Virtual visits confer similar weight loss to in-person visits for adults with obesity
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SAN DIEGO — Adults with obesity who attended virtual pharmacotherapy visits had a similar weight loss compared with those who attended in-person visits, according to study presented here.
In findings from a randomized controlled trial, adults with obesity who exclusively used telemedicine lost 6.5% of body weight from baseline to 12 weeks compared with a weight loss of 7.7% for adults attending in-person visits. There was no significant difference in weight loss between the two arms.
“We changed so fast to virtual visits and telemedicine in a matter of days with COVID-19,” Marcio L. Griebeler, MD, an obesity specialist at Cleveland Clinic’s Endocrinology & Metabolism Institute, told Healio. “We were almost 100% virtual in the first few weeks of the pandemic, and now a good chunk of our care is virtual. We learned that it’s convenient, the patients like it, we like it, sometimes we can work from home and the patients can be at home. But it’s new, and we needed to prove that the use of telemedicine or virtual care was sufficient to prescribe these obesity medications. What we tried to prove was that virtual visits were as good as, not better, as in-person. That’s the reason we did a noninferiority study.”
Griebeler and colleagues enrolled 70 adults aged 16 to 65 years who had obesity or overweight and one or more comorbidities. All participants owned a smartphone and were able and willing to join an online virtual visit platform to participate in the trial (90% women; mean age, 42.2 years; mean BMI, 41.2 kg/m2). Participants were randomly assigned to attend a virtual or in-person weight management program for 12 weeks. The study took place from December 2020 to August 2021 at the Cleveland Clinic. Participants in both groups were prescribed 37.5 mg phentermine at baseline and were instructed to take half a tablet per day for 2 weeks, followed by a full tablet if tolerated for the remainder of the trial. All baseline visits took place in-person. Follow-up visits occurred at 4, 8 and 12 weeks. Weight and vital signs were collected at each visit, with the virtual group using a remote scale and remote blood pressure cuff linked to Cleveland Clinic’s electronic medical record database. Modifiable lifestyle factors and educational topics were discussed at each visit. The primary endpoint was the percent change in body weight from baseline to 12 weeks.
Study results were also published in Obesity.
Similar weight loss with virtual, in-person care
There were 59 adults who completed the trial and had final weight measurements recorded, including 34 in the virtual visit group and 25 in the in-person group. At 4 weeks, the virtual group had a mean weight loss of 4.3% compared with 3.4% for the in-person group. At 8 weeks, the virtual group had a 6% weight loss compared with a 5.1% weight loss for in-person participants. At 12 weeks, the mean weight loss in the virtual group was 6.6% vs. 7.7% for the in-person group. At all three time points, the weight loss in the virtual group was noninferior compared with the in-person group.
At 12 weeks, 65% of virtual attendees and 71% of the in-person cohort had a weight-loss reduction of at least 5%, with no significant difference between the groups. There was also no difference in the percentage of participants who adhered to scheduled visits.
Phentermine tolerated by most
Medication tolerance, adherence and compliance were similar between the groups. The full dose of phentermine was tolerated by 85.7% of the virtual group and 90% of the in-person group. No serious adverse events occurred during the trial.
“This will solidify the use of telemedicine, specifically for weight management,” Griebeler said. “We provided the same care as in-person. ... Providers will feel safe in doing telemedicine because most care for obesity can be done virtually. If you have support, if you follow guidelines, if you get the vital signs when you are filling the prescription, if you have them weighed, then you should be fine.”
Griebeler said longer trials are needed to analyze whether telemedicine is noninferior to in-person care for long-term weight-loss maintenance. He added that future studies should also examine the impact of virtual coaching and physical activity interventions on weight loss compared with conventional care.
Reference:
Griebeler ML, et al. Obesity. 2022;doi:10.1002/oby.23548.
For more information:
Marcio L. Griebeler, MD, can be reached at griebem@ccf.org.
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Griebeler ML. O-099. Presented at: ObesityWeek; Nov. 1-4, 2022; San Diego.
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