How telehealth is shaping obesity care

Six months ago, if anyone had asked me how I felt about telehealth, my response would have been “I hate it”. Admittedly a strong reaction, but hear me out: I’m not the most tech-savvy person in the world. And like every doctor, I’m uncomfortable with things I’m not skilled at.

More importantly, I’m a face-to-face kind of person. I prefer analogue things to digital. And I believe in what I call the “live connection” between people – whether enjoying a friendly catch-up or trying to resolve a medical problem.

I have studied Motivational Communication to learn how to read peoples’ physical cues and non-verbal messaging. I consider the therapeutic effect inseparable from meeting in a physical space.

Five years ago, I built a clinic with a determination to get everything just right. I wanted it to be clinically sound, safe and accessible, warm and welcoming – a beautiful place of peace and healing.

I wanted patients to realise instantly that THIS time treatment would be different. And I wanted healthcare personnel working there to make sure that it was. I wanted a place that said, through every carefully managed detail, “You’ve come to a place where individual health is championed, and where every patient is first and foremost a person.”

Today, the Revolution Medical Clinic in Vancouver, Canada, where I am Medical Director, is one of the largest multidisciplinary Obesity Clinics in the country.

Run completely under the public socialized health system, we offer comprehensive obesity treatment to around 5000 patients. We are experts in medical as well as surgical bariatric approaches.

Our staff is composed of 4 Internal Medicine doctors, each with a specialty in Obesity Management, 3 nurses and 1 dietician. We are affiliated with Obesity Canada and have been recognized by the European Association for the Study of Obesity as an International Centre of Excellence.

On a regular day, the clinic would be visited by 50-70 people a day – coming from all over British Columbia. Our happy space was always busy and buzzing. Our system worked. True to my belief in face-to-face interactions, I needed to have patients in front of me first in order to really be effective. After that, Telehealth options might be relevant for some. And then the pandemic hit.

I came into the office on March 16, 2020, and by March 17 we had converted all visits to virtual. Going forward, we were going to rely on our Telehealth video platform and, to a lesser extent, telephone. Aside from these, we were going to use email.

We were lucky. To some degree, our clinic had already used technology for communication for years. We had signed permission to communicate electronically with our patients all of whom were listed in an electronic medical record system. We were able to access their records safely from anywhere. I was surprised how ready we were for this transition. The building blocks were all there. But it takes more than technology.

For me personally, what I needed to do immediately was transition my own mind and get fully behind this virtual delivery of care. But beyond the actual technical set up, something magical was emerging. I began realizing how the care I was providing was a revelation. Here we were in the middle of a plague.

People were sequestered in their homes – scared but safe, isolated but together. And here I was, reaching out to them WHEREVER THEY WERE and just checking in. 

If you still don’t see it, then consider that Obesity Management really is about the conversation. In fact, regardless of the medical issue, sometimes the most therapeutic thing we can do is to listen and to connect.

I understood that Telehealth gave me the ability to work around obstacles and make myself available to those who needed my attention, wherever they were. In spite of the pandemic, I was able to listen, support and help people see this through.

Contrary to my prior beliefs, it turned out not to matter whether a person was in my office, on my computer or in my earpiece. I was their doctor, the voice on the other end of the line.

My virtual visits are basically conversations with a clinical slant. They’re not that different from a regular doctor’s visit.

I call up a patient or connect through an online platform and ask how things are going. I listen, we come up with a plan for treatment and make arrangements to follow up and check in once again to see how things are going.

We adjust medication and make a plan. Sometimes that means just keeping a food diary. Sometimes it means planning to go for a 15 minute walk every day. I counsel on mental health, sleep, emotional eating etc.

The only diet I put people on is a “news diet”, by which I mean limiting the amount of news they watch so as to help their mental well-being. I adjust according to the conversation and the person on the other end of the line.

Via online platforms I teach people how to take medications and point them towards resources on anything from nutrition to COVID-19 updates. My team has gone to work transforming resources to online platforms and put together handouts on everything from Emotional Eating to Myths about Obesity.

We have converted our entire Bariatric Surgery Program into an online program because we understand that having quick and easy access to resources makes people feel safe and welcome.

Telehealth means that I have become a guest in my patients’ homes where arguably they feel safer, more confident and empowered than in the best of clinics. Rather than come see me for a personal consultation, they now log in for an office visit from their living rooms, kitchens and family rooms – the environment where they spend the majority of their lives.

Inevitably, communicating over the phone or internet can be a bit of a learning curve. Enabling healing, manifesting empathy and connecting with people virtually has required me to become a better, more effective communicator.

As such, I had to learn a new “language”. The visual cues were no longer as obvious, or even present, in some cases. I learned to listen for auditory cues, sighs and pauses. I learned where to listen and where to instruct. I learned to clarify and to connect and to communicate in a completely different way.

I have always known that communication is EVERYTHING in medicine. Science is gold, but communication is king. Here in my clinic, we had both. I was amazed to realize that these principles are even more apparent in Telemedicine.

Looking back, the key learning is that in many ways Telehealth works better for Obesity Management than the traditional clinical setting.

As an Obesity physician I treat a population of people who may be very accustomed to social isolation. A life with symptoms – it really doesn’t matter which – tends to isolate the person. Obesity is different from many other diseases in that patients’ symptoms and diagnosis are visible at all times. As a result, a life with obesity is all too often a life with discrimination and bias.

Our society, including people in my profession, has marginalized people with obesity for far too long. Patients have been brainwashed to see their disease as their own fault and their treatment as their responsibility. To WEIGH MORE IS to be judged as LESS THAN.

To this situation, Telehealth offers a great equalizer. My patients now have less barriers to care than ever before. I can now come to them and treat them LITERALLY where they are.

By ensuring that the virtual connection is never anything less than the real thing, optimal healing conditions are within reach. That sums up the current moment in Obesity Management: We’ve lowered the bar for access to care and raised it in terms of the quality we deliver.

2020 has left me deeply impressed with my obesity patients. Even when faced with a new storm, their grace, humanity, steadfastness and strength are abundant.

When social distancing measures were introduced, many of my patients had already been socially isolated for much of their lives. When you’re living with obesity, airplanes, restaurants and shopping centres are not welcoming.

For one unexpected moment, the rest of the world found itself as locked inside as many of them had been. But by being remarkable human beings who have learned the hard way to rise to the occasion against the odds, they would endure and thrive when everything else seemed bleak and undecided.

People just want to be well. They want to feel safe, valued and to know that they matter. Treatment, at its very core, delivers that message. It means that there is hope and that tomorrow will be better than today. Having access to that precise message has perhaps never been more important.

What I learned from life under lockdown has now become my new normal. As I write this I am well into Week 12 of Telehealth. I have walked more than a thousand kilometres and we have seen more than 2000 patients.

The world is slowly opening back up but my clinic will continue in the virtual world for a while longer. Post-COVID-19, our waiting room is too small to ensure my patients’ well-being.

Ironically, the space that I worked so hard to make a safe haven is now a place where they may be exposed to a different threat, one we never saw coming. And so I will continue to reach out to people with obesity on their terms and in their own spaces, in order to preserve our therapeutic alliance without compromising their safety.

I wouldn’t have thought it possible but Telehealth has convinced me that the best medicine has to offer can sometimes be delivered virtually. It took a plague to make me realize that it doesn’t matter where the “seat” is physically located. I’m sure there are areas of medicine where this isn’t as true, but in the world of Obesity Management Telehealth is actually perfect.

I’ve been a doctor now for more than two decades, and I still absolutely love with my work. I love that I’m still learning about the human body, that my career forces me to grow and adjust from minute to minute and be a little better every day.

Most importantly, I love being an Obesity Doctor because every single day I get to celebrate and help facilitate the victories of decent, brave, resilient human beings hoping and working to bring a little more wellness into their lives.

Regardless of the space – in an office, on a treadmill, on a telephone or an online platform – the view is still gloriously the same and the privilege continues to be all mine.