Telemedicine is growing rapidly in Minnesota, according to a study released last week, with rural patients seeking expertise via videoconferencing from urban specialists.

But telemedicine isn't just a one-way street from the cities to the sticks.

Dr. Mark Gustafson set up his medical weight management practice last year in Deer River, Minn., pop. 934. He provides in-person and videoconferencing advice on diet, exercise and medication to patients across the Iron Range.

"You know, patients are initially a little reluctant, just not knowing" how telemedicine works, said Gustafson, whose practice is part of the Duluth-based Essentia health system. "I think all of us are more comfortable with face to face visits. But most patients, once they do it … they like it. They certainly like the convenience of it."

Medical weight management is a growing specialty that helps healthy patients maintain good eating and exercise habits, and treats patients with diabetes and other weight-related disorders.

Most of Gustafson's visits remained face-to-face in his first year of practice, but he now spends a half day each week connecting to patients who are hours away in Ely and Chisholm. And he expects the telemedicine volume to increase with time. "A lot of my patients have mobility issues," he said, "and wintertime is tough for travel and there's not many docs doing what I'm doing. Demand is pretty high."

Gustafson left a family practice clinic from another health system, in Grand Rapids, and a contract clause prevented him from practicing there right away. So he set up in nearby Deer River — aided by the fact that Essentia has rigged all its clinics with telemedicine capabilities.

Gustafson replaced an Essentia specialist who in his final years before retirement had moved his entire practice via telemedicine to his home in Ely. Gustafson is one of the only weight management specialists in the region, but he said Essentia is adding a nurse practitioner who will see patients live in Ely and via telemedicine in International Falls.

Weight management has emerged in response to the rising U.S. obesity rate, which has increased the risk for diabetes, heart disease and stroke. Federal data showed that 32.2 percent of residents in Itasca County were obese in 2013, up from 24.5 percent a decade earlier.

Gustafson's practice is diverse. On Thursday, he was scheduled to see three men and eight women, ranging in age from 17 to 67. Standard practice is to help patient reduce their weight by 5 to 10 percent, but goals vary.

"Some patients are looking for a number on the scale," he said. "Others have knee pain or back pain and want to be around to see their grandkids."