Following positive feedback from patients and viewers, Sarah Samreen, MD, director of Metabolic and Bariatric Surgery, and Andrea Stark, DO, an internal medicine and obesity medicine physician, returned for another discussion about obesity care, long-term follow-up after bariatric surgery, and the rapidly evolving treatment landscape.
This episode was shaped in part by questions from patients and primary care providers, particularly about what happens years after bariatric surgery when a patient may no longer be seeing their original surgeon. Samreen and Stark also explored new treatment options and the importance of ongoing support to help patients maintain their long-term health goals.
Why long-term follow-up still matters after bariatric surgery
One of the main themes of the conversation was that bariatric surgery is not a one-time event. Even when patients are doing well, have lost weight, and are not experiencing obvious symptoms, long-term follow-up remains important.
Samreen explained that patients are often highly engaged during the first year or two after surgery. Over time, however, some may move, lose contact with their surgeon, or assume they no longer need specialized follow-up care.
That can become a concern years later if a patient develops symptoms such as numbness, neuropathy, or other issues that may be related to nutritional or vitamin imbalances.
As Samreen emphasized, obesity is a chronic disease, and patients who have undergone bariatric surgery should continue receiving ongoing care, just as they would for other chronic conditions.
During the first year after surgery, follow-up care typically focuses on recovery and monitoring for complications. Patients may be seen two weeks, six weeks, three months, six months, and one year after surgery, with additional visits as needed. After that, follow-up may continue at 18 months, two years, and then annually.
Nutrition, vitamins, and annual labs
For patients who are five, 10, or more years beyond surgery, nutrition remains one of the most important areas to monitor.
Samreen noted that long-term bariatric patients do not need to follow a highly restrictive diet forever. Instead, the goal is a healthy, balanced lifestyle with an emphasis on protein and complex carbohydrates.
She also addressed a common misconception around carbonated beverages and straws. Immediately after surgery, especially during the first three to six months, avoiding carbonation and straws can help reduce bloating and support healing. In the long term, however, these are not permanent restrictions for every patient.
The larger concern is whether patients are eating enough, maintaining protein intake, preserving muscle mass, and continuing appropriate vitamin supplementation.
Vitamins are especially important for bariatric patients because bariatric-specific supplements contain higher amounts of key nutrients than standard multivitamins. Samreen noted that this is particularly important for patients who have undergone procedures such as gastric bypass, duodenal switch, or single-anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S).
Annual laboratory testing may include monitoring levels of vitamin B1, folate, vitamin B6, vitamin B12, and vitamin D. For patients who have undergone certain procedures, testing may also include micronutrients such as zinc, copper, and selenium.
The conversation also touched on bone health. In general, patients who have undergone bariatric surgery should follow recommended primary care guidelines for osteopenia and osteoporosis screening, while taking into account individual risk factors.
What’s new in obesity medications
The physicians also discussed recent changes in obesity medications, particularly GLP-1 medications.
Stark explained that GLP-1 medications are no longer available only as injectables. Oral formulations are now available, which may appeal to some patients but are not necessarily easier or convenient for everyone.
Oral Wegovy, for example, must be taken daily and separated from food, drink, and other medications by 30 minutes. Patients can only take it only with a small amount of water and must wait before eating or drinking anything else. Stark noted that this routine can be challenging for some patients, particularly those with busy morning schedules.
The conversation also covered a second oral GLP-1 option, Foundayo, which Stark said has fewer food and drink restrictions because it is not a peptide or protein structure. Both oral medications may offer slightly less weight-loss efficacy than injectable GLP-1 medications, but they provide additional treatment options for patients.
Stark also discussed a higher-dose injectable Wegovy option, which she described as exciting because its reported weight-loss efficacy is approaching that of the highest-dose Zepbound for some patients.
Cost, coverage, and access still matter
Treatment decisions are not based only on clinical considerations. Cost, insurance coverage and access often shape which medications patients can realistically use.
Dr. Stark explained that manufacturer programs may be the most affordable self-pay route for some GLP-1 medications. Patients with commercial insurance also may be eligible for manufacturer savings cards if their health insurance plan covers the medication. She also noted that these programs generally do not apply to Medicare, Medicaid, Veterans Affairs (VA) or other Centers for Medicare & Medicare (CMS) coverage.
The physicians also discussed Medicare coverage changes for GLP-1 medications prescribed for obesity and encouraged patients to consult their physicians and reviewMedicare resources for the lastest information, as coverage policies, timelines, and plan details may change.
As of July 1, 2026, after this conversation was recorded, the Medicare Bridge program initiated coverage of select GLP-1 medications, including Zepbound, injectable Wegovy, oral Wegovy, and Foundayo. Please reference our latest UTMB News article on the Medicare Bridge program for criteria and coverage details.
Medication, surgery, or both?
A major takeaway from the episode is that obesity treatment is not always an either-or decision.
Stark and Samreen emphasized that patients should understand all available options, including lifestyle support, medication, bariatric surgery, and combination therapy.
Stark noted that she often starts by using body mass index (BMI) as a screening tool, while recognizing that BMI does not tell the whole story. For patients with a BMI of 40 or higher, she believes surgery should at least be part of the conversation so patients can make informed decisions about their options.
Samreen agreed, emphasizing that being a surgeon does not mean being biased against medication. The goal, she said, is to help patients choose the treatment approach that best aligns with their health, goals, readiness, and individual circumstances.
The physicians compared expected weight loss across different treatment approaches. Lifestyle interventions and older obesity medications generally result in total body weight loss of fall in the 5% to 10% . Newer GLP-1 medications may greater weight loss, while bariatric surgery often results in even greater total body weight loss, depending on the procedure and individual patient factors.
They also discussed combination therapy. Some patients may use medication before surgery to help reduce surgical risk, after surgery to support long-term results, or both.
Why consultation matters
Both physicians encouraged patients to seek consultation, even if they are unsure whether they want medication or surgery.
Patients do not need to arrive with a decision already made. A consultation can help them understand risks, benefits, expected outcomes, insurance coverage, and whether medication, surgery, or a combination approach makes the most sense for their needs.
Samreen also described using a risk-benefit calculator during the first appointment to help patients understand expected weight loss, potential metabolic improvements, and surgical risk based on their individual health profile.
The physicians emphasized that no specialist should be offended if a patient is gathering information, asking questions, or seeking a second opinion.
Type 2 diabetes and bariatric surgery
The episode concluded with an important discussion about patients with Type 2 diabetes and obesity.
Samreen said more payers are beginning to recognize updated bariatric surgery guidelines, particularly for patients with a BMI of 30 or higher and Type 2 diabetes. She noted that these patients may benefit from bariatric surgery earlier because of the potential effects on blood sugar control and long-term metabolic health.
She also emphasized that many patients with Type 2 diabetes and obesity have never been told bariatric surgery may be an option, even though major clinical guidelines increasingly support considering it for appropriate candidates.
Final takeaway
The biggest message from this episode is that obesity care is evolving rapidly, and patients should not feel limited by confusing or outdated perceptions of their treatment options.
Long-term follow-up remains important after bariatric surgery. New medications are expanding treatment options. Surgery continues to be a safe and effective option for many patients. For some, a combination of medication and surgery may offer the best path forward.
The most important first step is starting the conversation with a trusted physician, whether that is a primary care doctor, obesity medicine specialist, bariatric surgeon, or another another member of the patient’s care team.
As Stark and Samreen noted, some treatment is better than no treatment, and understanding all available options can help patients make informed decisions about their long-term health.