June 16, 2026 • 38 mins
GLP-1 injections are everywhere, bariatric surgery numbers are shifting, and patients are arriving more informed than ever. We sit down with Dr Seun Sowemimo, a board-certified bariatric and gastrointestinal surgeon and founder of Prime Surgic Care, to make sense of what actually works for sustainable weight loss and better metabolic health when real life, real budgets, and real habits collide.
We talk candidly about how GLP-1 receptor agonists affect the role of weight loss surgery, why access and insurance changes can derail progress, and why many people need ongoing medication to maintain results. Sean explains how he assesses whether someone is best suited to bariatric surgery, GLP-1 therapy, or a combination, including the importance of psychological readiness and structured follow-up. If you have ever wondered why some people keep weight off for a decade while others regain, his “escalator” analogy gives a clear, memorable answer.
Nutrition and lifestyle medicine run through the entire conversation. We dig into a whole foods, plant-forward approach, how processed food culture shapes chronic disease, and why exercise supports health even when diet drives most weight change. We also explore the business realities behind modern obesity treatment, from corporate consolidation to how small practices can use technology and AI to improve care without losing the human touch.
If this conversation helps you think differently about obesity care, medical weight loss, bariatric surgery, or long-term weight maintenance, subscribe, share it with a friend, and leave us a review. What tool or habit has made the biggest difference to your health journey?
👤 Guest Biography
Dr Seun Sowemimo is a board-certified bariatric and gastrointestinal surgeon and founder of Prime Surgicare in New Jersey. With advanced training in surgery, metabolic health, and healthcare leadership, he combines surgical expertise with lifestyle medicine and medical weight management strategies, including GLP-1 therapies. Dr Sowemimo is passionate about helping patients achieve sustainable health improvements through evidence-based obesity treatment and comprehensive long-term care.
Links
- Website: https://primesurgicare.com
- LinkedIn: https://www.linkedin.com/in/seunsowemimo/
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About the podcast
Voices in Health and Wellness features conversations at the intersection of medicine, lifestyle, and human potential, with clinicians, scientists, and thinkers shaping the future of care.
About Dr Andrew Greenland
UK-based medical doctor and founder of Greenland Medical, specialising in Integrative and Functional Medicine. Trained in both conventional and root-cause approaches, Andrew helps people optimise health, performance, and longevity, with a focus on cognitive resilience and healthy ageing.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr Andrew Greenland (00:00):
Welcome back to Voices in Health and
Wellness.
This is the podcast where weexplore the people and ideas
shaping the future ofhealthcare, especially at the
intersection of clinicalexcellence, lifestyle medicine,
and sustainable patientoutcomes.
Today I'm joined by Dr.
Seun Sowemimo, aboard-certified bariatric and
gastrointestinal surgeon,founder of Prime Surgic are, and
(00:21):
an expert in both surgical andmedical weight loss, including
GLP1 therapies and lifestylemedicine.
With a background that combinesclinical expertise and business
insight, Dr. Sowemimo brings areally valuable perspective on
how we approach obesity,metabolic health, and long-term
patient care in a rapidlyevolving landscape.
So with that, Sean, I'd love towelcome you to the show and
(00:42):
thank you very much for joiningme today.
Speaker (00:44):
Thanks for having me, Dr.
Greenland.
Happy to be here.
Dr Andrew Greenland (00:48):
To start, would you mind sharing a little
bit about your journey intobariatric surgery and what led
you to build prime surgic care?
Speaker (00:55):
Yeah, uh, thanks for that.
I originally trained in Lagos,Nigeria, and then I took a trip
to the UK, started my surgicaltraining there, and around that
time was when bariatric surgery,you know, was starting to take
hold, uh, especially with newtechnology around laparoscopic
(01:17):
surgery, which was intriguing tome.
So I went into that field, anduh I actually didn't start out
just really wanting to take careof people with weight loss.
It was the technology thatattracted me to it because
literally you were doing surgeryon the biggest people you could
find with the smallestincisions.
So after getting into that, youknow, you find out that
(01:41):
bariatric surgery in itself isnot, you know, a one fix for
everything.
And people still had to, youknow, eat a proper diet and
everything.
And I found out that what wewere following um more protein,
less carbs, and all this wasn'treally working that well for
everybody.
(02:01):
And this hit home when I myselfstarted to put on a few pounds
and develop high cholesterol,pre-diabetes.
So that is what led me down therabbit hole of finding out what
truly works for health, forwellness, you know, for
maintaining a healthy weight.
(02:21):
And that is why my practice,Prime Surgicare, sort of focuses
not just on the surgical aspectand bariatric surgery, but the
wellness aspect, the nutritionalaspect, uh, exercise, and all
these other pillars that I'msure we will get into.
So that's how I got into it.
Dr Andrew Greenland (02:41):
Lovely, thank you.
Always good to have somebackground and context for what
we're discussing.
So tell us a bit about thepractice itself, prime surgic
care.
What does it look like today?
How is it set up?
And maybe talk a little bitabout a typical patient journey.
I know there is no such thingas a typical patient journey,
but how does it look like from apatient using your service?
Speaker (02:59):
Yeah, so we get our patients that primarily either
coming to us for uh weight losssurgery or they're coming to us
for weight loss medications.
So right now I'm uh the solephysician in the practice.
I'm supported by physicianassistants and medical
assistants.
(03:19):
Uh so we intake all thesepeople, and then we're either
guiding them down the path ofyou know getting a bariatric
surgery procedure or being onweight loss medications more
recently.
But on top of all that is whatI've learned that you know 20
years plus of being in thisfield of trying to get people
(03:42):
healthier and lighter, all thatyou know, experience uh to guide
them in terms of changing theirlifestyle to support uh a
healthy weight and health ingeneral, because we get people
coming in with all the usualchronic diseases, heart disease,
diabetes, high cholesterol,even people finding out that
(04:05):
they have some cancers.
And uh the shocking thing isthat these cancers are also
related to lifestyle, and in alarge part to what we eat, how
we move, how we sleep.
And uh that is very interestingbecause the the every all of
those things coming together uhtie into the fact that people
(04:28):
tell you, oh, you changed mylife at the end of the day when
they've come through thisjourney.
And it it is because weight andthe things surrounding that
affect every other aspect oflife and living.
So the practice is sort of setup in that way where we're we're
trying to sort of uh touchpeople's lives in in a profound
(04:52):
way.
We also do some generalsurgery, hernia's uh surgery,
gallbladder surgery, but thecenter of the practice is around
transforming people's livesaround weight and health.
Dr Andrew Greenland (05:05):
Thank you.
Now there's obviously been ahuge shift with the GLP1
medications.
How are you seeing that impactthe role of surgery in weight
management from yourperspective?
Speaker (05:15):
Well, I think there's the initial sort of excitement
about uh GLP1s that like it's acure all.
Um, but I've found that likeeverything else in life, to do
anything properly or achieve agood result, you're gonna have
to do more than one thing.
So it's gonna, even with peopleon GLP1s, it usually requires
(05:39):
more than just uh themedication.
But it's had an impact in asmuch as we've seen numbers of
bariatric surgeries drop.
However, we still have somepeople who cannot tolerate the
medications.
We have some people for whom umaccess to the medication is a
(06:02):
problem because uh here in theUnited States a lot of insurance
is tied to employment.
Employment changes, or theychange the policy around uh the
coverage for these medications,and then people find themselves,
you know, starting and stoppingthe medication.
So there's there's accessproblems uh like that.
(06:23):
And then the medications rightnow are more expensive, you
know, at uh at a level thatpeople cannot afford.
And it may actually be cheaperin the long term right now to
get the surgery than to have totake the medication, which for a
(06:44):
lot of people, what peopledon't understand is that once
you get on these medications isnot something that you do, get
to a certain weight, and thenstop the medication.
You indeed have to continue themedication to maintain your
weight.
Dr Andrew Greenland (07:00):
Got it.
So do you see the medicationsas a comp as competition in a
inverse commons or more of acomplementary tool?
So I guess I guess because youhave a more holistic approach,
they're in your in your toolbox,but how do you view them?
Speaker (07:14):
Well, initially it it it was uh competition because
once we started seeing themedications come on board, uh a
lot of um uh our surgery numbersstarted to drop, and you could
see that people were asking uhthe any physician they knew,
hey, do you prescribe uh GLP1medications?
I'll be in church trying to youknow worship, and someone will
(07:38):
be nudging me and saying, Hey,Dr.
Sean, do you do thosemedications?
So it's uh interesting in thatway, but as time has gone on and
these other factors that Imentioned have come into play,
um, we're seeing that people aremixing both.
I I personally have givenmedication to a fair number of
(08:00):
my patients whom, after theirsurgery a few years on, have
started seeing some weight creepback on.
Um, some people have used themas a complementary strategy with
the surgery in people that haveuh super morbid obesity,
meaning that their BMI is sohigh that we know that even
(08:21):
though surgery will have asignificant impact, we would
really like more weight loss tobring them back towards a normal
weight.
So it's becoming more of acombination now.
But where exactly that balancesettles actually depends on the
uh individual and the localcircumstances.
Dr Andrew Greenland (08:40):
Thank you.
I guess um what major shiftsare you seeing in how patients
approach weight today comparedto a few years ago?
I'm guessing the drugs are afeature of that, but I just
wonder if there's any else, anyother shifts that you're seeing
in their approach.
Speaker (08:54):
Yeah, so there's more people coming to um uh uh to use
these tools for weight loss,you know, because when the most
powerful and effective, which isprobably still the case, uh the
most powerful and effectivetool that we had was surgery.
(09:15):
People had a barrier to usethat tool.
People were fearful sometimes,even though weight loss surgery
is really safe, uh, but peoplewere fearful.
So now that barrier has beenlowered significantly, given
that it's medications uh thatbring people to the point that
they they accept the fact of uhdoing an intervention.
(09:39):
It's also brought along with itsome people who do not
necessarily qualify, you know,due to uh by the standards that
are set.
You have people with BMIs thatare close to normal and they're
only slightly overweight, youknow, wanting to take the
medication, people uh wanting totake the medication before an
event or the wedding orsomething like that, you know,
(10:02):
to lose some weight to fit in adress, that sort of thing.
But by and large, it's broughtmore people into the fold, which
is a good thing, because one ofthe things that I believe is we
have a finite period of timethat we're here as human beings.
You owe it to yourself to behealthy for the most part of
(10:26):
that and be able to do what youknow what gives you pleasure,
what allows you to enjoy yourlife.
So whether it be weight losssurgery, whether it be
medications, whether it be acombination of those and
lifestyle changes, I encouragepeople to do whatever is needed
so that they're not uh ending uplike some of my patients say,
(10:48):
Oh, I wish I had done this 10years ago.
Because there's there's lifethat they're missing on the
people, simple things, even liketaking a ride with your your
kids and at a park, you know,that some people have to be on
the sidelines and be on theoutside looking in.
Uh, these are interventionsthat can help you to get that
(11:11):
back and get your life while youstill have it, you know, uh and
not spend all you know yourbest years trying to lose
weight.
Dr Andrew Greenland (11:24):
Thank you.
So, what does a typical day umfor you look like in practice at
the moment?
I do accept that there is nosuch thing as a typical day, but
trying to get some sense of howthings plan out for you on a
daily basis.
Speaker (11:36):
Well, I think on a daily basis, it's it's it falls
into two categories.
I'm either operating or I'mjust seeing patients.
Or on an operating day, I'm inthere either doing bariatric
surgery, example, the gastricsleeve, which is our most common
surgical procedure, um, ordoing some general surgery,
(11:56):
fixing hernias, taking out uhdiseased gallbladders.
So that those are that's asurgical day.
On a clinical day like today,what I'll be doing later on,
it's just uh early morning here,um, is seeing patients.
I'll see a combination of newpatients, you know, uh offering
(12:20):
them weight loss solutions,whether it be surgery or getting
on a GLP1, making sure thatthey qualify for that, and
telling them what the process islike.
I always like to give them acomp an overview first, in terms
of these are the strategies forweight loss.
It always involves uh exercise,physical activity.
(12:41):
It always involves uh dietarychanges, for which I advise the
patients mainly on a plant-baseduh with natural foods, whole
foods uh-based sort of diet.
I'm a firm believer that youknow the diet is really central
(13:02):
because a lot of the informationthat is out there, people never
tell us how much dietcontributes to the problems
around weight and chronicdisease.
So, diet for me is a key onethat people need to pay
attention to.
So I really like to try anddrive that home.
And then the procedure thatthey're trying to uh do, whether
(13:22):
it be surgery or the weightloss medications, how it works
and how best to prepare for it,and how to make sure that you're
working in tandem with theintervention that you've chosen
rather than doing something thatis uh against uh what that
intervention is trying to do.
Dr Andrew Greenland (13:42):
Thank you.
Now, I guess it's highlycomplex, but can you give us a
sense of how you determinewhether a patient is best suited
for bariatric surgery, GLP1therapy, or a combination of
both?
Speaker (13:54):
Oh, that's a simple one.
Uh Dr.
England because most peoplecome in and say, This is what I
want.
So it's a matter of trying toqualify them or making sure that
they are appropriate for whatthey want.
Uh, I mean, we live in asociety there's so much
information out there.
A lot of my patients come intelling me, hey doctor, I've
(14:17):
done my research.
So this is what I want to do.
So I take what they want to doand I look at their BMI, I look
at their lifestyle and theirprofile, and decide if that's
appropriate for them.
If it's not appropriate, then Iwould, you know, uh introduce
them to a solution that isbetter suited.
(14:39):
But for most people, whatthey're wanting to go for is
appropriate.
Um I want to give an example.
Uh, some people, for instance,if you are uh more advanced in
age, you have a lot of medicalchronic diseases going on, and
um the risk of surgery issignificant.
(15:00):
Now we have, you know, it mightbe easier for you to go or
safer for you to go on one ofthe weight loss medications to
achieve the weight loss that youneed, you know.
Dr Andrew Greenland (15:14):
And what about psychological readiness
for surgery?
How do you um prepare patientspsychologically?
Speaker (15:21):
Yeah, so part of the process, or one of the things
that is prominent about theprocess is a psychological
review.
So we do get clinicalpsychologists or psychiatrists
to evaluate patients.
And the idea is to first of allweed out if there is or find
out if there's any sort ofpathological eating disorder
(15:42):
that is uh the case with thepatients.
If not, then we would proceedand find out that they are an
appropriate candidate, that theycan follow the kind of
instructions that would helpthem to be successful around the
time of surgery and even forthe long term.
Um thankfully, very fewpatients are uh have the
(16:07):
psychological profile that theydon't qualify uh for the
surgeries.
We also do some medical tests,cardiac uh uh clearances to make
sure that from a cardiacstandpoint they're a good
candidate for surgery, pulmonaryas well.
So that's the whole gamut of uhtests that we do to make sure
(16:29):
people are ready for that sortof intervention.
Dr Andrew Greenland (16:32):
Thank you.
And on that note, whatcharacteristics do your most
successful bariatric patientstend to have in common if there
are some commonalysis?
Speaker (16:41):
The people that really do well and succeed are people
who are motivated, people who'vetried different things and uh
have had some limited amount ofsuccess, and people who, when
they come into our program, weintroduce them to some of the
lifestyle changes.
And between the time that theystart the program and get their
(17:04):
surgery, if they're able toapply those lifestyle changes
and lose some weight, that isthe best predictor that after
the surgery they're going to dovery well at losing a
significant amount of weight.
Dr Andrew Greenland (17:18):
And you talked about weight regain a
little bit earlier on.
I mean, what separates patientswho maintain weight loss for 10
years from those who struggleto sustain the results?
Speaker (17:28):
Yeah, uh, the analogy I give my patients is that the
weight loss is like going on anescalator.
You go on a from a weight thatis up here to a weight that is
down here, on this escalatorgoing down for a limited period
of time.
Typically a year to two years,they're actively losing weight
primarily because of theprocedure.
While you're on that escalator,you want to be walking down the
(17:51):
escalator.
And that you do with lifestylechanges that are mainly dietary
in terms of the uh impact andexercise.
Exercise is fantastic, but theimpact on weight itself is not
as much.
Um, the impact of exercise ismore on keeping away chronic
(18:13):
disease.
But in any case, thoselifestyle changes are like
walking down that escalator sothat you go down further and
faster and that you're able tokeep going after you're off the
escalator.
So the escalator of thesurgery, you know, acts as
something that multiplies yourlifestyle change over a period
(18:34):
and gets you to a lower,healthier weight, but you have
to use the lifestyle changes tokeep going along that journey.
Dr Andrew Greenland (18:44):
And how important is ongoing follow-up
after bariatric surgery?
I guess it seems like anobvious question, but I'm just
interested to hear yourperspective because you have a
much more holistic approach.
Speaker (18:54):
Yeah, I think it's very important because um people are
facing a tsunami of differentand varying and confusing
information on diet andlifestyle.
So that to keep them on track,uh you really have to keep
(19:17):
reinforcing this message.
So for the first two yearsafter someone has a bariatric
surgery, we believe that wewould need to see them pretty
frequently to keep reinforcingthis message.
And I it's worked because wherewe used to see people um, you
know, have the surgery and theygo and they come back, and
(19:37):
they're always telling you, oh,you know, I'm following the
diet, I'm eating more proteinand less carbs, which is not
what we preach.
Um now, with reinforcing thisconstantly on our messaging, on
our social media, and withpatient visits, people are
beginning to understand that,you know, uh changing your diet,
(20:00):
you know, not necessarily inline with the culture that we
find ourselves in modernsociety, but changing your diet
where you're eating mostly wholefoods, mostly natural foods as
opposed to processed foods, halfyour diet being fruits and
vegetables, fresh and fruits andvegetables.
The other half consistingmainly of whole grains and
(20:22):
complex starches and uh legumes,beans, lentils, chickpeas, and
the like, and minimizing animalprotein, you know, eating a
little bit of nuts and seedsthat summarizes, you know, a
well-rounded, healthy diet thatcan help you to maintain a good,
(20:45):
healthy weight and keep off uha lot of the chronic diseases
that we see out there.
Dr Andrew Greenland (20:52):
Um so what does a long-term comprehensive
care pathway look like for yourpatients?
Obviously, the frequent visitsthat you've alluded to, but what
what else is in that kind ofprogram to keep them where they
need to be?
Speaker (21:06):
Well, it's just like modeling the in my mind,
modeling the behavior.
I try to do that for mypatients, you know, with the
diet, also with exercise.
I I I bike and uh do some roadbiking uh during the season, and
I encourage people, whateversort of form of exercise that
(21:26):
you you can do that you enjoy,that you do mostly in a social
setting, you have uh people thatenjoy that with you, um, is
going to be useful for you.
So over the long term,obviously we can't follow people
uh for the rest of their lives,you know, from a practical
standpoint.
So we just try and reinforce iton the front end.
(21:48):
And as long as they keep comingback, we see patients on a
yearly basis after the secondyear.
As long as they keep comingback, we're just reinforcing
these principles, we're makingthat the kind of thing, making
sure.
That they're staying on track.
And uh the messaging that wesent out on send out on all our
channels is supporting that.
A lot of our patients, youknow, are on those uh channels
(22:11):
and receive our emails, ournewsletter letters.
So we're trying that way tokind of keep in touch, and
hopefully, we've already putthem in communities where they
know people who are adoptingthis sort of lifestyle.
And that's something hopefullythat can follow them for the
long term.
Um it all comes down to, forme, uh, from my perspective, a
(22:37):
lifestyle change that isenduring, you know, and once
you've welded that healthy wayof living into your life, you
have um things in yourday-to-day living that makes it
easy and convenient for you tofollow through with this kind of
lifestyle, then then that Ithink I've done my job.
Dr Andrew Greenland (22:59):
Amazing.
So we've been talking a lotabout bariatric surgery for
weight reduction.
Um, but could you speak alittle bit to the metabolic
benefits that are oftenoverlooked by patients and you
know, things like type 2diabetes, cardiovascular risk
factors?
Could you speak to that alittle bit?
Speaker (23:13):
Yes.
Um a lot of people think thatthose things, uh, the chronic
diseases, follow weight andweight loss, and that is true,
but in a lot of instances, it isactually not because of the
weight and uh obesity per se.
(23:35):
It is it follows more tightlywith the kind of diet that we're
consuming and lifestyle.
And one example that I caneasily describe is that when
we've moved to uh become asociety where animal products
(23:56):
are at the center of our diet,and a lot of the animal products
that we consume aremanufactured in a factory kind
of setting.
It's called uh, you know, uhthis concentrated animal farming
operations.
So we're producing animals, forinstance, take chicken, we
(24:16):
produce this in the billions.
And it takes a shorter time nowto get a chicken of a certain
weight compared to when theynaturally mature.
It takes about three months.
Now we do it in about threeweeks.
That chicken is not therelifting weights and building uh
(24:39):
muscles and protein.
That chicken has more fatcontent, more saturated fat.
And consuming this at thecenter of our diet translates
into a situation where ratherthan our blood flow being, you
know, more fluid withwater-based, your blood flow has
(25:01):
more saturated fat in it.
And the places in our arterieswhere uh arteries divide is a
source of friction in that flow.
And the accumulation of fat inthese places essentially is what
leads us to heart attacks.
Because when it happens in theheart where the vessels divide,
(25:23):
you can get blockage there.
And it also leads to stroke,where it happens in the blood
supply going to our brain wherethe vessels divide, and there's
friction, and you have moresaturated fat, you have more
cholesterol growth flowingthrough your vessels, can lead
to stroke.
So I've just given this examplehow heart disease and stroke,
(25:47):
brain disease can be connectedbecause of what we're consuming
and what we're eating.
If you can reverse thosesituations by eating better, the
body can heal.
And this is the very basis ofuh the American College of
Lifestyle Medicine, whichteaches people uh how to live
(26:13):
according to six major pillars,which let me try and recall if I
can mention them dietarychanges, uh, exercise, good
sleep, uh, reduced stress,social connection.
So these are the major uh uhpillars, and if you can turn
(26:35):
these things around in a healthydirection, your body can
actually reverse any of thesechronic diseases that you may
find yourself uh having,including obesity.
Dr Andrew Greenland (26:52):
Thank you.
So turning now to the businessside of the practice, what's
working particularly well inyour practice from a business
angle at the moment?
Speaker (27:00):
Well, in uh from the business uh aspect, I mean,
we've gone through a lot ofmajor changes here in in the US.
I mean, uh we've talked aboutone thing, which is uh the
change the coming in of the GLP1medications.
Here they have also um uhgovernment regulations uh around
(27:25):
uh practices and peoplereceiving uh you know uh bills
from uh physician practices.
There have been a lot ofchanges in that area.
Um there's also been a paradigmshift in that independent
practices like my own, primesurgic care, are becoming relics
(27:46):
of the past.
And a lot of practices arebeing bought up either by
hospital systems, large hospitalsystems, or um the marketplace,
private equity VC firms.
So there is a lot of tensionthere, it's become more
difficult to run individualprivate practices like what we
(28:10):
have.
You know, it used to be beforethat this was the engine of
small business in the country,and uh, but now it's becoming
more corporate medicine.
So that's that's a bigchallenge, and we're having to
make a lot of changes, try to uhdo some things like uh the big
uh players do, and try our bestin that regard, negotiating
(28:33):
contracts with insurancecompanies, uh getting attorneys
to help us with billing servicesand things like that.
So uh it's it's been more of astruggle, but uh we're bracing
up to the task so far.
Dr Andrew Greenland (28:48):
That's really insightful.
Thank you.
Are there any other kind ofmajor um hurdles, roadblocks,
bottlenecks that you have toface day to day or are
navigating at the moment, asidefrom the whole um corporate
medicine kind of creeping in?
Speaker (29:02):
Yeah, it's the use of uh I would say one thing along
those lines is the use oftechnology.
You know, uh everybody knowsthat AI is the new thing around
the corner.
So we're trying to see how wecan leverage that um to leapfrog
some of these problems thatwe've talked about that we're
(29:23):
having.
So implementing AI in a smallpractice that you know is uh
it's sort of a good thingbecause AI has become so
democratized, and you have thistechnology that everybody can
apply.
So we're just trying to seewhere in our workflows, in terms
of seeing patients, uhdelighting the patients in the
(29:45):
services that we have, and uh,you know, also running the
business side of things, youknow, uh getting reimbursed for
our services and trying to seewhere AI can help us in in those
areas.
So those are the things.
Dr Andrew Greenland (30:02):
Thank you.
Um and how has your MBAinfluenced the way you approach
healthcare and practiceownership?
Because you have that sort ofadded business strand to your
bow.
And how's that um influencedthings?
Speaker (30:13):
Yeah, it's it's it's helped me to be able to assess
the bigger picture of healthcareand uh where uh practice like
my practices like uh mine fitin.
So in the bigger picture, youknow, healthcare is a big
industry, billions of dollarsare spent there.
(30:35):
We talk about cost reduction,but we don't specify cost to
whom that we're reducing.
Is it cost to the patient?
Is it cost to the insurancecompany and those kind of
things?
We found out that they'remiddlemen that uh uh reap a lot
of profits in the healthcareindustry without uh giving more
(30:57):
access, more or providing bettercare.
Uh so here in the in the US,especially our healthcare is so
complex and the prices are high.
So that really, my MBA helpedme to open my eyes to the entire
uh the entire industry and thecomplexity of the industry along
(31:25):
its entire value chain.
You know, and what it it haspersonally helped me to see is
where do I want to engage morein the health system and where
are the areas that I I don'twant to uh uh apply myself.
So it's giving me a bigger andbetter perspective of the entire
(31:49):
healthcare industry, and it'shelping shape how I make
decisions.
Dr Andrew Greenland (31:57):
So I guess your total addressable market is
huge for the problems that youhelp patients with.
If you experience a suddeninflux of new patients next
week, what would happen?
Would anything break?
Hopefully, not you.
What would happen?
Speaker (32:13):
What will happen?
We will try to cope with that.
I think we have um we have someroom to expand.
Um I've had uh you know apractice where there have been
two surgeons, so that's anexpansion slot that we can
always um uh explore.
Should there be suddenunleashing of lots of patients
(32:38):
that I can't personally handlemyself or with the physician
assistance that I have?
Um so we're still at a placewhere I wouldn't say we're at
capacity, we can take in morepatients.
And if that sort of situation,there's a tsunami of patients,
we we definitely have uh somemeans of expansion that we can
(33:01):
explore.
Dr Andrew Greenland (33:03):
And what about um things like group
programs, digital education,telehealth or technology to
support patients beyond theone-to-one consultations?
Clearly, you can't replicateyourself for surgery, but all
the other aspects of theirlong-term treatment program.
Have you thought about any ofthose kind of um medalities?
Speaker (33:19):
Yeah.
Yeah, we've always had apresence on social media, and I
believe social media is moreimportant now.
Um, if you can get your messageout there, because part of my
um passion is just getting outthe education, especially on the
nutritional or dietary piece.
(33:41):
Because as a society, we'removing more towards uh more
processed foods, more factoryfarmed animals uh that is
leading to the chronic diseasesthat we see.
So I like to get the word outon that, you know, not even just
to patients that I mightencounter, but as far as I can
(34:04):
reach uh throughout the world,the entire globe, I'd like to
get that message out.
So I think social media is veryimportant for that.
The internet is very importantfor that.
So we want to engage more inthose spheres.
A podcast like yours isimportant for that as well.
Uh, if we can get the messageout into you know the areas that
(34:28):
you influence into where youare, that's what we want to do.
We want this is a globalmessage that I think would help
lots of people.
Um, and uh we have the toolswith which we can communicate
globally.
So that's that's a good thing.
Dr Andrew Greenland (34:45):
For sure.
And anything we can do to helpum you know raise awareness and
promote your message with this,we will do.
Um, so what about the futurethen?
What how do you see the futureof obesity care evolving from a
business and deliveryperspective going forward?
Speaker (35:00):
I think more of it is gonna be determined by the
culture, which is a factor thatwe we uh often overlook.
But culture drives a lot ofthings, it drives the messages
that get out there, uh, itdrives how people actually
behave, because having theknowledge sometimes is not
(35:23):
enough.
If the person opposite you uhon a table is eating in a
certain way, the chances arethat you're more likely to eat
along that way.
People don't want to be uhisolated, you know.
We thrive in communities.
So changing the culture uh inour lifestyles is very important
(35:48):
if we can if we're going to seethe change that we desire in
terms of obesity.
Uh beyond that is the tools.
It's a good thing that we'regetting more tools to treat
things on the back end whenpeople have already fallen off
the cliff, as it were.
You know, um, that is a goodthing because ultimately we're
(36:11):
all as humans only going to behere for a while.
You need to use whatever youcan to fix the problem so that
you have a great life.
But a lot more emphasis needsto be paid to making sure people
don't fall off the cliff, topreventing the problems of
obesity and the other diseasesthat we know are associated,
(36:35):
diabetes, heart disease,cancers, those sort of things.
So if we are able to change theculture to prevent these
things, uh then that's that'sthat's where we want to be.
And I hope people across theentire spectrum of uh lay
people, physicians, uhlawmakers, governments all get
(36:58):
on board with that messagebecause to shift the culture, it
will require everybody alongthe entire spectrum of
influence.
Dr Andrew Greenland (37:08):
Thank you.
And thinking about the futurefor you and prime surgic care,
where would you like thebusiness to be in the next six
to twelve months' time?
Anything on the cards for you?
Anything you're hoping toachieve, looking to do?
Speaker (37:19):
Yeah, with prime surgic care, seeing more patients, uh
offering our services, changinglives, transforming lives.
I would also like to, from thebusiness perspective, be more
vertically integrated.
Uh, we're thinking about youknow, uh surgery center, having
our own surgery center, which Ithink is quite ambitious as I
(37:41):
explained to you that you knowwe're becoming relics as uh uh
independent practices, but it'sit's something that I would like
to get into before I you knowhang up my scalpel and retire.
Dr Andrew Greenland (37:57):
And with that, she wanted to thank you so
much for joining me today.
It's been such a rich andinsightful conversation.
So thank you for sharing what abit about what you do, uh what
you're seeing in the space, anda little bit about the business
aspects of your work.
It's been really fascinating,and I'm very grateful for your
time.
Speaker (38:13):
Thank you, Dr.
Greeland.
It's my pleasure.
Welcome back to Voices in Health and
Wellness.
This is the podcast where weexplore the people and ideas
shaping the future ofhealthcare, especially at the
intersection of clinicalexcellence, lifestyle medicine,
and sustainable patientoutcomes.
Today I'm joined by Dr.
Seun Sowemimo, aboard-certified bariatric and
gastrointestinal surgeon,founder of Prime Surgic are, and
(00:21):
an expert in both surgical andmedical weight loss, including
GLP1 therapies and lifestylemedicine.
With a background that combinesclinical expertise and business
insight, Dr. Sowemimo brings areally valuable perspective on
how we approach obesity,metabolic health, and long-term
patient care in a rapidlyevolving landscape.
So with that, Sean, I'd love towelcome you to the show and
(00:42):
thank you very much for joiningme today.
Speaker (00:44):
Thanks for having me, Dr.
Greenland.
Happy to be here.
Dr Andrew Greenland (00:48):
To start, would you mind sharing a little
bit about your journey intobariatric surgery and what led
you to build prime surgic care?
Speaker (00:55):
Yeah, uh, thanks for that.
I originally trained in Lagos,Nigeria, and then I took a trip
to the UK, started my surgicaltraining there, and around that
time was when bariatric surgery,you know, was starting to take
hold, uh, especially with newtechnology around laparoscopic
(01:17):
surgery, which was intriguing tome.
So I went into that field, anduh I actually didn't start out
just really wanting to take careof people with weight loss.
It was the technology thatattracted me to it because
literally you were doing surgeryon the biggest people you could
find with the smallestincisions.
So after getting into that, youknow, you find out that
(01:41):
bariatric surgery in itself isnot, you know, a one fix for
everything.
And people still had to, youknow, eat a proper diet and
everything.
And I found out that what wewere following um more protein,
less carbs, and all this wasn'treally working that well for
everybody.
(02:01):
And this hit home when I myselfstarted to put on a few pounds
and develop high cholesterol,pre-diabetes.
So that is what led me down therabbit hole of finding out what
truly works for health, forwellness, you know, for
maintaining a healthy weight.
(02:21):
And that is why my practice,Prime Surgicare, sort of focuses
not just on the surgical aspectand bariatric surgery, but the
wellness aspect, the nutritionalaspect, uh, exercise, and all
these other pillars that I'msure we will get into.
So that's how I got into it.
Dr Andrew Greenland (02:41):
Lovely, thank you.
Always good to have somebackground and context for what
we're discussing.
So tell us a bit about thepractice itself, prime surgic
care.
What does it look like today?
How is it set up?
And maybe talk a little bitabout a typical patient journey.
I know there is no such thingas a typical patient journey,
but how does it look like from apatient using your service?
Speaker (02:59):
Yeah, so we get our patients that primarily either
coming to us for uh weight losssurgery or they're coming to us
for weight loss medications.
So right now I'm uh the solephysician in the practice.
I'm supported by physicianassistants and medical
assistants.
(03:19):
Uh so we intake all thesepeople, and then we're either
guiding them down the path ofyou know getting a bariatric
surgery procedure or being onweight loss medications more
recently.
But on top of all that is whatI've learned that you know 20
years plus of being in thisfield of trying to get people
(03:42):
healthier and lighter, all thatyou know, experience uh to guide
them in terms of changing theirlifestyle to support uh a
healthy weight and health ingeneral, because we get people
coming in with all the usualchronic diseases, heart disease,
diabetes, high cholesterol,even people finding out that
(04:05):
they have some cancers.
And uh the shocking thing isthat these cancers are also
related to lifestyle, and in alarge part to what we eat, how
we move, how we sleep.
And uh that is very interestingbecause the the every all of
those things coming together uhtie into the fact that people
(04:28):
tell you, oh, you changed mylife at the end of the day when
they've come through thisjourney.
And it it is because weight andthe things surrounding that
affect every other aspect oflife and living.
So the practice is sort of setup in that way where we're we're
trying to sort of uh touchpeople's lives in in a profound
(04:52):
way.
We also do some generalsurgery, hernia's uh surgery,
gallbladder surgery, but thecenter of the practice is around
transforming people's livesaround weight and health.
Dr Andrew Greenland (05:05):
Thank you.
Now there's obviously been ahuge shift with the GLP1
medications.
How are you seeing that impactthe role of surgery in weight
management from yourperspective?
Speaker (05:15):
Well, I think there's the initial sort of excitement
about uh GLP1s that like it's acure all.
Um, but I've found that likeeverything else in life, to do
anything properly or achieve agood result, you're gonna have
to do more than one thing.
So it's gonna, even with peopleon GLP1s, it usually requires
(05:39):
more than just uh themedication.
But it's had an impact in asmuch as we've seen numbers of
bariatric surgeries drop.
However, we still have somepeople who cannot tolerate the
medications.
We have some people for whom umaccess to the medication is a
(06:02):
problem because uh here in theUnited States a lot of insurance
is tied to employment.
Employment changes, or theychange the policy around uh the
coverage for these medications,and then people find themselves,
you know, starting and stoppingthe medication.
So there's there's accessproblems uh like that.
(06:23):
And then the medications rightnow are more expensive, you
know, at uh at a level thatpeople cannot afford.
And it may actually be cheaperin the long term right now to
get the surgery than to have totake the medication, which for a
(06:44):
lot of people, what peopledon't understand is that once
you get on these medications isnot something that you do, get
to a certain weight, and thenstop the medication.
You indeed have to continue themedication to maintain your
weight.
Dr Andrew Greenland (07:00):
Got it.
So do you see the medicationsas a comp as competition in a
inverse commons or more of acomplementary tool?
So I guess I guess because youhave a more holistic approach,
they're in your in your toolbox,but how do you view them?
Speaker (07:14):
Well, initially it it it was uh competition because
once we started seeing themedications come on board, uh a
lot of um uh our surgery numbersstarted to drop, and you could
see that people were asking uhthe any physician they knew,
hey, do you prescribe uh GLP1medications?
I'll be in church trying to youknow worship, and someone will
(07:38):
be nudging me and saying, Hey,Dr.
Sean, do you do thosemedications?
So it's uh interesting in thatway, but as time has gone on and
these other factors that Imentioned have come into play,
um, we're seeing that people aremixing both.
I I personally have givenmedication to a fair number of
(08:00):
my patients whom, after theirsurgery a few years on, have
started seeing some weight creepback on.
Um, some people have used themas a complementary strategy with
the surgery in people that haveuh super morbid obesity,
meaning that their BMI is sohigh that we know that even
(08:21):
though surgery will have asignificant impact, we would
really like more weight loss tobring them back towards a normal
weight.
So it's becoming more of acombination now.
But where exactly that balancesettles actually depends on the
uh individual and the localcircumstances.
Dr Andrew Greenland (08:40):
Thank you.
I guess um what major shiftsare you seeing in how patients
approach weight today comparedto a few years ago?
I'm guessing the drugs are afeature of that, but I just
wonder if there's any else, anyother shifts that you're seeing
in their approach.
Speaker (08:54):
Yeah, so there's more people coming to um uh uh to use
these tools for weight loss,you know, because when the most
powerful and effective, which isprobably still the case, uh the
most powerful and effectivetool that we had was surgery.
(09:15):
People had a barrier to usethat tool.
People were fearful sometimes,even though weight loss surgery
is really safe, uh, but peoplewere fearful.
So now that barrier has beenlowered significantly, given
that it's medications uh thatbring people to the point that
they they accept the fact of uhdoing an intervention.
(09:39):
It's also brought along with itsome people who do not
necessarily qualify, you know,due to uh by the standards that
are set.
You have people with BMIs thatare close to normal and they're
only slightly overweight, youknow, wanting to take the
medication, people uh wanting totake the medication before an
event or the wedding orsomething like that, you know,
(10:02):
to lose some weight to fit in adress, that sort of thing.
But by and large, it's broughtmore people into the fold, which
is a good thing, because one ofthe things that I believe is we
have a finite period of timethat we're here as human beings.
You owe it to yourself to behealthy for the most part of
(10:26):
that and be able to do what youknow what gives you pleasure,
what allows you to enjoy yourlife.
So whether it be weight losssurgery, whether it be
medications, whether it be acombination of those and
lifestyle changes, I encouragepeople to do whatever is needed
so that they're not uh ending uplike some of my patients say,
(10:48):
Oh, I wish I had done this 10years ago.
Because there's there's lifethat they're missing on the
people, simple things, even liketaking a ride with your your
kids and at a park, you know,that some people have to be on
the sidelines and be on theoutside looking in.
Uh, these are interventionsthat can help you to get that
(11:11):
back and get your life while youstill have it, you know, uh and
not spend all you know yourbest years trying to lose
weight.
Dr Andrew Greenland (11:24):
Thank you.
So, what does a typical day umfor you look like in practice at
the moment?
I do accept that there is nosuch thing as a typical day, but
trying to get some sense of howthings plan out for you on a
daily basis.
Speaker (11:36):
Well, I think on a daily basis, it's it's it falls
into two categories.
I'm either operating or I'mjust seeing patients.
Or on an operating day, I'm inthere either doing bariatric
surgery, example, the gastricsleeve, which is our most common
surgical procedure, um, ordoing some general surgery,
(11:56):
fixing hernias, taking out uhdiseased gallbladders.
So that those are that's asurgical day.
On a clinical day like today,what I'll be doing later on,
it's just uh early morning here,um, is seeing patients.
I'll see a combination of newpatients, you know, uh offering
(12:20):
them weight loss solutions,whether it be surgery or getting
on a GLP1, making sure thatthey qualify for that, and
telling them what the process islike.
I always like to give them acomp an overview first, in terms
of these are the strategies forweight loss.
It always involves uh exercise,physical activity.
(12:41):
It always involves uh dietarychanges, for which I advise the
patients mainly on a plant-baseduh with natural foods, whole
foods uh-based sort of diet.
I'm a firm believer that youknow the diet is really central
(13:02):
because a lot of the informationthat is out there, people never
tell us how much dietcontributes to the problems
around weight and chronicdisease.
So, diet for me is a key onethat people need to pay
attention to.
So I really like to try anddrive that home.
And then the procedure thatthey're trying to uh do, whether
(13:22):
it be surgery or the weightloss medications, how it works
and how best to prepare for it,and how to make sure that you're
working in tandem with theintervention that you've chosen
rather than doing something thatis uh against uh what that
intervention is trying to do.
Dr Andrew Greenland (13:42):
Thank you.
Now, I guess it's highlycomplex, but can you give us a
sense of how you determinewhether a patient is best suited
for bariatric surgery, GLP1therapy, or a combination of
both?
Speaker (13:54):
Oh, that's a simple one.
Uh Dr.
England because most peoplecome in and say, This is what I
want.
So it's a matter of trying toqualify them or making sure that
they are appropriate for whatthey want.
Uh, I mean, we live in asociety there's so much
information out there.
A lot of my patients come intelling me, hey doctor, I've
(14:17):
done my research.
So this is what I want to do.
So I take what they want to doand I look at their BMI, I look
at their lifestyle and theirprofile, and decide if that's
appropriate for them.
If it's not appropriate, then Iwould, you know, uh introduce
them to a solution that isbetter suited.
(14:39):
But for most people, whatthey're wanting to go for is
appropriate.
Um I want to give an example.
Uh, some people, for instance,if you are uh more advanced in
age, you have a lot of medicalchronic diseases going on, and
um the risk of surgery issignificant.
(15:00):
Now we have, you know, it mightbe easier for you to go or
safer for you to go on one ofthe weight loss medications to
achieve the weight loss that youneed, you know.
Dr Andrew Greenland (15:14):
And what about psychological readiness
for surgery?
How do you um prepare patientspsychologically?
Speaker (15:21):
Yeah, so part of the process, or one of the things
that is prominent about theprocess is a psychological
review.
So we do get clinicalpsychologists or psychiatrists
to evaluate patients.
And the idea is to first of allweed out if there is or find
out if there's any sort ofpathological eating disorder
(15:42):
that is uh the case with thepatients.
If not, then we would proceedand find out that they are an
appropriate candidate, that theycan follow the kind of
instructions that would helpthem to be successful around the
time of surgery and even forthe long term.
Um thankfully, very fewpatients are uh have the
(16:07):
psychological profile that theydon't qualify uh for the
surgeries.
We also do some medical tests,cardiac uh uh clearances to make
sure that from a cardiacstandpoint they're a good
candidate for surgery, pulmonaryas well.
So that's the whole gamut of uhtests that we do to make sure
(16:29):
people are ready for that sortof intervention.
Dr Andrew Greenland (16:32):
Thank you.
And on that note, whatcharacteristics do your most
successful bariatric patientstend to have in common if there
are some commonalysis?
Speaker (16:41):
The people that really do well and succeed are people
who are motivated, people who'vetried different things and uh
have had some limited amount ofsuccess, and people who, when
they come into our program, weintroduce them to some of the
lifestyle changes.
And between the time that theystart the program and get their
(17:04):
surgery, if they're able toapply those lifestyle changes
and lose some weight, that isthe best predictor that after
the surgery they're going to dovery well at losing a
significant amount of weight.
Dr Andrew Greenland (17:18):
And you talked about weight regain a
little bit earlier on.
I mean, what separates patientswho maintain weight loss for 10
years from those who struggleto sustain the results?
Speaker (17:28):
Yeah, uh, the analogy I give my patients is that the
weight loss is like going on anescalator.
You go on a from a weight thatis up here to a weight that is
down here, on this escalatorgoing down for a limited period
of time.
Typically a year to two years,they're actively losing weight
primarily because of theprocedure.
While you're on that escalator,you want to be walking down the
(17:51):
escalator.
And that you do with lifestylechanges that are mainly dietary
in terms of the uh impact andexercise.
Exercise is fantastic, but theimpact on weight itself is not
as much.
Um, the impact of exercise ismore on keeping away chronic
(18:13):
disease.
But in any case, thoselifestyle changes are like
walking down that escalator sothat you go down further and
faster and that you're able tokeep going after you're off the
escalator.
So the escalator of thesurgery, you know, acts as
something that multiplies yourlifestyle change over a period
(18:34):
and gets you to a lower,healthier weight, but you have
to use the lifestyle changes tokeep going along that journey.
Dr Andrew Greenland (18:44):
And how important is ongoing follow-up
after bariatric surgery?
I guess it seems like anobvious question, but I'm just
interested to hear yourperspective because you have a
much more holistic approach.
Speaker (18:54):
Yeah, I think it's very important because um people are
facing a tsunami of differentand varying and confusing
information on diet andlifestyle.
So that to keep them on track,uh you really have to keep
(19:17):
reinforcing this message.
So for the first two yearsafter someone has a bariatric
surgery, we believe that wewould need to see them pretty
frequently to keep reinforcingthis message.
And I it's worked because wherewe used to see people um, you
know, have the surgery and theygo and they come back, and
(19:37):
they're always telling you, oh,you know, I'm following the
diet, I'm eating more proteinand less carbs, which is not
what we preach.
Um now, with reinforcing thisconstantly on our messaging, on
our social media, and withpatient visits, people are
beginning to understand that,you know, uh changing your diet,
(20:00):
you know, not necessarily inline with the culture that we
find ourselves in modernsociety, but changing your diet
where you're eating mostly wholefoods, mostly natural foods as
opposed to processed foods, halfyour diet being fruits and
vegetables, fresh and fruits andvegetables.
The other half consistingmainly of whole grains and
(20:22):
complex starches and uh legumes,beans, lentils, chickpeas, and
the like, and minimizing animalprotein, you know, eating a
little bit of nuts and seedsthat summarizes, you know, a
well-rounded, healthy diet thatcan help you to maintain a good,
(20:45):
healthy weight and keep off uha lot of the chronic diseases
that we see out there.
Dr Andrew Greenland (20:52):
Um so what does a long-term comprehensive
care pathway look like for yourpatients?
Obviously, the frequent visitsthat you've alluded to, but what
what else is in that kind ofprogram to keep them where they
need to be?
Speaker (21:06):
Well, it's just like modeling the in my mind,
modeling the behavior.
I try to do that for mypatients, you know, with the
diet, also with exercise.
I I I bike and uh do some roadbiking uh during the season, and
I encourage people, whateversort of form of exercise that
(21:26):
you you can do that you enjoy,that you do mostly in a social
setting, you have uh people thatenjoy that with you, um, is
going to be useful for you.
So over the long term,obviously we can't follow people
uh for the rest of their lives,you know, from a practical
standpoint.
So we just try and reinforce iton the front end.
(21:48):
And as long as they keep comingback, we see patients on a
yearly basis after the secondyear.
As long as they keep comingback, we're just reinforcing
these principles, we're makingthat the kind of thing, making
sure.
That they're staying on track.
And uh the messaging that wesent out on send out on all our
channels is supporting that.
A lot of our patients, youknow, are on those uh channels
(22:11):
and receive our emails, ournewsletter letters.
So we're trying that way tokind of keep in touch, and
hopefully, we've already putthem in communities where they
know people who are adoptingthis sort of lifestyle.
And that's something hopefullythat can follow them for the
long term.
Um it all comes down to, forme, uh, from my perspective, a
(22:37):
lifestyle change that isenduring, you know, and once
you've welded that healthy wayof living into your life, you
have um things in yourday-to-day living that makes it
easy and convenient for you tofollow through with this kind of
lifestyle, then then that Ithink I've done my job.
Dr Andrew Greenland (22:59):
Amazing.
So we've been talking a lotabout bariatric surgery for
weight reduction.
Um, but could you speak alittle bit to the metabolic
benefits that are oftenoverlooked by patients and you
know, things like type 2diabetes, cardiovascular risk
factors?
Could you speak to that alittle bit?
Speaker (23:13):
Yes.
Um a lot of people think thatthose things, uh, the chronic
diseases, follow weight andweight loss, and that is true,
but in a lot of instances, it isactually not because of the
weight and uh obesity per se.
(23:35):
It is it follows more tightlywith the kind of diet that we're
consuming and lifestyle.
And one example that I caneasily describe is that when
we've moved to uh become asociety where animal products
(23:56):
are at the center of our diet,and a lot of the animal products
that we consume aremanufactured in a factory kind
of setting.
It's called uh, you know, uhthis concentrated animal farming
operations.
So we're producing animals, forinstance, take chicken, we
(24:16):
produce this in the billions.
And it takes a shorter time nowto get a chicken of a certain
weight compared to when theynaturally mature.
It takes about three months.
Now we do it in about threeweeks.
That chicken is not therelifting weights and building uh
(24:39):
muscles and protein.
That chicken has more fatcontent, more saturated fat.
And consuming this at thecenter of our diet translates
into a situation where ratherthan our blood flow being, you
know, more fluid withwater-based, your blood flow has
(25:01):
more saturated fat in it.
And the places in our arterieswhere uh arteries divide is a
source of friction in that flow.
And the accumulation of fat inthese places essentially is what
leads us to heart attacks.
Because when it happens in theheart where the vessels divide,
(25:23):
you can get blockage there.
And it also leads to stroke,where it happens in the blood
supply going to our brain wherethe vessels divide, and there's
friction, and you have moresaturated fat, you have more
cholesterol growth flowingthrough your vessels, can lead
to stroke.
So I've just given this examplehow heart disease and stroke,
(25:47):
brain disease can be connectedbecause of what we're consuming
and what we're eating.
If you can reverse thosesituations by eating better, the
body can heal.
And this is the very basis ofuh the American College of
Lifestyle Medicine, whichteaches people uh how to live
(26:13):
according to six major pillars,which let me try and recall if I
can mention them dietarychanges, uh, exercise, good
sleep, uh, reduced stress,social connection.
So these are the major uh uhpillars, and if you can turn
(26:35):
these things around in a healthydirection, your body can
actually reverse any of thesechronic diseases that you may
find yourself uh having,including obesity.
Dr Andrew Greenland (26:52):
Thank you.
So turning now to the businessside of the practice, what's
working particularly well inyour practice from a business
angle at the moment?
Speaker (27:00):
Well, in uh from the business uh aspect, I mean,
we've gone through a lot ofmajor changes here in in the US.
I mean, uh we've talked aboutone thing, which is uh the
change the coming in of the GLP1medications.
Here they have also um uhgovernment regulations uh around
(27:25):
uh practices and peoplereceiving uh you know uh bills
from uh physician practices.
There have been a lot ofchanges in that area.
Um there's also been a paradigmshift in that independent
practices like my own, primesurgic care, are becoming relics
(27:46):
of the past.
And a lot of practices arebeing bought up either by
hospital systems, large hospitalsystems, or um the marketplace,
private equity VC firms.
So there is a lot of tensionthere, it's become more
difficult to run individualprivate practices like what we
(28:10):
have.
You know, it used to be beforethat this was the engine of
small business in the country,and uh, but now it's becoming
more corporate medicine.
So that's that's a bigchallenge, and we're having to
make a lot of changes, try to uhdo some things like uh the big
uh players do, and try our bestin that regard, negotiating
(28:33):
contracts with insurancecompanies, uh getting attorneys
to help us with billing servicesand things like that.
So uh it's it's been more of astruggle, but uh we're bracing
up to the task so far.
Dr Andrew Greenland (28:48):
That's really insightful.
Thank you.
Are there any other kind ofmajor um hurdles, roadblocks,
bottlenecks that you have toface day to day or are
navigating at the moment, asidefrom the whole um corporate
medicine kind of creeping in?
Speaker (29:02):
Yeah, it's the use of uh I would say one thing along
those lines is the use oftechnology.
You know, uh everybody knowsthat AI is the new thing around
the corner.
So we're trying to see how wecan leverage that um to leapfrog
some of these problems thatwe've talked about that we're
(29:23):
having.
So implementing AI in a smallpractice that you know is uh
it's sort of a good thingbecause AI has become so
democratized, and you have thistechnology that everybody can
apply.
So we're just trying to seewhere in our workflows, in terms
of seeing patients, uhdelighting the patients in the
(29:45):
services that we have, and uh,you know, also running the
business side of things, youknow, uh getting reimbursed for
our services and trying to seewhere AI can help us in in those
areas.
So those are the things.
Dr Andrew Greenland (30:02):
Thank you.
Um and how has your MBAinfluenced the way you approach
healthcare and practiceownership?
Because you have that sort ofadded business strand to your
bow.
And how's that um influencedthings?
Speaker (30:13):
Yeah, it's it's it's helped me to be able to assess
the bigger picture of healthcareand uh where uh practice like
my practices like uh mine fitin.
So in the bigger picture, youknow, healthcare is a big
industry, billions of dollarsare spent there.
(30:35):
We talk about cost reduction,but we don't specify cost to
whom that we're reducing.
Is it cost to the patient?
Is it cost to the insurancecompany and those kind of
things?
We found out that they'remiddlemen that uh uh reap a lot
of profits in the healthcareindustry without uh giving more
(30:57):
access, more or providing bettercare.
Uh so here in the in the US,especially our healthcare is so
complex and the prices are high.
So that really, my MBA helpedme to open my eyes to the entire
uh the entire industry and thecomplexity of the industry along
(31:25):
its entire value chain.
You know, and what it it haspersonally helped me to see is
where do I want to engage morein the health system and where
are the areas that I I don'twant to uh uh apply myself.
So it's giving me a bigger andbetter perspective of the entire
(31:49):
healthcare industry, and it'shelping shape how I make
decisions.
Dr Andrew Greenland (31:57):
So I guess your total addressable market is
huge for the problems that youhelp patients with.
If you experience a suddeninflux of new patients next
week, what would happen?
Would anything break?
Hopefully, not you.
What would happen?
Speaker (32:13):
What will happen?
We will try to cope with that.
I think we have um we have someroom to expand.
Um I've had uh you know apractice where there have been
two surgeons, so that's anexpansion slot that we can
always um uh explore.
Should there be suddenunleashing of lots of patients
(32:38):
that I can't personally handlemyself or with the physician
assistance that I have?
Um so we're still at a placewhere I wouldn't say we're at
capacity, we can take in morepatients.
And if that sort of situation,there's a tsunami of patients,
we we definitely have uh somemeans of expansion that we can
(33:01):
explore.
Dr Andrew Greenland (33:03):
And what about um things like group
programs, digital education,telehealth or technology to
support patients beyond theone-to-one consultations?
Clearly, you can't replicateyourself for surgery, but all
the other aspects of theirlong-term treatment program.
Have you thought about any ofthose kind of um medalities?
Speaker (33:19):
Yeah.
Yeah, we've always had apresence on social media, and I
believe social media is moreimportant now.
Um, if you can get your messageout there, because part of my
um passion is just getting outthe education, especially on the
nutritional or dietary piece.
(33:41):
Because as a society, we'removing more towards uh more
processed foods, more factoryfarmed animals uh that is
leading to the chronic diseasesthat we see.
So I like to get the word outon that, you know, not even just
to patients that I mightencounter, but as far as I can
(34:04):
reach uh throughout the world,the entire globe, I'd like to
get that message out.
So I think social media is veryimportant for that.
The internet is very importantfor that.
So we want to engage more inthose spheres.
A podcast like yours isimportant for that as well.
Uh, if we can get the messageout into you know the areas that
(34:28):
you influence into where youare, that's what we want to do.
We want this is a globalmessage that I think would help
lots of people.
Um, and uh we have the toolswith which we can communicate
globally.
So that's that's a good thing.
Dr Andrew Greenland (34:45):
For sure.
And anything we can do to helpum you know raise awareness and
promote your message with this,we will do.
Um, so what about the futurethen?
What how do you see the futureof obesity care evolving from a
business and deliveryperspective going forward?
Speaker (35:00):
I think more of it is gonna be determined by the
culture, which is a factor thatwe we uh often overlook.
But culture drives a lot ofthings, it drives the messages
that get out there, uh, itdrives how people actually
behave, because having theknowledge sometimes is not
(35:23):
enough.
If the person opposite you uhon a table is eating in a
certain way, the chances arethat you're more likely to eat
along that way.
People don't want to be uhisolated, you know.
We thrive in communities.
So changing the culture uh inour lifestyles is very important
(35:48):
if we can if we're going to seethe change that we desire in
terms of obesity.
Uh beyond that is the tools.
It's a good thing that we'regetting more tools to treat
things on the back end whenpeople have already fallen off
the cliff, as it were.
You know, um, that is a goodthing because ultimately we're
(36:11):
all as humans only going to behere for a while.
You need to use whatever youcan to fix the problem so that
you have a great life.
But a lot more emphasis needsto be paid to making sure people
don't fall off the cliff, topreventing the problems of
obesity and the other diseasesthat we know are associated,
(36:35):
diabetes, heart disease,cancers, those sort of things.
So if we are able to change theculture to prevent these
things, uh then that's that'sthat's where we want to be.
And I hope people across theentire spectrum of uh lay
people, physicians, uhlawmakers, governments all get
(36:58):
on board with that messagebecause to shift the culture, it
will require everybody alongthe entire spectrum of
influence.
Dr Andrew Greenland (37:08):
Thank you.
And thinking about the futurefor you and prime surgic care,
where would you like thebusiness to be in the next six
to twelve months' time?
Anything on the cards for you?
Anything you're hoping toachieve, looking to do?
Speaker (37:19):
Yeah, with prime surgic care, seeing more patients, uh
offering our services, changinglives, transforming lives.
I would also like to, from thebusiness perspective, be more
vertically integrated.
Uh, we're thinking about youknow, uh surgery center, having
our own surgery center, which Ithink is quite ambitious as I
(37:41):
explained to you that you knowwe're becoming relics as uh uh
independent practices, but it'sit's something that I would like
to get into before I you knowhang up my scalpel and retire.
Dr Andrew Greenland (37:57):
And with that, she wanted to thank you so
much for joining me today.
It's been such a rich andinsightful conversation.
So thank you for sharing what abit about what you do, uh what
you're seeing in the space, anda little bit about the business
aspects of your work.
It's been really fascinating,and I'm very grateful for your
time.
Speaker (38:13):
Thank you, Dr.
Greeland.
It's my pleasure.
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