Telemedicine offers emerging opportunities to reduce barriers to obesity care faced by healthcare providers, patients and health plans, according to a paper published online in Obesity journal. In particular, the study's authors note that poor access to healthcare providers with training in obesity medicine and interdisciplinary treatment teams poses a significant barrier to effective care. The authors add that geographic barriers, particularly in rural areas, further reduce access to care.
"Healthcare providers and policymakers increasingly recognise the potential of telemedicine and remote healthcare," said Dr Scott Kahan, director of the National Center for Weight and Wellness, Washington DC, and instructor at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, and lead author of the paper, ‘Telemedicine in Obesity Care’, published in Obesity. "Use of telemedicine for the management of chronic diseases, including obesity, is vital to support access to high-quality healthcare, especially for persons with limited mobility, those who are under- or uninsured and those living in geographical areas with limited healthcare options."
The authors noted that access may also be limited by a perceived shortage of time and the relatively low priority given to obesity treatment during primary care office visits.
It has been estimated that by 2030 nearly 80% of adults in the US will have pre-obesity or obesity. Despite the continued increase in obesity prevalence and the challenges for many patients to lose and maintain weight, use of guideline-supported treatments, such as pharmacotherapy, intensive behavioural therapy and bariatric surgery, remains underutilised, according to the study's authors.
Notable barriers to use of these treatments and to effective long-term weight management include limited access to specialized care, high cost, limited availability of trained obesity medicine and weight management specialists and limited insurance coverage.
In a 2016 report by the US Department of Health and Human Services, it was estimated that 61% of healthcare institutions in the US were using some version of telemedicine. The COVID-19 pandemic has driven the rapid expansion of telemedicine as most patients have been unable, unwilling or dissuaded from in-person care. According to the Centers for Disease Control and Prevention, there was a 154% increase in telehealth visits during the first year of the COVID-19 pandemic.
The authors argue there are multiple opportunities for telemedicine to address key barriers for improving obesity treatment. Primary care providers can make referrals to specialists beyond their geographic locations to improve access to care. A randomised clinical trial consisting of males and females that were socioeconomically disadvantaged with obesity and elevated risk for cardiovascular disease demonstrated greater weight loss with a digital app and clinician counselling.
Virtual interactions between patients and healthcare providers may be less expensive and more cost effective than in-person visits. In one study by Spring et al., researchers evaluated individual components of behavioural obesity treatments, including those delivered remotely, to assess their cost-effectiveness in contributing to weight loss over a period of six months.
The combination of treatment packages - including a smartphone application, personalized goals, online lessons, 12 coaching calls, a support buddy and progress reports sent to a primary care provider - led to nearly 60% of participants losing at least 5% of baseline body weight, a magnitude of weight loss that leads to improvements in diabetes, cardiovascular risk and health-related quality of life.
By decreasing the time and resource commitments needed for frequent counselling appointments, telemedicine may also help improve long-term adherence. In one study, patients who participated in a weight-loss intervention visit via videoconference, compared with those who attended in person, showed a 96% retention rate for those who participated virtually, compared to 70% for the in-person group.
Challenges for use of telemedicine include the need for training of healthcare providers to implement remote healthcare and the licensing of secure videoconferencing software compliant with the Health Insurance Portability and Accountability Act. Other limitations may include patient access to reliable internet connection and concerns regarding insurance reimbursement.
Kahan and co-authors explain that future research should focus on patient engagement, retention and evaluation of patient phenotypes that may contribute to improved long-term outcomes in virtual-only programs. Optimal patient profiles (e.g., extent of obesity comorbidities) should be considered for prescribing pharmacotherapy via telemedicine.
Co-authors of the study include Michelle Look, San Diego Sports Medicine and Family Health Center, University of California–San Diego and Angela Fitch, Massachusetts General Hospital Weight Center and Harvard Medical School, Boston, MA.
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