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Objective: This study aimed to demonstrate noninferiority using telehealth in treating obesity with phentermine in patients with BMI ≥ 27 kg/m 2 with comorbidities or BMI ≥ 30 compared with the standard in-person approach over a 90-day period., Methods: A 12-week, randomized, prospective, single-center, open label trial compared the use of virtual visits versus in-person visits for the treatment of obesity using phentermine. The primary end point was percentage mean change in body weight from baseline to 12 weeks. A noninferiority approach assuming a 3% noninferiority region was used to assess effect size differences., Results: The weight loss in the virtual visit arm was noninferior to the in-person arm at all time points. At 12 weeks, the mean change in weight was -6.5% among the virtual group and -7.7% among the in-person group. In addition, 65% of virtual patients and 71% of in-person patients demonstrated a weight reduction of at least 5%. There was no difference in medication tolerance, adherence, and compliance., Conclusions: These results indicate that the virtual obesity pharmacotherapy visits in adults aged 18 to 65 years prescribed phentermine are effective and noninferior in achieving meaningful weight loss after 12 weeks. Future clinical trials are needed to better assess the effectiveness of televisits for obesity pharmacotherapy., (© 2022 The Authors. Obesity published by Wiley Periodicals LLC on behalf of The Obesity Society.)