医疗专业人员

April 12, 2025

Interest and demand for glucagon-like peptide-1 receptor agonists (GLP-1 RAs) continue to rise, leaving fewer people choosing bariatric surgery for weight loss. Yet research has consistently shown that bariatric surgery results in improvements in health and quality of life as well as sustainable weight loss compared with medications and lifestyle interventions.

The growing interest in GLP-1 RAs may be due to misperceptions about surgical risk and the fact that preparation and bariatric surgery requirements involve many appointments related to physical and mental health, lab work, nutrition, and physical activity education. People considering bariatric surgery typically have an average BMI of 45 and may have limitations in mobility, health and overall functioning. The needed appointments can serve as a physical barrier to effective treatment and place a financial and logistical burden on patients and their families.

Gretchen E. Ames, Ph.D., a clinical health psychologist working with the bariatric surgery team at Mayo Clinic in Jacksonville, Florida, says that telemedicine may be one way to relieve these burdens.

"Patients often feel overwhelmed when they realize the extent of the workup process for bariatric surgery," says Dr. Ames. "Telemedicine reduces travel time, related expenses, and time away from work and other responsibilities. Patients can receive care in the comfort and safety of their homes."

Effect of telemedicine on bariatric care choice

To test their theory, Dr. Ames and the Bariatric Center team in Florida conducted a randomized study to see whether the ability to conduct appointments virtually would have effectiveness similar to that of in-person visits in terms of completion of program visits, patient satisfaction and length of time to surgery. The results of this study were published in Mayo Clinic Proceedings.

The researchers offered two obesity care pathways — hybrid telemedicine (HTM) or face-to-face (F2F) — to 50 patients seeking bariatric surgery. Most of the participants were white (74%) and female (77%) with an average age of 51 and an average BMI of 43 (HTM) and 46 (F2F). In the end, one-third of participants underwent bariatric surgery; one-third chose treatment with GLP-1 RAs; and one-third were lost to follow-up during the process.

"We had more patients engage with our program and complete the surgery from our HTM group than our F2F group," says Dr. Ames. "Of the patients who either did not start our program or disengaged during the presurgical process, more were in the group required to have in-person appointments."

There was no significant difference in patient satisfaction with program visits or length of time to surgery regardless of whether appointments occurred in person or virtually.

Utility of telemedicine when preparing for bariatric surgery

Given the results of this research, Dr. Ames says the way to increase access to bariatric surgery is by providing more-flexible options to patients. She notes that, unlike many other bariatric surgery programs, the entire bariatric team at Mayo Clinic in Florida resides in one location. This centralization provides access to everything a patient needs for preop patient optimization.

"Offering a hybrid pathway lets people choose what works best for their lifestyle and comfort level," says Dr. Ames. "If they have the flexibility of choice, our study demonstrated they are more likely to go further in the process and ultimately receive the best treatment for their condition."

In a hybrid pathway, people can attend initial medical consultations virtually. This approach makes it easy for potential patients to learn about treatment options and what each entails. Most other appointments can be conducted virtually as well. The exceptions are presurgical workups requiring physical health exams. Even lab work and endoscopy can feasibly be performed close to patients' homes if they can access the right healthcare professionals. Mayo Clinic's telehealth technology has been built into the medical record system, making it extremely safe and secure with regard to patient privacy.

"Patients often make decisions about their bariatric care before they have all the information," says Dr. Ames. "An initial telemedicine appointment allows them to do that without investing a lot of resources. Then they can match weight-loss treatment with their personal goals and lifestyle."

As a psychologist, Dr. Ames feels that a hybrid pathway is especially critical for patients who might benefit from additional mental health support. "Bariatric surgery often provides secondary benefits for mental health conditions, such as mood disorders and maladaptive eating behaviors," Dr. Ames explains. "The psychology appointment helps patients feel safe and heard. It can open their eyes to weight-loss options, including bariatric surgery. But they may not make it as far as the psychology visit when the process feels overwhelming."

Limitations of telemedicine for weight loss surgery

Even though the upside of using telemedicine for bariatric care is substantial, Dr. Ames says that there are limitations, such as:

• Access to technology. People considering virtual care options in bariatric surgery need to be comfortable with technology. They also need access to sufficient broadband that can support video connection.
• Provider licensing. While psychologists may be licensed to see patients across the country, most physicians are not. This factor limits the virtual appointments available to patients from other states.

"There are still aspects of telemedicine that aren't perfect for all appointments and patients seeking bariatric care and surgery," says Dr. Ames. "A hybrid approach to the bariatric patient pathway holds promise for increasing access and scalability of the most effective treatment for severe obesity."

For more information

Ames GE, et al. Rethinking patient and medical professional perspectives on bariatric surgery as a medically necessary treatment. Mayo Cjavascript:void(0);linic Proceedings. 2020;95:527.

Refer a patient to Mayo Clinic.