Telemedicine Weight Loss Interventions During COVID-19 Prove Comparable to On-site Care

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Weight loss outcomes during the COVID-19 pandemic were similar for patients with overweight or obesity who had only telemedicine visits, had only in-person visits, and who had a combination of both, according to data presented at ObesityWeek 2021.

Researchers led by Chenel Morrison of Weill Cornell Medicine in New York were interested in how the rapid shift to telemedicine as a means of maintaining and expanding patient care would impact weight loss outcomes and weight management practices. They identified 516 charts eligible for review of patients who established care at the Weill Cornell Comprehensive Weight Control Center during September-November 2019 and May-July 2020.

After excluding patients who did not return for a follow-up visit within 6 ± 3 months or who were missing relevant data, 245 (47.5%) were included in their final analysis. Within this group, 69 presented for in-person visits only (in-person); 91 had video visits only (video); and 85 began the program in-person and switched to video visits later (hybrid).

In the in-person, video, and hybrid groups, median ages were 56, 49, and 49 years, respectively; baseline median weights were 98.9, 96.8, and 93.0 kg, also respectively.

After 6 months of follow-up Morrison et al report that the median percent weight loss was not significantly different among the 3 groups nor was there a significant difference in the proportion of each group that achieved weight loss of ≥5% (table).

The median number of visits over the 6-month follow-up was 4 for in-person and hybrid groups and 5 for the video cohort. Antiobesity medications were used in all groups with a median of 1 for the for the in-person group and 2 for the hybrid and video cohorts. The most common drugs prescribed were metformin (all groups) followed by semaglutide (in-person, video) or topiramate (hybrid).

Based on the comparable outcomes for the telemedicine-only group when compared to the in-person and hybrid visit groups the authors state that video-visits appear to be an effective component of a weight management strategy and require further exploration vs clinic visits.

Another group of investigators presenting at ObesityWeek 2021 came to similar conclusions after exploring the potential effect on weight loss of a “telemedically” delivered low-carbohydrate intervention with nutritional ketosis (NKI).

Led by Shaminie J. Athinarayanan, PhD, of Virta Health in San Francisco, this team identified 746 patients with BMI ≥25kg/m2 enrolled from January to March 2020 and treated for at least 1 year in the NKI program (pandemic cohort, PC) and a group of 699 patients who received 1 year of the NKI in the preceding years (enrolled in 2018) (pre-pandemic cohort, Pre-PC). The researchers assessed within- and between-group differences in 1-year weight loss. Age and baseline weight were similar for the groups.

Athinarayanan et al report weight loss of 7.2% in the PC cohort (-8.1±0.3 kg from baseline, p<.001) and loss of 8.4% in the Pre-PC cohort (-9.5±0.4 kg from baseline, p<.001) over 1 yr. Absolute weight and percentage of weight lost did not differ between the cohorts.

The efficacy of a very low carbohydrate intervention was comparable before and during the pandemic, they write, resulting in clinically significant weight loss. “Lifestyle changes and limited on-site treatment accessibility associated with [the] pandemic did not affect this intervention delivered telemedically.

Echoing Morrison et al, the investigators call for additional studies to assess factors associated with continued success of remote intervention during the pandemic.