Dangers and Benefits of Treating Obesity via Telehealth

Telehealth is being increasingly utilized to improve access to obesity treatment. At the same time, emerging evidence links Ozempic and other novel weight-loss drugs to severe side effects. Is it safe to prescribe these medications without seeing a patient in person? Two physicians weigh in.

By launching a new online drugstore and telehealth service, Eli Lilly added its name to a growing list of companies offering obesity treatment without visiting a physician's office.

There is little doubt that Zepbound (tirzepatide), a weight-loss drug, will become its best seller. Along with Ozempic, Wegovy, and Saxenda, the drug belongs to a novel class of medications called GLP-1 receptor agonists.

Initially developed for type 2 diabetes, the drugs are being popularly used for weight loss, often off-label. While highly effective, as they can help lose up to 15% of the body weight, they are associated with severe side effects, including inflammation of the pancreas and stomach paralysis.

Some visits could be done via telehealth

There are safe ways to provide obesity care via telehealth to patients who are well established and have been at the doctor's office before, says Juliana Simonetti, M.D., co-director of the Comprehensive Weight Management Program at the University of Utah.

However, providing care becomes more difficult when a doctor has never seen a patient, especially if they have obesity-related complications, such as diabetes or heart disease.

For instance, patients with higher body mass index are often diagnosed with heart failure with preserved ejection fraction, and they need to start taking diuretics.

As these patients may need to be monitored more closely when on GLP-1 receptor agonists, Simonetti says it would be more appropriate for them to start the treatment with an in-person visit.

Simonetti explains that physicians warn patients taking GLP-1 receptor agonists to seek urgent care if they develop symptoms like severe nausea, vomiting, or abdominal pain because they could be signs of pancreatitis.

We should also be monitoring more significant weight loss, as seen with the newer classes of medications. In particular, in older patients who may be at a higher risk of losing weight very rapidly. If they are not eating enough, we advise them of the appropriate protein intake that we're measuring.

Juliana Simonetti, M.D.

Moreover, physicians look at the blood work of patients on GLP-1 receptor agonists to ensure the kidney function is stable.

Nevertheless, even in cases of closer monitoring, some visits could be done via telehealth, Simonetti says. As with most other chronic conditions, there is no one-size-fits-all approach to obesity treatment.

Dangers of online services

Online weight management programs offer a wide variety of services — from nutrition plans to prescriptions to weight-loss medications, including GLP-1 receptor agonists. Some platforms provide Ozempic, although the U.S. Food and Drug Administration (FDA) only approved the drug for type 2 diabetes.

According to a 2021 review, telemedicine interventions for weight loss, such as regular sessions on portion control and increased physical activity, can successfully help patients with obesity lose weight and expand treatment access to hard-to-reach populations.

Zoobia Chaudhry, M.D., a gastroenterologist and assistant professor at the Johns Hopkins University School of Medicine, says virtual weight-loss programs where patients fill out online forms to be assessed for eligibility for obesity drugs should not be called telehealth.

"Because they're not seeing or talking to the patient or looking at their medical records," she tells Healthnews.

Chaudhry says prescribing GLP-1 receptor agonists without seeing a patient in person comes with risks, as any other prescription drugs.

When prescribing these medications in her clinical practice, she is well aware of a patient's history. Moreover, the patient knows how to contact her or her office if there is a need to do so before the next appointment.

Another risk with online weight management programs is that some of them sell compounded GLP-1 receptor agonists, Chaudhry says.

Drug compounding refers to combining and mixing ingredients to create a medication specifically formulated for a patient. However, such drugs are not approved by the FDA.

The agency has recently warned against using compounded Ozempic, Rybelsus tablets, and Wegovy following the reports of patients experiencing adverse health events. The FDA said these products may not contain the same active ingredient as its approved semaglutide drugs.

Fighting the obesity stigma

During the COVID-19 pandemic, Simonetti says telehealth has proven to be an effective way to deliver care, especially in non-urban areas.

With developing technology and artificial intelligence tools, telehealth may become even safer. But for now, telehealth visits are more suitable for some patients than others. Simonetti points out that even Lilly's new platform has the option of seeing a physician in person.

"Telehealth might not be for everyone, and more complicated patients might still need to come in person. There are still benefits of seeing patients and having human connection," she tells Healthnews.

Some online weight management platforms claim they help to destigmatize obesity. Evidence shows that patients with obesity are reluctant to seek care because they feel judged and stigmatized by their providers, Chaudhry says.

Many healthcare providers hold strong negative attitudes about people with obesity, according to a 2015 study. Such attitudes influence judgment and decision-making and can impact the care they provide.

Things like not having appropriate-size chairs in the waiting room or blood pressure cuffs in the size that patients can fit only add to the stigma of coming into the doctor's office, Chaudhry explains.

With more than 40% of Americans being overweight or having obesity, it is crucial to improve access to obesity care. Although telehealth visits may be safe and effective for some patients, consider starting obesity treatment by visiting your doctor’s office.