Effectiveness of telehealth versus in-person appointments for the treatment of obesity in a Brazilian public tertiary care center: A randomized controlled trial

Introduction Although telehealth interventions have produced weight-management outcomes comparable with in-person care in several settings, 12-month randomized evidence from public tertiary services in middle-income countries remains limited. This study compared remote and in-person consultations for obesity treatment in a Brazilian public tertiary-care center, focusing on continuity of care, weight loss, and exploratory metabolic outcomes. Methods This 12-month, matched-pair randomized, prospective, single-center, open-label pilot trial included 32 adults in a multidisciplinary weight-management program. Participants were allocated to telehealth video consultations or standard in-person care. The primary outcomes were appointment attendance and treatment adherence, defined a priori as the proportion of missed appointments that were rescheduled and subsequently attended. Secondary outcomes included percentage change in body weight, the proportion of participants achieving ≥5% weight loss, anthropometric measures, and metabolic parameters. Results The overall absence rate did not differ significantly between the telehealth and in-person groups (12.5% vs. 17.1%; p = .413). All 10 missed telehealth appointments were rescheduled and attended, compared with 8 of 14 missed in-person appointments (100% vs. 57.1%; p = .024). Mean 12-month percentage weight change was −4.8% ± 4.7% in the telehealth group and −5.5% ± 3.8% in the in-person group, and 56.3% and 62.5% of participants, respectively, achieved ≥5% weight loss. Both groups had significant within-group reductions in waist and hip circumferences. HbA1c decreased within the telehealth group (6.39% ± 1.08% to 5.98% ± 0.46%; p = .005), but no between-group difference in HbA1c change was demonstrated. Discussion In this pilot trial, telehealth produced weight and anthropometric outcomes similar to those observed with in-person care and were associated with a higher proportion of missed appointments being rescheduled. The HbA1c finding was exploratory and does not establish metabolic superiority. Larger multicenter trials are needed to confirm these findings and assess long-term effectiveness, implementation, and cost-effectiveness. Trial registration Brazilian Registry of Clinical Trials (ReBEC), RBR-7wt6hzm; UTN U1111-1318-5411. Registered on 7 April 2025, retrospectively.