We had the opportunity to speak with Dr. Amit Algotar, MD, PhD, MPH, FOMA, FACPM who leads a telehealth-based lifestyle weight loss clinic at Banner University Medical Center South. His innovative approach focuses on using lifestyle modifications as a primary treatment modality for managing and preventing chronic conditions like cardiovascular disease, diabetes, and even certain cancers. In this Q&A, Dr. Algotar shares the philosophy behind his work, the impact he’s seeing, and how telehealth is helping him reach more patients.
Q: What inspired you to center your clinical work around lifestyle medicine as a core treatment approach for chronic diseases?
A: During my PhD research, I did a deep dive into understanding the relationship between lifestyle factors and multiple chronic diseases like obesity, cardiovascular disease, diabetes, and cancer. Recognizing the significant role these factors play in the development and management of multiple chronic diseases, I felt there was a need to bridge research and clinical practice. My goal has been to help patients address the root causes of these conditions and truly treat the whole person which improves their quality of life.
Q: How does your weight loss clinic differ from more traditional models of chronic disease care?
A: My clinic’s philosophy is to provide patient-centered, whole person care through evidence based, guideline driven, comprehensive obesity treatment plans. Each plan is customized, multi-modal, and delivered through telemedicine with compassion and care. Having a patient-centered, customized approach allows the treatment team to meet the patient where they are and address their specific needs. A comprehensive multi-modality plan leverages the benefits of powerful modalities such as nutrition, physical activity, sleep optimization, stress management, and anti-obesity medications using the latest data available. Delivering this plan through telemedicine offers convenience and frequent touch points for support which is crucial for successful weight loss and maintenance. Additionally, this is done in a non-judgmental compassionate manner without any bias or stigma, thus supporting patients in the best way possible during their weight loss journey.
Q: Your clinic delivers care through telehealth. Can you describe what the virtual care experience looks like for your patients?
A: Given that our clinic is part of Banner Health, we use a Banner Health telemedicine platform called “EVisit.” Once an appointment is made, we send a letter to our patients explaining what to expect from a telemedicine visit and how they can prepare for it. It provides clear instructions on what to do and what to avoid and gives patients a technical support number they can reach before the appointment to ensure their device of choice (smart phone or laptop) is compatible with Evisit. On the day of the appointment, the medical assistant (MA) will reach out to the patient to obtain their vitals and weight and then send a link to their device via a text or email. Once the patient is on the screen, the MA will let the physician know and send the link to the physician to join the telemedicine session. If the patient is having difficulty joining the telemedicine session, the MA will help the patient troubleshoot. Once the physician joins the session, the MA leaves, allowing the physician and patient to have a private conversation. In addition to providing audio and video communication, EVisit also provides a screen-sharing feature. This allows patients to share their food and activity journals with their physician, enabling both to review the information together, much like they would during an in-person office visit.
Q: Why would a patient choose telehealth (or hybrid) over traditional care for their weight loss program?
A: Telemedicine provides an attractive model for patients facing challenges related to time, distance, or physical limitations. I work with a diverse group of patients including physicians, nurses, CEOs, and single mothers, many of whom are balancing demanding careers, caring for their children and aging parents, managing their households, and while striving to prioritize their health and weight loss goals. For patients like these, attending in-person appointments every 2 to 4 weeks is often impractical, especially when they’re also trying to prioritize their diet, physical activity, and other components of their treatment plan. The second category of patients who benefit from a telemedicine model are those who live in rural areas and lack access to a board-certified obesity medicine physician in their communities. Our clinic serves patients from across Arizona, including Lake Havasu, Payson, Yuma, Green Valley, Show Low, and numerous smaller communities in the southern part of the state such as Douglas, Bisbee, Nogales, St. David, Benson, and Sierra Vista. We also provide care to patients from tribal communities. My clinic serves patients with physical and mental health disabilities for whom traveling to and from the clinic is not easy. Some of the disabilities our patients have are severe mental health disabilities that require them to live in group homes, individuals with mobility impairments who use a wheelchair, and individuals for whom driving is not possible due to visual impairments.
Q: Can you share an example or patient story that captures the impact of your approach?
A: Weight loss is often a complex process and maintaining it can be even more difficult due to metabolic adaptation. As a result, many patients repeatedly lose and regain the same 30 to 50 pounds. However, with a customized treatment plan, it is possible to break this cycle, even when dealing with a life-altering diagnosis like cancer. This is clearly demonstrated by our patients.
One of our patients began her journey during the COVID-19 lockdown while also navigating the challenges of working from home. She followed her custom treatment plan designed to lose 100 pounds in one year. She turned the isolation of the pandemic and the transition to remote work into an opportunity to focus on her health, committing to consistent meal planning and preparation to reach her goals, including having enough energy to play with her grandchildren.
I have multiple patients like her who have not only lost more than 100 pounds but have also been successful in keeping it off for several years. Beyond the physical transformation, it is often the human impact that is most significant. For example: a wife embraced by her husband for the first time in years; a grandmother playing freely with her grandkids; and an individual overcoming lifelong weight-related stigma who finally embraces their authentic self. There is also the busy executive who is no longer embarrassed to ask for a seat belt extension, the single father losing weight to better care for his special-needs child, the patient who is able to shower and manage daily needs independently, and the father who walked, unaided, down the aisle with his daughter.
Q: What kinds of outcomes have you observed related to weight loss, disease reversal, or reduced health risks?
A: Maintaining a 10% reduction in body weight for one year is considered a successful outcome. Given the close support, education, and accountability the telemedicine clinic provides to our patients, they can maintain a 15-20% reduction in body weight. Through a combination of lifestyle modifications, with or without using anti-obesity medications, I routinely see patients achieving a 15-25% reduction in body weight, results that are comparable to bariatric surgery, but without the associated risks, adverse effects, or lifelong restrictions. Once patients transition to maintenance, the support provided by the telemedicine program is instrumental in helping them maintain weight loss.
Lower body weight is often associated with improvements in other chronic diseases like pre-diabetes, diabetes, heart disease, fatty liver, cholesterol, blood pressure, polycystic ovary syndrome, infertility, and sleep apnea. Many patients can stop their diabetes or blood pressure medications after losing weight. Weight loss can also improve fertility, fulfilling patients’ desires of becoming a mother. Improvement in joint pain can improve patients’ mobility and their quality of life. Likewise, improvements in cardiovascular risk factors can improve patients’ quality of life and longevity.
Watching a patient’s mood and confidence improve as they lose weight is truly heartwarming and a satisfying experience that I feel privileged to witness. I feel honored that patients allow me to be part of their journey.
Q: What challenges have you encountered in delivering lifestyle-based care through telehealth, and how have you worked to overcome them?
A: The current challenges we face are twofold: technology issues and payer coverage. Technological issues, such as glitches in the telemedicine app, unreliable internet speed or connectivity, or incompatible devices, can be challenging for patients, especially those living in rural areas. We do our best to help patients troubleshoot these problems. If they need additional support, we provide them with a customer service number that can also ensure their devices are compatible.
On the coverage side, payer support for telehealth services has been extended through September 30, 2025. While Congress has continued to renew this coverage, it has yet to make these waivers permanent. We remain hopeful that a long-term solution will be reached soon.
Q: Where do you see lifestyle medicine and telehealth heading in the next few years?
A: Given the current obesity epidemic in the U.S., with 74% of adults classified as overweight or obese, I’m hopeful that access to lifestyle-based obesity treatment can be expanded through telemedicine. This could significantly improve population health, given the strong link between obesity and numerous chronic diseases, as well as several types of cancer. Looking ahead over the next 5-10 years, I believe telemedicine will become the primary tool for delivering lifestyle interventions and obesity treatment.
Q: Any final thoughts?
A: The Institute for Healthcare Improvement has championed a systems-based approach that aims to simultaneously improve population health, enhance the care experience, reduce costs, and support healthcare workforce wellbeing. This approach is often referred to as the Quintuple Aim. In a complex and complicated system like ours, balancing these priorities can be challenging. Although telemedicine is not without its limitations, it has the potential to achieve this elusive goal. A systems level approach to telemedicine, paired with the right technologies and sustained support from payers, may serve as a pathway to realizing the Quintuple Aim.
Interviewer
Carrie Foote, BA, BS
Associate Director, Administration, Arizona Telemedicine Program
Ms. Foote assumes responsibility for creating and curating public relations materials and serves as editor for both the ATP and SWTRC blogs.
