Dr. Beverly Tchang
Obesity in the United States continues to contribute to a significant increase in disease and death as well as to the financial burden to both patients and the public. The COVID-19 pandemic further intensified these personal and public health burdens associated with obesity with the establishment of mandatory lockdowns and stay-at-home guidelines. During this period, patients reported increased anxiety and depression and were less likely to achieve their weight loss goals. As in other specialties, access to care moved primarily to telemedicine consults as opposed to in-person visits.
Beverly G. Tchang, MD, an endocrinologist in the Department of Endocrinology, Diabetes, and Metabolism, NewYork-Presbyterian/
This retrospective observational study is the first to describe weight loss outcomes in patients with medically managed obesity across a telemedicine transition.
Dr. Tchang and the team reviewed the charts of 245 new patients with established care for medically managed overweight/obesity (BMI ≥ 25 kg/m2) at the Weill Cornell Comprehensive Weight Control Center during September to November 2019 and May to July 2020 and who completed 6 months of follow-up.
During these periods, the Center employed 10 physicians, including four endocrinologists, one nurse practitioner, and three registered dietitians. Patients who attended in-person visits were weighed in person; those participating in video visits self-reported weights from home scales or other medical office visits. The primary outcomes were percent of weight loss from the initial visit, the proportion of patients who achieved clinically significant weight loss defined as ≥ 5 percent weight loss, and the proportion of patients who achieved ≥ 10 percent weight loss.
Of an initial 541 charts, 245 (49 percent) records were analyzed. Of these patients:
- 69 had in-person visits only
- 85 had in-person and video visits (hybrid)
- 91 had video visits only
The three cohorts consisted of predominantly white females with median ages of 56, 49, and 49 years, respectively. The baseline median weights were 98.9, 96.8, and 93.0 kg; and baseline median BMIs were 35.3, 34.4, and 34.0 kg/m2 for in-person, hybrid, and video cohorts, respectively. The most common comorbidities among all the patients were hyperlipidemia followed by hypertension or prediabetes.
The study findings, which were published in the March 10, 2022, issue of Frontiers in Endocrinology, indicated that the median percent weight changes over six months were not significantly different among cohorts:
- -4.3 percent in the in-person cohort [-8.5, -1.5]
- -5.6 percent in the hybrid group [-8.7, -2.2]
- -5.8 percent in the video cohort [-9.7, -2.4]
- percent of patients who achieved ≥5 percent weight loss were also similar: 46.4 percent, 55.3 percent, and 59.3 percent, respectively
- median number of visits in the video cohort was more than in the in-person or hybrid groups (5 versus 4)
- median number of anti-obesity medications prescribed was similar among groups, with metformin the most prescribed followed by semaglutide or topiramate
The authors concluded that the implementation of telemedicine brought about by the COVID-19 pandemic is driving a paradigm shift in the delivery of patient care. They noted, “Our exploratory data suggest that telemedicine was similarly effective to in-person visits for weight loss outcomes over this time frame. In the field of obesity medicine, telehealth might be a strategy to reach specific racial/ethnic populations who are at higher risk of obesity. Further studies are needed to guide health professionals in the use of video visits as part of obesity management.”
“A number of studies point to weight gain as another consequence of the pandemic,” says Laura C. Alonso, MD, Chief of Endocrinology, Diabetes, and Metabolism at NewYork-Presbyterian/Weill Cornell Medical Center. “Remarkably, the results of this research by the Weill Cornell Comprehensive Weight Control Center showed that patients lost on average 4 to 5 percent of their body weight – impressive outcomes especially during the pandemic.”