity management?

Extensive research has changed the dynamic of obesity; it’s no longer considered a personal issue with willpower, and the “eat less and move more” mantra is ineffective for most people.  Effective, sustained weight loss requires an evidence-based, comprehensive treatment plan. Studies show that intensive lifestyle modification is the cornerstone of a successful weight loss program. Medical and/or surgical interventions and lifelong support are integral to obesity management. 

Obesity management can be divided into four pillars: nutrition therapy, physical activity, behavioral modification, and medical interventions.

Nutrition Therapy:

Most people who suffer from obesity have diets that are high in ultra-processed foods. The first step to weight loss is diet modification. These dietary changes focus on calorie restriction by eating more whole grains, veggies, and lean proteins, while eating less ultra-processed foods. 

Obesity management guidelines recommend that patients have sixteen 30-minute visits with a registered dietitian in the first 6 months of treatment for intensive behavioral therapy, then at least one visit every other month for the rest of the year. These visits can occur either in person or online.  

Physical activity:

Current guidelines recommend that adults get at least 150-300 minutes of aerobic activity every week, combined with two days of strength training of all major muscle groups. Physical activity is a vital part of long-term weight loss. Physical therapists, exercise physiologists, or personal trainers can help patients formulate an exercise program to meet these goals. 

Behavioral Modification: 

Behavioral modification for weight loss can look like counseling for eating disorders, cognitive behavioral techniques to address emotional eating and triggers, or motivational interviewing to enhance commitment to the necessary changes. Behavioral therapy can also help resolve poor quality sleep or high stress levels, both of which have been shown to contribute to weight gain. 

Medical Intervention:

Medical intervention may be necessary if patients can’t lose weight by incorporating the first three pillars of treatment. Medical interventions include medications and surgical procedures. 

Several medications are FDA-approved for the treatment of obesity. These include the popular GLP-1 shots, such as semaglutide or tirzepatide.

Surgical options include the gastric sleeve,  the gastric bypass surgery, and other procedures that aren’t frequently used.

Effective, evidence-based obesity care requires a team approach. What does a comprehensive obesity care team look like? It can consist of any combination of the following:

Patients who participate in a comprehensive weight management plan that utilizes the four pillars of obesity management can lose an average of 21% of their total body weight, using weight loss shots. On average, patients who undergo bariatric surgery as part of their weight management plan can lose 30 to 38% of their total body weight.   

What are the barriers to long-term weight loss?

Less than 1% of people with obesity receive care from their healthcare provider. Several barriers prevent people from reaching out for help. 

• Physical barriers to care
• Lack of access to an interdisciplinary team
• Lack of patient engagement
• Cost of obesity treatment
• Weight stigma and patient discomfort
• Treatment adherence issues

How can telemedicine help those with obesity overcome the barriers to weight loss?

Telehealth —exchanging health information via technology between two locations— has revolutionized obesity treatment. Several telemedicine platforms, such as WW (Weight Watchers), Teladoc, and Noom, have developed comprehensive weight loss programs that help patients succeed in their weight loss journey. Weight loss telehealth platforms are booming, and that growth is expected to continue. 

Whether by increasing access to a multi-disciplinary team or offering virtual support groups, telemedicine is overcoming many barriers patients face to successful weight loss. Telemedicine is a successful weight loss modality because of the technology’s ability to reach people where they are. 

Telemedicine breaks down physical barriers to care.

Telemedicine allows patients to access healthcare from anywhere, at any time. Rural and underserved communities often lack local health services, particularly those required for effective weight management. Public transportation is limited or non-existent in many communities. Telemedicine platforms allow patients to connect with care no matter where they live. 

Telemedicine also helps patients reduce the time spent traveling and the associated travel costs by eliminating the need for in-person visits. Comprehensive obesity treatment requires multiple visits every month, which can be a financial burden to those living in remote areas who seek in-person care.  

Flexible scheduling of telemedicine visits helps patients who work or have kids. They no longer need to miss work or find childcare to attend their visits. 

Patients have better access to a multi-disciplinary team. 

Successful weight loss requires a team approach. Many patients don’t have access to in-person nutritionists or therapists, and there are few obesity medicine specialists in the US. 

Telemedicine platforms can incorporate all four pillars of obesity treatment into the treatment plan, streamlining patient care. People can connect with an obesity specialist for help with weight loss medications or referrals to bariatric surgeons. 

Online dietitians are also available for intensive behavioral counseling (IBC). IBC is the cornerstone of a comprehensive obesity treatment plan. IBC consists of at least 16 visits over 6 months with a registered dietitian. Patients may find it challenging to find time for those visits in a traditional setting, but nutritional counseling via telemedicine can help patients stay on track.  

The Academy of Nutrition and Dietetics Evidence-Based Practice Guideline recognizes the importance of offering IBC through telehealth platforms:

“The described recommendations have the potential to increase access to care and decrease costs through telehealth and group counseling as effective delivery methods, and to address other barriers to overweight and obesity management interventions.”

Telehealth enhances patient engagement.

Patients often feel more engaged in their obesity treatment program when using telehealth. By developing a personalized care plan with their online team, patients tend to have more buy-in. 

Telemedicine platforms that treat obesity often offer virtual support groups, further enhancing patient involvement. Patients can connect with others who suffer from obesity, leading to ongoing peer support.

Patients can also stay engaged by tracking goals using remote wearable devices. Remote wearable devices help patients monitor their progress in real-time. The team can remotely monitor weight, vitals, sleep quality, and daily physical activity. In addition, mobile health apps can help people track calorie and nutrient intake, which can be easily relayed to their team. 

Just-in-time adaptive interventions (JITAIs) are an advanced form of health apps and wearable devices that improve patient compliance and behaviors. JITAA can provide immediate patient support when patient behaviors change. For example, if a patient has set a goal of walking 30 minutes a day, and the tracker detects a decrease in physical activity, an instant message can be sent to the patient as a reminder of their goal. Similar interventions can be sent during peak snacking times and poor-quality sleep.

The authors of a 2022 review article titled  “The Potential Role of Digital Health in Obesity Care,” published in Advances in Therapy, had this to say:

“Existing technologies, such as telehealth and mobile health apps and wearable devices, offer emerging opportunities to improve access to obesity care and enhance the quality, efficiency, and cost-effectiveness of weight management interventions and long-term patient support.” 

Virtual care is a more cost-effective approach to weight loss programs.

Many insurance companies cover telehealth weight loss programs (including some Medicare and Medicaid plans), but some limit their coverage of obesity treatment. Some plans don’t cover the cost of weight loss visits to physicians and other care team members,  and many don’t pay for weight loss medications. Patients can bear the brunt of high out-of-pocket costs when seeking obesity treatment. 

Telemedicine can provide these services at a lower cost to both the patient and the healthcare provider.

Patients benefit from lower out-of-pocket costs when they utilize telemedicine for treatment. Telemedicine visits cost less, there are no transportation costs, and patients don’t need to miss work. In addition, telemedicine platforms can often offer weight loss medications at a lower price, saving the patient even more money. 

Healthcare providers can provide obesity treatment at reduced cost. The overhead costs are minimized because a brick-and-mortar facility requires costly upkeep, and fewer staff members are needed. 

Online care addresses concerns of weight stigma and privacy.

Many patients suffering from obesity experience social stigma related to their weight, which may cause them to avoid doctors’ offices. Telemedicine allows patients to have private consultations with their obesity team from home. Patients often feel more comfortable at home and have less weight-associated anxiety as compared to in-person visits. 

Telemedicine platforms offer secure, HIPAA-compliant sites that help patients feel more confident with their care. 

Telemedicine can improve patient adherence. 

The most important aspect of obesity management is recognizing obesity as a chronic, complex, relapsing disease. Obesity requires lifelong treatment just like high blood pressure or diabetes. Once patients lose weight, they are often lost to follow-up and are at high risk of regaining their weight. 

Telemedicine platforms can provide sustained support for patients with routine check-ins with their care team for ongoing motivation and lifestyle adjustments if needed. Virtual peer group support is also vital in long-term weight management. 

What does the future of obesity management via telemedicine look like? 

Artificial intelligence (AI) and machine learning are the future of obesity management. Treatment plans will become more personalized as the use of these technologies expands.

Data from a patient’s blood tests, genomic testing, remote wearable devices, and mobile health apps will be integrated into machine learning algorithms to formulate a precision, comprehensive treatment plan. 

AI behavioral chatbots are being developed to provide real-time psychological support for patients and promote ongoing education, treatment adherence, and overall health. 

Sources & Further Reading

• National Institute of Health: National-level and state-level prevalence of overweight and obesity among children, adolescents, and adults in the USA, 1990-2021, and forecasts up to 2050
• National Institute of Health: Health Risks of Overweight & Obesity
• Journal of the American Medical Association: Obesity Management in Adults A Review
• Obesity Science & Practice: Retention and weight outcomes after transitioning an intensive behavioral weight management program from an in‐person to a virtual format
• Obesity (Silver Spring): A Protocol to Deliver Intensive Behavioral Therapy (IBT) in Primary Care Settings: The MODEL-IBT Program 
• Advances in Therapy: The Potential Role of Digital Health in Obesity Care
• Obesity Action Coalition: The Future of Telehealth in Obesity Care