We all know that we are amidst an epidemic of obesity, with more than 40% of the US population affected.
What is less well known is that obesity is a vastly undertreated chronic disease, and that telehealth may be revolutionizing access to obesity care for our patients. Here are some thoughts for fellow health care professionals who may want to learn more about options for obesity treatment for their patients (or for themselves!), with a focus on how telehealth has changed a landscape that was already evolving quickly.
Less than 3% of people with obesity receive medical treatment for it. Access to specialized medical care is limited, in part because there are less than 5,000 doctors who are accredited by the American Board of Obesity Medicine (ABOM) in the entire country, and most of them practice in urban areas.
Physicians across the board, including those in primary care, consistently identify lack of training and lack of time as barriers to addressing obesity in clinical practice. Another enormous limitation to evidence-based obesity treatment is the reality that most Americans do not have insurance coverage for anti-obesity medications, most of which are still brand-name only due to their relatively recent FDA approval. While coverage for metabolic surgery options is broader, there are still a lot of hurdles to qualify for covered services.
“Obesity is a vastly undertreated chronic disease, and that telehealth may be revolutionizing access to obesity care for our patients.”
While of course telehealth does not address all of these barriers, it may transform the future of the field. The exponential adoption of telehealth during the COVID-19 pandemic has made it easier to connect with physicians who have specialized training and certification in obesity care. This is particularly impactful for those living in more distant geographic regions, or for those with difficulty making a trip to an in-person clinic. Telehealth has also expanded access to a mutli-discplinary team, making it more convenient to work with Registered Dietitians, exercise physiologists, and mental health professionals.
Even before the pandemic, many studies supported the efficacy of incorporating telehealth check-ins for weight management interventions. Studies showed similar or sometimes better results and high patient satisfaction and engagement. In general, weight loss research consistently shows that more frequent care team interactions yields more pounds lost. Because virtual appointments can be more frequent, with no need to take time off from work, or arrange childcare, telehealth often enables increased contact and therefore improved results. More recently, weight treatment programs across the country are reporting that telehealth during the pandemic enabled them to deliver great care and great results.
Incorporating telehealth into obesity care may have additional benefits. It may lower the cost of care, both because eliminating travel often reduces the cost of visits to a patient, and because of decreased overhead costs to the healthcare entity, with comparable reimbursement –many states have implemented ‘parity’ regulations that require insurance companies to cover telemedicine visits the same way they cover in-person visits. Telehealth also brings a degree of privacy and comfort that some living with obesity appreciate, as bias, shame and stigma (even within medical settings) are reported patient barriers to obtaining weight care. The impact will need to continue to be studied, so we can have a full understanding of the positives and the limitations, as telehealth will not be the best solution for every individual or every situation.
It is also worth noting that not all telehealth services are created equal, because these distinctions become important when evaluating the choices our patients have to receive care, and, let’s be honest, what we can feel good about recommending. Telemedicine specifically refers to the use of live video conferencing to provide clinical services. Telehealth, defined as technology-enabled health care delivery, also includes interactions that are much less like a traditional clinical visit, such as a transfer of medical information in writing (asynchronous care), or store-and-forward options, where patients receive recorded content.
So, as telehealth obesity care options become increasingly available to our patients, it’s important for us to know how to help them evaluate programs, and for us to feel good about supporting their participation in the programs as part of their health care. Here are some key questions that I would highlight to evaluate the options that are out there.
Who will be providing medical care? Will the patient be evaluated by a doctor who is medically trained to treat obesity and has certifications to verify that training (such as American Board of Obesity Medicine)? Are they licensed providers in the patient’s state and do they have other reputable credentials (such as board certification in their primary specialty)? This information should be publicly available, as a matter of law in many states, so if it is very difficult to find, that is a red flag.
Who will be providing medical care? Will the patient be evaluated by a doctor who is medically trained to treat obesity and has certifications to verify that training (such as American Board of Obesity Medicine)? Click To Tweet
What is the care model? Different programs offer different services, and this is not a bad thing, as patients have different needs. But it is important to understand who the patient will be working with regularly. For example, how often will they see a doctor? Is it always the same doctor? And what are the credentials of other members of the team? Working with a Registered Licensed Dietitian is standard at most academic programs and in some telehealth offerings. If the care is provided by a health coach, what are their credentials? There is not enough standardization in this emerging area, and coaches can be anything from college graduates with minimal on-the-job training, to professionals, including physicians, who have undergone rigorous training programs for certification.
What is the spectrum of tools the team recommends for weight loss? The most important thing here is to beware that many weight loss offerings around the country support tools that are not evidence-based, including unregulated supplements that have been reported to have serious adverse events. The programs we want for our patients use only FDA-approved tools, including medical grade meal replacements and medications. Beyond this, some programs offer a broader toolkit of nutrition and behavioral strategies, and flexibility to find what is best for individual patients. Others have more rigid protocols. At worst, they won’t deviate from specific interventions such as a specific type of diet, or even kick people out if they do not lose a certain amount of weight.
What do telehealth appointments look like? As we reviewed, telehealth encompasses a variety of care delivery options. What can count legally as a check-in may be different from what we envision when we think about a patient getting medical care for a chronic medical condition with broad impact on their health. I recommend understanding if appointments are via video, phone, a check-in by email, or review of a questionnaire. It’s important that the patient is using a model that works for them and that you feel comfortable that the care is appropriate for their level of medical complexity.
What can count legally as a check-in may be different from what we envision when we think about a patient getting medical care for a chronic medical condition with broad impact on their health. Click To Tweet
What kind of support do patients receive between visits? Another aspect that has come to light as differentiating the telehealth medical weight loss programs that are available is whether patients can ask questions of their care team in between appointments. If patients are engaging in significant lifestyle change and especially if they are being prescribed medications, side effects and adverse events are going to happen. The medical team should be appropriately available for the patient as a basic safety precaution.
How long does the support last? Obesity is a chronic disease. Crash interventions rarely work, because a lot of physiology drives weight regain after weight loss. Recently approved weight loss medications have long-term indications for use, and data support that weight regain is common with discontinuation. So a trustworthy medical program should have plans for patient support once weight loss goals are met. Is there continued care available? Is there a maintenance offering?
Is there an option or a requirement for in-person visits? Some programs require starting with an in-person visit, and sometimes for follow-ups. Others are fully virtual. There may be pros and cons with each, so be sure your patients know what will be expected of and available to them.
What is the cost? Cost structures of medical weight loss programs vary greatly. Anyone considering weight care should understand the possible costs, and anything that signals there may be hidden costs.
Anyone considering weight care should understand the possible costs, and anything that signals there may be hidden costs. Click To Tweet
Some services are covered by insurance, some are self-pay. Some lock a patient in for a predetermined time, like one year, and others allow cancellation. There is also a lot of misinformation about insurance coverage, coupons, and other payment options for anti-obesity medications (feel free to message me if you have questions about this; I can help!)
The recent increase in adoption of telehealth has changed healthcare. Decades of research and treatment advances have also changed the tools we have to treat overweight and obesity as chronic medical conditions. Telehealth represents a tremendous opportunity to expand access to expert care for obesity, and could help people achieve a healthier weight to improve their health. As new obesity treatment options emerge, it will be relevant to all health care professionals, regardless of specialty, to help people with obesity navigate these options, with the goal of achieving long term success. More research is needed to better understand how telehealth can be leveraged to help our society manage the obesity epidemic, and help individuals living with obesity. But in all likelihood, future treatment options will increasingly involve logging on, rather than driving in.