Telehealth Weight Program Boosts TJA Eligibility

More patients who participated in a telehealth-based weight-loss program prior to total joint arthroplasty reached their preoperative targets for body mass index (BMI) compared with those who received conventional lifestyle advice, according to a new study presented at the 2025 annual meeting of the American Academy of Orthopaedic Surgeons.

 Jeffrey B. Stambough, MD, an orthopedic surgeon at the University of Arkansas for Medical Sciences in Little Rock, Arkansas, said the program, called 20Lighter, offers a short-term alternative to pharmacological or surgical weight loss, which may enhance preoperative care and healthcare efficiency.

“This is important because in 8 weeks, patients can experience significant weight loss, lowering their risk factors to make them eligible for necessary joint replacement surgery,” Stambough told Medscape Medical News. “We found that 20Lighter’s preoperative patient-optimization program led to higher total joint arthroplasty eligibility conversion rates and a greater reduction in visceral fat rating compared to the standard of care.”

In recent years, Stambough and his colleagues have treated many patients with advanced hip or knee arthritis who were unable to undergo arthroplasty because their BMIs were too high — between 41 and 47 — values in excess of what was considered a safe threshold at the tertiary care center.

“We wanted to help provide these patients an option without them necessarily having to get gastric bypass-type surgery or start some of the new injection medications, which were not as commonplace and can have effects of rebound weight gain when stopped,” he said.

The 20Lighter is a proprietary 8-week medical weight-loss program created at the University of Arkansas that includes a series of tailored meal plans, along with nutritional supplements, and daily telehealth engagement that connects users with a dedicated healthcare provider using a smartphone app.

The prospective, randomized investigation comprised a cohort of patients with BMIs ranging from 41 to 48, all of whom were seeking to undergo total joint arthroplasty at the institution’s orthopedic clinic. Half were offered the weight-loss intervention and half received standard of care.

Forty six men and women were enrolled in the trial and 23 of whom completed it, 10 in the preoperative weight-loss program and 13 in standard of care. The two groups were statistically comparable with respect to baseline body-composition metrics such as BMI, body fat percentage, visceral fat rating, and body water percentage, and baseline laboratory values, Stambough reported.

As Stambough reported, individuals in the telehealth weight-loss program saw their mean BMI fall from 44.52 ± 2.32 to 39.15 ± 2.23 at the 90-day follow-up, whereas BMI among those in the control group fell from a mean of 45.05 ± 1.94 to 44.35 ± 2.51 at that same point (P <.001). Patients in the weight-loss program also had less visceral fat at 90 days (P =.004 ). Conversion rates to eligibility for total joint arthroplasty were 70% in telehealth patients and 0% in those receiving standard care (P < .001).

“This telehealth weight loss and nutrition program offers a noninvasive, short-term alternative to pharmacological or surgical weight loss, potentially enhancing presurgical care and healthcare efficiency,” Stambough said.

When the researchers assessed telehealth patients at 6 weeks after surgery, they found an average improvement in the hip disability and osteoarthritis outcome score for joint replacement/knee injury and osteoarthritis outcome score for joint replacement of 31.19 points (P = .013).

Sean S. Rajaee, MD, MS, associate director of the Outpatient Hip and Knee Center at Cedars-Sinai Orthopaedics in Los Angeles, called the intervention “very promising.” 

However, Rajaee urged caution in using absolute BMI cutoffs and instead recommended each patient’s care instead be individualized.

“At times, forcing patients to reach a BMI cutoff to become a ‘surgical candidate’ can cause more harm to the patient if they become malnourished in the interim or lead to further physical deterioration due to their orthopedic diagnosis,” Rajaee said. “Becoming healthier is important prior to surgery but losing weight does not always equate to ‘being healthier.’”

Stambough agreed the telehealth weight-loss program is not without its challenges, as nearly half the patients screened for inclusion could not adhere to the strict diet, limited calories, and required telehealth check-ins. “Participants must adhere to the reduced-calorie diet during the 40-day meal plan and were prohibited from alcohol consumption,” he said.

Nevertheless, for those who persevered, the results were encouraging and demonstrated that the preoperative weight-loss program can be a highly effective way to enhance eligibility for total joint arthroplasty.

“If [other orthopedic surgeons] can identify motivated patients who are on the cusp of meeting their weight requirements necessary before arthroplasty, they should consider a similar 8-week preoperative patient optimization program that takes advantage of telehealth services and provides comprehensive health benefits,” he said.

Stambough and Rajaee reported no relevant financial conflicts of interest.

Michael Vlessides is a best-selling author, personal biographer, and medical journalist.