Dr. David Voellinger

When Austin Biles first met Dr. David Voellinger, medical director of Novant Health Bariatric Solutions - Elizabeth, he weighed 425 pounds. He’d battled weight his whole life and never gotten very far.

And he figured there was only one option left. “I went to see Dr. Voellinger with the full assumption I’d have gastric surgery,” said the 25-year-old Realtor from Belmont, North Carolina.

“I’ve tried to lose weight many times, but was never able to lose more than 15 or 20 pounds. I never could stick to a regimen.”

At their first appointment, Voellinger threw Biles a bit of a curve ball. He offered the option of remote patient monitoring (RPM), a program Novant Health Bariatric Solutions was piloting. It’s part of Novant Health’s commitment to innovation and technology for providing leading-edge care and meeting patients where they live.

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RPM care for bariatrics doesn’t involve medications or surgery but instead allows a patient to rely on their clinical team as an accountability partner. The patient does the work, but they’re closely connected, via an app, to their health care team and are in regular communication.

Voellinger introduced Biles to a dietitian and nutritionist and sent him home with an RPM kit, which includes an electronic tablet or phone app, blood pressure monitor, glucometer with test strips and lancets, pulse oximeter, stethoscope, thermometer and a scale. The tablet prompts patients to complete daily symptom surveys. Their survey responses give nurses a clear picture of how patients are doing each day. The tablet also includes educational information and other resources. Biles agreed to try RPM for two months and then evaluate his progress.

With RPM, clinicians can monitor patients daily, responding to risk alerts based on patients’ reported vitals and symptoms. Nurses can contact patients by text message or phone to evaluate issues or just help motivate their patients.

Austin Biles before
Austin Biles before

Biles put in the work. He made significant changes in his lifestyle and diet. He got serious about drinking eight glasses of water – and often, more – each day. He started walking for exercise, weighing himself daily and eating better.

To Biles’ great surprise, he lost 50 pounds before his two-month follow-up appointment. “I like instant gratification,” he said. “I started to see results right away, and that made me want to keep going.”

As one of 50 bariatric patients to participate in a year-long RPM trial, he was monitored for about nine months. Since he began his weight loss journey in July 2022, he’s down 157 pounds. He still wants to reach a goal weight of 250, but he’s ecstatic about his progress.

As for the surgery he assumed he’d have? He and Voellinger determined it wasn’t necessary. He was already achieving terrific results without it.

With you ‘all the time’

The RPM program has clear benefits for bariatric patients. “We hear time and time again that patients like feeling our presence,” Voellinger said. “It’s as if they have us with them all the time. They’ve got a daily accountability partner. They can educate themselves using the tools what we provide on their own schedule. They feel motivated. And they feel taken care of, knowing they have a direct line to a clinical nurse.”

RPM can also play a role before and after surgery. It allows the medical team to monitor patients’ vitals, educate them in real time, give them a level of comfort. And it may decrease the length of their hospital stay and the chance they have to be readmitted.

“It used to be that post-op, we might not see a patient for up to a year after their initial follow-up,” Voellinger said. “We can catch issues sooner; rather than wait until a patient has regained 50 pounds, we know when they’ve regained 10 and can address it then.”

Voellinger is optimistic about the pilot’s results and the possibilities for his – and other – patients going forward. “This is technology at its best,” he said. “We hope there’ll be opportunities to add even more to what we’re doing now. This is one of the most important advancements in bariatrics I’ve seen in my career. We’re able to meet folks where they are. RPM offers an unprecedented level of care.”

Health care from home

The use of remote patient monitoring (RPM) is just one of many new programs at Novant Health as the system embraces innovation to deliver leading-edge, convenient care to its communities.

While telehealth and virtual doctor visits boomed during the COVID-19 pandemic, the use of remote technology is expanding in a variety of ways. For instance, Novant Health doctors stationed in large medical centers help provide stroke care to rural hospitals in North Carolina. The system is also harnessing artificial intelligence to offer better stroke care faster communities.

When it comes to remote patient monitoring, the programs are part of a national trend that’s expected to increase by 11% between 2022 and 2028.

And the bariatric pilot wasn’t Novant Health’s first trial with RPM. A similar program for heart failure and cardiac patients in the Charlotte area was launched in 2022 with strong results. It’s already been expanded. OB-GYN care in Winston-Salem is using RPM, and so is New Hanover emergency medical services.

Novant Health will expand to other patient populations later this year as part of its partnership with Health Recovery Solutions. The New Jersey-based company provides technology and related services in the fast-growing field of remote patient monitoring that lets patients receive medical care and attention from the comfort of their own home.

Taking time to listen

Biles knew right away that Voellinger was on his side.

“Doctors I’d seen before never seemed to really listen to me,” Biles said. “They were telling; not helping. Dr. Voellinger understood me. It was very refreshing. He’s my favorite doctor I’ve ever been to. And if I could have him as my primary care, I’d be 100% on board.

“I don’t think I’d have gotten on the scale every day if I weren’t on this program,” he added. “Knowing I needed to check in daily kept me accountable. Dr. Voellinger needed my numbers every morning by 9.”

RPM is not for everyone. “Some patients don’t want to be monitored that closely,” Voellinger said. “They don’t want aggressive hand-holding. We want patients to have the choice.”

For most of the patients who were part of the pilot, RPM did what it’s designed to do. Less than 5% weren’t able to stay compliant, Voellinger said. And 90% said they’d do it again.

Gotta get moving

Biles took the accountability concept to a whole new level. He made himself publicly accountable via social media. He’d previously used his social media accounts to post about TV and movies, comic books, anime and fantasies like “Lord of the Rings” and “Star Wars.”

But when he began his weight loss journey, he posted about it on Day One. He’s since amassed 650,000 followers on TikTok.

Prior to meeting Voellinger, Biles was among the 25% of Americans who are not at all physically active. And 60% of Americans don’t get the recommended amount of exercise. That first day, he walked two miles and then filmed himself, drenched in sweat, for TikTok. He got immediate kudos. “No one insulted me, ever,” he said. “People started to say that I inspired them.”

The internet proved to be another effective accountability partner. “I wasn’t just doing this for my friends and family or to please a doctor,” Biles said. “I had more than 600,000 people watching me. Their reactions warmed my heart. I never expected such a positive response. It kept the fire going inside me.”

Austin Biles after
Austin Biles after

Biles lost steadily until December 2022 and then plateaued. “I think I just got too comfortable with where I was. I told myself I could be happy at that weight. My numbers, including my blood pressure, were in check. But I was still 300 pounds, and that’s not where I wanted to be.”

His weight loss remained stalled until early February. “I sat myself down and said: You’ve got to stop making excuses. Excuses are how you got here in the first place.” And so he kept on working on his exercise and lifestyle.

He stopped RPM last November and sent the scale back with the monitoring kit. But he’d gotten in the habit of weighing himself daily and bought a scale. Other healthy habits had already taken hold. “I was always an emotional eater. Now, I’ve replaced a bad habit with a good one.” Instead of reaching for a snack, Biles now takes a walk. He’s up to six miles a day.

It’s not that he loves walking for exercise. But it’s become routine: “I’d feel weird if I didn’t do it.”

“I surprised a lot of people, but no one more than myself,” he said. “I’ll never claim it was easy. But when I look at before and after pictures, I see two completely different people.”