A common struggle we hear from our patients at the Nicholson Clinic, is how hard it is to make time to prioritize weight loss goals. While it can be challenging, creating a balanced schedule that prioritizes self-care, weight loss goals, and overall well-being can help you stay consistent and motivated. Here are some practical ideas to structure time each day or week for these areas:
Morning Rituals for a Positive Start
- Stretching or Yoga (5-10 minutes): Gentle stretching or a quick yoga session helps wake up the body and clear the mind.
- Set Daily Intentions (5 minutes): Spend a few minutes reviewing your goals or journaling, setting intentions to focus on well-being throughout the day.
- Healthy Breakfast Prep (10 minutes): Prepare a nutrient-dense, high-protein breakfast to kickstart metabolism and keep you feeling full.
Plan Dedicated Time for Exercise
- Schedule Workouts as Appointments: Block out time 3-5 days a week for exercise, ideally at the same time each day for consistency. Whether it’s a 30-minute walk, a gym session, or a home workout, treat it like any other important commitment.
- Active Breaks During the Day: Take 5-10 minute movement breaks every hour or two. This could be a quick walk, a few resistance band exercises, or stretching to keep your energy up and prevent prolonged sitting.
Mindful Eating Practices
- Meal Prep or Plan Weekly: Dedicate time on a weekend or the beginning of the week to prepare healthy meals or plan balanced options that align with your weight loss goals.
- Mindful Eating (5 minutes per meal): Slow down during meals to savor each bite, which helps you feel satisfied and avoid overeating. Try to make each meal an intentional experience without distractions.
Build in Self-Care Time
- Daily “Me Time” (15-30 minutes): Carve out time daily for a self-care activity like reading, meditating, or spending time in nature. This helps relieve stress and recharge.
- Unplug from Devices in the Evening: Aim for an hour before bed without screens. This can improve sleep quality and help you wind down. Use this time for something relaxing, like reading or practicing deep breathing.
Goal-Tracking and Reflecting
- Weekly Check-In (10-15 minutes): Set aside a few minutes each week to track your weight loss progress, reflect on your achievements, and adjust your goals as needed.
- Gratitude or Reflection Journal: Write down three things you’re grateful for or have accomplished each day. This helps keep you motivated and reminds you of your progress.
Prioritize Sleep and Recovery
- Establish a Consistent Bedtime Routine: Try to go to bed and wake up at the same time each day, aiming for 7-8 hours of sleep. Incorporate calming activities like a warm bath, herbal tea, or light stretching before bed.
- Practice Breathing or Meditation Before Sleep: Breathing exercises or guided meditation can help reduce stress and prepare you for restful sleep.
Weekend Planning and Self-Care Focus
- Plan for Active, Fun Outings: Schedule time for a hike, bike ride, or walk with friends or family to enjoy movement outside your regular workouts.
- Prep for the Week: Take a couple of hours over the weekend to prep healthy snacks, meals, or plan workouts, so you’re ready to start the week aligned with your goals.
Sample Schedule
Morning
- 10 minutes: Stretching or yoga
- 5 minutes: Set daily intentions
- 10 minutes: Healthy breakfast preparation
Lunchtime
- 10-15 minutes: Light movement or walk
Afternoon
- 5-10 minutes: Mini active break or meditation
Evening
- 30 minutes: Exercise or self-care activity
- 15 minutes: Reflect on the day (goal tracking or journaling)
Night
- 1 hour before bed: Relaxing screen-free routine
This schedule provides consistency while being flexible enough to adapt as you need. The key is to make these moments purposeful and achievable, so they gradually become a routine that aligns with your wellness goals.
Nicholson Clinic is thrilled to announce that Dr. Thomas Roshek has been named to the Texas Super Doctors® list for the 10th year! This remarkable achievement spans from 2014 to 2024 and includes recognition as a Super Doctors® Rising Star from 2014-2016. This distinction is awarded to exceptional physicians who have been fully-licensed for approximately 10 years or less. Dr. Roshek was then recognized as a Texas Super Doctor® from 2018-2024.
This honor highlights Dr. Roshek’s unwavering dedication to providing exceptional care to his patients and his commitment to the weight loss surgery field. Earning a place on the Super Doctors® list is a significant accomplishment, as doctors are nominated and selected by their peers in the medical field. Only 5% of doctors in a state or region are named Super Doctors®, and even fewer (2.5%) are recognized as Rising Stars.
Dr. Roshek’s commitment to his patients is evident in his approach to care. He believes in building relationships with his patients and goes beyond simply treating them. Dr. Roshek’s contributions to bariatric surgery and patient care have earned him numerous awards and accolades beyond the Texas Super Doctors® list.
These include:
- Being named one of D Magazine’s “Best Doctors in Dallas” for 2013, 2017, and 2019-2023.
- Recognition as one of D Magazine’s Best Doctors in Collin County for 2013, 2016-2018, and 2020-2024.
- Being voted onto Living Well Magazine’s “Top Docs” list in the Bariatric and/or General Surgeon category for 2019-2024.
- The Nicholson Clinic surgical team, of which Dr. Roshek is a part, was voted Living Magazine’s Best of Three-Eighty North for 2016 & 2017, Best of Frisco/Plano for 2020-2024, Best of McKinney/Allen for 2022 & 2024, Best of Prosper/Celina for 2022, and Best of Richardson/Murphy for 2022-2024.
Dr. Roshek’s 10 years of recognition on the Super Doctors® list is a testament to his ongoing dedication to the field of bariatric surgery. Join us in congratulating Dr. Roshek on this incredible achievement!
Thanksgiving is a time for family, gratitude, and, of course, delicious food! However, for those in the pre-op, post-op or maintenance phase, it can also pose a challenge. But don’t worry—there are plenty of ways to enjoy the holiday while staying on track with your health goals!
Many people try to “save up” calories for their Thanksgiving celebration by skipping meals earlier in the day. However, this can backfire, causing them to overeat appetizers or make unhealthy choices during the main meal because they are overly hungry. Our Nicholson Clinic dietitian recommends treating Thanksgiving like any other day by eating a small healthy breakfast and lunch. This approach prevents you from arriving at the Thanksgiving meal feeling famished and helps you make more mindful, healthier choices throughout the day. Here’s a few other tips things to consider from our team:
Embrace Healthy Thanksgiving Foods
Thanksgiving fare can be quite nutritious, featuring great sources of protein, an abundance of veggies, and a small amount of starch. To make the most of your meal, try these tips:
- Start with Protein: Prioritize lean turkey and other proteins available at your meal. This will help you feel fuller and satisfied.
- Enjoy in Moderation: It’s okay to indulge a bit! Remember, one meal won’t derail all your hard work.
- Savor Your Food: Take your time, enjoy each bite, and focus on the company around you.
Portion Control Tips
If you’re concerned about portion sizes, consider these strategies:
- Take Small Bites: Allow yourself to taste different dishes without overindulging.
- Chew Thoroughly: This aids digestion and helps you appreciate the flavors.
- Bring a Healthy Option: Contribute a nutritious dish to the meal, ensuring you have something healthy to enjoy.
And remember the “3-2-1 method”: take three bites of protein, two bites of vegetables, and one bite of carbohydrates. This helps you prioritize the right foods.
Special Considerations for Pre-Op and Post-Op Patients
Pre-Op Patients
If you’re in the two-week pre-surgery phase, you can still partake in the Thanksgiving feast! Opt for:
- 5 ounces of lean turkey
- 2 cups of non-starchy veggies (like green beans)
- A pumpkin pie-flavored protein shake or bar for dessert
Post-Op Stage 1: Full Liquids
At this stage, solid foods like turkey are not suitable yet, but you can still enjoy:
- Delicious soups like butternut squash or pumpkin soup.
- A pumpkin pie protein shake for a tasty treat
Post-Op Stage 2: Soft Foods
Once you reach Stage 2, you can include:
- 1-2 ounces of soft turkey meat
- 1-2 tablespoons of cooked, mushy green beans or cauliflower
- A small portion (about 1 tablespoon) of mashed potatoes or casserole
- A pumpkin pie protein shake for something festive and sweet
Remember to chew everything thoroughly and eat slowly.
Post-Op Stage 3: Solid Foods
In Stage 3, you’ll likely be able to enjoy a broader range of Thanksgiving foods. Focus on:
- 3 ounces of turkey, cut into tiny pieces with a bit of gravy
- 1/4 cup of green beans
- Mashed cauliflower and butternut squash
- A couple of tablespoons of dessert
Enjoy the Holiday!
Thanksgiving is a wonderful opportunity to connect with loved ones and celebrate. By keeping these tips in mind, you can enjoy a satisfying meal while still prioritizing your health. Have a fantastic Thanksgiving filled with gratitude, love, and delicious food!
While Halloween is a time for fun and celebration, it can be a difficult period for those committed to their weight loss goals. The season’s temptations can easily derail the progress you’ve made. At the Nicholson Clinic, we want to help you stay on track during Halloween, so we’ve put together some tips for navigating the holiday, some alternatives to traditional candy, and how to resist the temptation of indulgent foods.
Set Yourself Up for Success
Here’s few suggestions that can help this time of year!
- If you are buying candy to hand out at Halloween, buy candy you don’t like.
- Don’t buy candy too early so it’s not sitting around all month to tempt you.
- Keep candy out of sight, out of mind.
- Eat protein and manage your hunger. Plan healthy meals so you are satisfied.
- Have your water bottle handy. Drink water and stay hydrated.
- Stay active, take walks and stick to the game plan.
Smart Candy Alternatives
Instead of buying candy, consider healthier alternatives that are still fun. Here are some ideas for non-candy treats to hand out:
- Halloween-themed toys, like spooky stickers, vampire fangs, or fake fingers
- Fun items like glow-in-the-dark bracelets, temporary tattoos, or mini activity pads
- Healthier snacks like dried fruit, mini packs of nuts or small bags of microwave popcorn
- Mini water bottles as kids are always thirty when trick or treating
By thinking creatively, you can enjoy the spirit of Halloween without compromising your health goals.
Managing the Trick-or-Treat Aftermath
When kids bring home bags full of candy, it can be hard to resist dipping into their stash. To avoid this, establish a plan before the candy enters your home. Some patients let their children and spouse hide it, so they don’t know where it is. Others have found success limiting the amount they have in their house. Here’s a few options to allow your children to pick some of their favorite treats and then donate the rest.
- Many dental offices offer these programs to reduce the candy supply in households.
- Another option is to donate leftover candy to organizations that send treats to military personnel.
- Or let a friend or family member take some to their office to be enjoyed.
By planning ahead, you can minimize temptation and make the post-Halloween period easier to manage.
Building a Support System
Having a strong support network is invaluable during the holiday season. Whether it’s family, friends, or our healthcare team, having people to lean on can help you stay committed to your goals. If you’re feeling overwhelmed, consider joining the Nicholson Clinic Facebook Support Group where you can share experiences and gain insights from others who have undergone bariatric surgery.
Engaging with a community or seeking advice from a healthcare professional, such as our medical staff or our in-house dietitian, can provide additional strategies for managing the holiday season. Don’t hesitate to use the resources available to you.
Don’t let Halloween derail the progress you’ve made after bariatric surgery. Remember the importance of maintaining your new lifestyle and diet. With careful planning and a solid support system, you can navigate the holiday season successfully, keeping your health and weight loss journey on track.
If you have been hesitant about bariatric surgery due to cost, remember that your Flexible Spending Account (FSA), Health Savings Account (HSA), or Health Reimbursement Arrangement (HRA) could help cover the expenses for your weight loss procedure! Not only do these accounts help cover the cost, but they also offer tax advantages that can save you money.
Bariatric surgery, such as Gastric Sleeve, Gastric Bypass or SADI-S, is considered a qualified medical expense under IRS guidelines, meaning it is eligible for payment or reimbursement through your FSA, HSA, or HRA. Here’s how each account can help:
Using Your FSA: If you have an FSA, you can use the funds to pay for pre-surgery consultations, the surgery itself, post-operative care, and any other related medical expenses. Since FSA contributions are pre-tax, you effectively reduce your taxable income, which lowers your overall tax burden.
Using Your HSA: HSAs offer even more flexibility since the funds roll over year to year, and you can contribute up to a certain limit annually. The 2024 contribution limits for Health Savings Accounts (HSAs) are $4,150 for self-only coverage and $8,300 for family coverage. Individuals who are 55 and older can contribute an additional $1,000 as a catch-up contribution. You can use your HSA to cover the full spectrum of bariatric surgery expenses. Additionally, because HSA funds can grow tax-free, they can serve as a long-term savings strategy for those planning surgery in the future.
Using Your HRA: If your employer offers an HRA, you can be reimbursed for bariatric surgery costs, including surgery, hospital stays, and any necessary medications. While you don’t contribute to the HRA, the reimbursements are tax-free, reducing the financial burden.
Bariatric surgery is a financial investment, but using an FSA, HSA, or HRA can make the cost more manageable and provide valuable tax savings. Check your plan rules and consult a tax advisor. By carefully planning and maximizing the benefits of these accounts, you can ease the financial burden of surgery while taking an important step toward better health and a longer lifespan.
Nicholson Clinic is committed to preventing finances from limiting any patients from receiving life-changing weight loss surgery. In order to best serve all of our patients, we offer a number of payment options, including traditional payments; financing through the CareCredit® (approval required); and insurance coverage.
In many cases, bariatric surgery is considered a medical necessity and is at least partially covered by most insurance companies, provided the patient meets their requirements. Our team of insurance specialists will help you manage the process, working directly with your insurance provider to acquire approval. For more information on insurance coverage for your weight loss procedure, click here. Patients who plan to self-pay for their weight loss procedure can find a procedure cost list here. We offer some of the lowest, all-inclusive, package pricing in the country. For information on payment plans and financing with CareCredit®, click here.
If you’re considering bariatric surgery, now is the time to explore these options and create a plan that works best for you.
Nicholson Clinic is pleased to announce each of our surgeons has been voted to Living Well Magazine’s 2024 list of “Top Docs” and Living Magazine’s “Best of” 2024 list! These annual recognitions are decided on by the magazines’ readers through an online voting process.
This is the 10th year that the Nicholson Clinic has been recognized by Living Magazine readers, this year in three markets: Frisco/Plano, McKinney/Allen, and Richardson/Murphy. The winners are announced in the August 2024 issue. Living Magazine is a leading lifestyle magazine and community resource in North and South Texas.
And for the sixth consecutive year the Nicholson Clinic was recognized in both the Top Bariatric Surgeon and Top General Surgeon Category by Living Well Magazine, a health and lifestyle magazine in Dallas and Collin County. Winners are announced in the July/August issue.
“We are truly honored to be selected as ‘Top Docs’ in our field by both publications. These recognitions inspire us to continue our commitment to providing the highest level of care and compassion to our patients,” says Dr. Nick Nicholson.
Thank you for your confidence in us and choosing the team at the Nicholson Clinic to walk alongside you and your loved ones in your journey to improved health. We are honored to have Dr. Nick Nicholson, Dr. Brian Long and Dr. Thomas Roshek recognized as “Top Docs” again in 2024!
Life before surgery was becoming increasingly difficult for Chris. He found himself spending most of his time sitting in a recliner in front of the TV. His then 3-year-old son would ask him to come outside and play, but Chris often felt too tired or too embarrassed about his weight to join in. Even simple tasks like walking up a flight of stairs left him breathless. Health issues were starting to mount as well: his blood pressure was on the rise, and he had been diagnosed with sleep apnea.
Years of dieting had led to an exasperating cycle of losing and regaining weight, often ending up heavier than before. Chris was getting frustrated continually needing larger clothing sizes and not being able to maintain any weight loss. Conversations with family members who had successfully undergone weight loss surgery prompted Chris to consider a surgical solution. He decided to have weight loss surgery after recognizing that his health and quality of life were at stake.
Choosing the Nicholson Clinic
Chris chose the Gastric Sleeve procedure with the Nicholson Clinic, influenced by a family member who had been a patient there and spoke highly of the clinic. Researching further on the clinic’s website and social media, Chris was impressed by the success stories and testimonials. Despite the clinic being farther from his home than other options, he was convinced it was the right choice.
Time was of the essence for Chris, as he aimed to have the surgery during a scheduled vacation to avoid taking additional time off work. Dr. Long saw Chris for his initial consultation and was able to get him in quickly for surgery.
The Nicholson Clinic Experience
“The process with the Nicholson Clinic was very quick and easy, and I was able to use my insurance which was great!”
Chris needed to get insurance approval quickly to fit the surgery into his vacation schedule. The clinic’s insurance staff submitted and received approval in less than a week. He swiftly completed the necessary consultations with the clinic-recommended nutritionist and psychologist, ensuring he met all the requirements in time.
Chris praised the Nicholson Clinic for making the insurance process straightforward and stress-free. This efficiency allowed him to schedule his surgery date perfectly within his planned time off, starting his pre-op diet promptly.
Recovery and Results
“I was able to walk out of the surgery center on my own within a few hours after my surgery!”
Chris’s concerns about recovery were quickly alleviated. Just hours after surgery, he was able to walk out of the surgery center on his own. The recovery process was mostly pain-free and complication-free, thanks to the clear instructions provided by the clinic.
Being a pilot, Chris expected a significant delay before returning to work. However, Dr. Long cleared him to resume flying just two weeks post-op, a testament to the smooth recovery process.
Life After Surgery: A New Beginning
“Losing over 100 pounds in 8 months has been great!”
Eight months after surgery and over 100 pounds lighter, Chris’s life has transformed. He no longer hesitates when his son asks him to play outside or get on the floor. Physically, he can do much more without the aches and pains that plagued him before. His sleep has improved significantly, and he anticipates being able to stop using his CPAP machine after another sleep study.
Chris’s health has improved dramatically. His blood pressure is now within the normal range, and a liver biopsy performed during the surgery revealed fatty liver disease, which has since shown signs of reversal. His liver doctor believes his liver has healed, pending confirmation from upcoming tests.
Emotionally, Chris feels better about himself and is more comfortable in public. He and his family recently purchased almost seven acres of property, a decision driven by his newfound energy and ability to maintain it. Chris also enjoys training his German Shepherd, Ziva, which involves lots of walking—something that was once a struggle but is now a breeze.
Maintaining Success
To maintain his weight loss, Chris continues to attend follow-up appointments and adhere to the dietary guidelines provided by Dr. Long and his team. He enjoys family walks and is considering starting running.
Chris’s journey with the Nicholson Clinic and Dr. Long has been a life-changing experience. From struggling with daily activities and health issues to enjoying an active and fulfilling life, his story is a testament to the profound impact of weight loss surgery when supported by a dedicated medical team.
Meet Tanya, she gifted herself weight loss surgery for her 48th birthday, and it was the best present she could have ever received! She decided to take control of her life and health by undergoing gastric sleeve surgery with Dr. Roshek at the Nicholson Clinic. Here’s her inspiring story of transformation.
Life Before Surgery: Tanya’s life before surgery was filled with challenges. “Life was miserable,” Tanya says. At 5’5 and 370 lbs, she was up to a 5x in clothes and on 12 medications. She struggled with mobility issues and deteriorating mental health and self-esteem. Simple tasks like walking were painful, and she felt trapped in a cycle of hopelessness.
Decision to Undergo Surgery: After years of unsuccessful attempts of yo-yo dieting, losing weight and regaining weight, and several health scares, Tanya stumbled upon a bariatric group on Facebook where she found inspiration in a fellow member’s before and after photos. Encouraged by the positive experience shared, she chose the Nicholson Clinic for her journey to better health.
Working with the Nicholson Clinic: Tanya’s experience with the Nicholson Clinic was nothing short of exceptional. From the support of her dedicated Patient Care Advocate to the professionalism of the medical staff, she felt guided and cared for every step of the way. “I had so much support; it was really incredible during a very vulnerable time”, Tanya shares.
Despite initial setbacks with insurance, Tanya opted for self-pay and took out a loan—an investment she now considers invaluable. Tanya explains, “initially I was going to go through insurance and about 2 weeks into pre-op appointments I received a letter from my insurance company stating my approval was denied due to a contractual exclusion. I was devastated! I chose to take out a personal loan and it was the best $10k I’ve ever spent in my life. I’ve spent that and more over the years becoming obese.”
Life Now: Fast forward to today, and Tanya is living a life she never thought possible. “Life NOW is how I wish it had been for the last 20 years. It’s a brand-new life!” From 370 lbs to 266, a significant weight loss of 104 lbs, she exudes newfound energy and positivity. Emotionally, she’s undergoing therapy to address her relationship with food and past traumas, while physically, she’s embraced a more active lifestyle, participating in virtual walking challenges, in-person 5ks, and even discovering a love for pickleball. Tanya is happy to report, “I’ve gone from being a couch potato to my own version of being an athlete, lol! I am SO grateful for my new lease on life.”
Maintaining Weight Loss: Tanya attributes her continued success to a strong support system of family and friends, managing her mental health, and staying active. While she doesn’t adhere strictly to a specific diet, she makes intentional food choices, practices portion control, and listens to her body’s cues. Most importantly, she’s learned to cherish her second chance at life and refuses to let food dictate her happiness.
Tanya’s journey serves as a beacon of hope for anyone struggling with obesity and its associated health issues. Through determination, support, and the right medical intervention, she’s reclaimed her health and happiness, proving that it’s never too late to rewrite your story.
If you’re considering weight loss surgery, take inspiration from Tanya’s story and reach out to the Nicholson Clinic for expert guidance on your own transformative journey.
How much weight have you lost overall?
137lbs from my highest weight and 117 from my surgery date
Brief overview of what life was like before surgery, and why you decided to have weight loss surgery?
Before deciding to have the gastric sleeve life was an uphill battle daily physically and mentally. I was trapped in my body and felt frustrated and defeated daily. I tried everything you could imagine. Programs , non-stimulant diet pills , shakes , exercise. For 16 yrs the weight wouldn’t budge. My I wasn’t always obese , I was very thin , athletic and full of energy. My obesity was due to poor coping skills and food addiction. Once I realized this was the root of the issue I wanted help and found Nicholson Clinic in addition to a behavioral therapist to prepare me for the right coping skills so I would not self-sabotage after surgery!
What was the process like working with the Nicholson Clinic, pre-op and post-op? Anything specific you want to say about your doctor and/or staff?
The process was seamless and easier than I imagined. The staff made you feel like a person. I loved how Dr long would sit back in his chair and prop his leg over his other one lol it was as if he were at home and soaking in your story and concerns. I never felt rushed or a number!
What is life like now? What’s different physically and emotionally?
Life after surgery is so beautiful! My life before was beautiful however now it’s as if a veil has been lifted and things are in color! God has used this tool to give me new found joys in life and freedom! I am healed from food addiction by his grace and now have a tool to help me succeed in my health! No more Hypertension no more Shortness of breath no more joint pain no more stress inconstance better sleep. I can do things with my children and be an example as a nurse to my own patients. I’ve been more adventurous and food is savored now instead of gulped down. Eating is no longer a chore or addiction it is a part of living. Eating is no longer an addiction but a choice of freedom! Since my surgery I have chosen to be 100% Keto. For me the addiction to sugar was not something I was willing to risk. My husband and family were a huge support and never gave up on me!
Any advice for someone considering weight loss surgery?
Do it! Prepare yourself. Do the ground work and study. This is a tool and tool trust. Know what to expect and weigh those expectations against your own. For me the risk of not having the surgery were far greater than the risk that came with the surgery. My post op recovery was so great. The Nicholson team were there every step of the way. Be willing to make personal changes and grow and watch the joys unfold!! “
Bariatric surgery continues to play a major role in obesity management despite the emergence of potent new weight-loss medications, according to two experts who spoke at an Endocrine Society science writers briefing.
“Bariatric surgery is safe, effective, and unfortunately underutilized for treating obesity and its complications,” said Jaime Almandoz, MD, medical director of the Weight Wellness Program at the University of Texas Southwestern Medical Center, Dallas.
Added Almandoz, who is triple board-certified in internal medicine, endocrinology, and obesity medicine, “Sometimes this gets presented in a linear fashion. ‘We’ll try lifestyle first and if that doesn’t work, we’ll try medications and if that doesn’t work, we’ll try surgery.’ But sometimes we might need to go straight to surgery instead of going through medications first, because it may be the most effective and evidence-based treatment for the person in the office in front of you.”
Moreover, he pointed out that currently, Medicare and many private insurers don’t cover antiobesity medications but do cover bariatric surgery.
Indeed, Srividya Kidambi, MD, professor and chief of endocrinology and molecular medicine at the Medical College of Wisconsin/Froedtert Hospital, Milwaukee, Wisconsin, said there are certain types of patients for whom she might consider bariatric surgery first. One would be a person with a body mass index (BMI) greater than 40 kg/m2 or with a BMI greater than 35 kg/m2 and severe comorbidities.
Another, she said, would be young, relatively healthy people with obesity who have no comorbid conditions. “We know that if we stop the medication, the weight comes back. So, if I see a 20- to 25-year-old, am I really to commit them to lifelong therapy, or is bariatric surgery a better option in these cases? These drugs have not been around that long…so I tend to recommend bariatric surgery in some patients.”
During the recent briefing, Almandoz summarized the evidence base for the benefits of bariatric surgery beyond weight loss, which include remission of type 2 diabetes and fatty liver disease, reduction of the risks of cardiovascular disease and cancer, and increased life expectancy.
“Everyone seems to be talking about GLP-1s for facilitating weight loss and treating obesity…. What I want to do is provide a counterpoint to accessible therapies that are covered by more insurance plans and that may, in fact, have a better evidence base for treating obesity and its related complications,” he said in his introduction.
Bariatric surgery has been used for decades, and many centers of excellence perform it, with greatly reduced complication rates seen today than in the past. “It’s comparable to having a gallbladder surgery in terms of perioperative risk,” he noted.
Medicare and private insurers generally cover bariatric surgery for people with BMI greater than 40 kg/m2 or 35–39 kg/m2 and at least one weight-related comorbidity, including type 2 diabetes, obstructive sleep apnea, hypertension, atherosclerotic disease, hyperlipidemia, and fatty liver disease.
Data suggest that weight reduction of about 3% can lead to meaningful reductions in blood glucose and triglyceride levels, but weight loss of 15% or greater is associated with reductions in cardiovascular events and type 2 diabetes remission. Lifestyle modification typically produces about 5% weight loss, compared to 20% to 35% with bariatric surgery with sleeve gastrectomy or gastric bypass.
Older weight loss medications produced weight loss of 5% to 10%; only the newer medications, semaglutide 2.4 mg and tirzepatide, come close to that. Weight loss with semaglutide is about 15%, while tirzepatide can produce weight loss of up to 22%. But, there are still issues with affordability, access, and lack of coverage, Almandoz noted.
One recent randomized trial of more than 400 individuals showed that bariatric surgery was more effective than lifestyle and medical therapies for treating metabolic-associated steatohepatitis (MASH) without worsening of fibrosis.
Another showed that the surgery was associated with fewer major adverse liver outcomes among people who already had MASH. That same study showed a 70% reduction in cardiovascular events with bariatric surgery.
For patients with type 2 diabetes, numerous trials have demonstrated long-term remission and reduced A1c at 5 years and 10 years post surgery, along with reductions in microvascular and macrovascular complications.
Other data suggest that a shorter history of type 2 diabetes is among the factors predicting remission with bariatric surgery. “Oftentimes, both patients and providers will wait until the diabetes is quite advanced before they even have the conversation about weight loss or even bariatric surgery. This suggests that if we intervene earlier in the course of disease, when it is less severe and less advanced, we have a higher rate of causing remission in the diabetes,” Almandoz said.
The American Diabetes Association’s Standards of Care incorporate bariatric surgery as either “recommended” or “may be considered” to treat type 2 diabetes, depending on BMI level, for those who don’t achieve durable weight loss with nonsurgical methods, he noted.
A retrospective cohort study showed significant reductions in cardiovascular outcomes with bariatric surgery among people with baseline cardiovascular disease. “This is not just about bariatric surgery to cause weight loss. This is about the multitude of effects that happen when we treat obesity as a disease with highly effective therapies such as surgery,” he said.
Even cancer risk and cancer-related mortality were significantly reduced with bariatric surgery, another study found.
And in the long-term Swedish Obese Subjects Study, among people with obesity, bariatric surgery was associated with a 3-year increase in life expectancy compared with not undergoing surgery.
However, Almandoz also pointed out that some patients may benefit from both weight-loss medication and bariatric surgery. “Once someone has undergone pharmacotherapy, there may still be a role for bariatric procedures in helping to optimize body weight and control body weight long term. And likewise for those who have undergone bariatric surgery, there’s also a role for pharmacotherapy in terms of treating insufficient weight loss or weight recurrence after bariatric surgery…. So I think there’s clearly a role for integration of therapies.”
Almandoz serves as consultant/advisory board member for Novo Nordisk, Boehringer Ingelheim, and Eli Lilly. Kidambi is director of TOPS Center for Metabolic Research Supported by TOPS Inc and is medical editor of TOPS Magazine, for which her institution receives an honorarium.
Miriam E. Tucker is a freelance journalist based in the Washington DC area. She is a regular contributor to Medscape, with other work appearing in the Washington Post, NPR’s Shots blog, and Diabetes Forecast magazine. She is on X (formerly Twitter) @MiriamETucker.
