In today’s healthcare landscape, obesity is more than just a personal struggle—it’s a public health crisis, directly linked to diseases like diabetes and heart disease. But as the conversation around obesity continues to evolve, so too does the approach to treating it. Dr. Garren, a seasoned bariatric surgeon with 25 years of experience, has led the charge in integrating both medical and surgical weight loss strategies into a comprehensive care model at UW Health. This unified approach not only addresses obesity from multiple angles but also incorporates critical elements like nutrition, health psychology, and exercise physiology, creating a holistic and patient-centered treatment plan.

In this interview, Dr. Garren shares his insights on the challenges and opportunities of building a successful weight loss program, the benefits of technology in patient education, and the exciting future of obesity care. From empowering patients with information to improving care coordination, his work exemplifies the positive impact that a technology-driven, comprehensive treatment model can have on both patient outcomes and healthcare systems.

What inspired the creation of a unified weight loss clinic model at UW Health?

Dr. G: I would really say it's patient need. For many years, obesity has been neglected as a major health problem in this country. There isn't, as we all know, a one-size-fits-all approach to obesity. So, developing a program that encompasses both medical and surgical approaches, along with complementary disciplines like nutrition, health psychology, and exercise physiology, is what's really needed for an effective population-based approach to obesity. Over the past several years, this has proven to be the most effective way to address the problem.

What were some of the challenges you had to navigate to make this happen, whether it was winning over hearts and minds internally, or dealing with the technology itself to make the unified clinic model possible?

Dr. G: As the medical director of this program, there are both clinical and administrative challenges. From the clinical standpoint, the challenge is education—education of our patients. Not everyone learns in the same way, and obesity care requires extensive patient education. There are many choices patients need to make, and they must understand not just the "how" but the "why" behind what we do. This is particularly challenging when working with people from different backgrounds.

From an administrative perspective, the challenge is getting the word out to as many people as possible. Most bariatric surgery programs, particularly in the early 2000s and 2010s, relied on in-person seminars to introduce people to our specialty. But that quickly became neither feasible nor efficient. So, finding alternative ways to spread the word—without solely relying on advertisements—became crucial. It’s about helping people understand that these services are available within healthcare systems and that they can be a critical resource for improving health.

It sounds like that's both a challenge and an opportunity. The challenge is getting the word out, but there’s also this opportunity to reach people in different ways.

Dr. G: Exactly. The administrative benefit is that it's an easy conversation to have with stakeholders. I can explain that improving outreach and education ultimately drives greater throughput, which is a key consideration for healthcare organizations.

What benefits are you seeing for patients and the care team now?

Dr. G: The biggest benefit is the ability to push educational content to patients. We can update our material easily as new research and ideas emerge. We no longer have to rely on outdated resources. This allows us to provide better education up front, which makes the first consultation with the surgeon or bariatric medicine provider much more effective. By the time patients meet face-to-face with us, they already have a solid understanding of what we do and why. Throughout their journey, we can continue to send relevant information, whether it's about nutrition, reading food labels, or recipes that align with their care plan. We also provide data on their progress, which helps them track their journey and stay motivated.

How do you guide patients on their journey from medical to surgical care, if applicable?

Dr. G: When running a comprehensive program that includes both medical interventions—such as GLP-1 medications—and surgical options, patient choice is crucial. Some patients aren’t ready for bariatric surgery and need time to work through that decision. Others may come in seeking medical therapy but are better suited for surgery. We use digital tools and resources  to introduce patients to the broad spectrum of treatments available. After they have some background education, whether through videos or written materials, they can make an informed decision about whether to pursue medical or surgical treatment. Once they’re in the program, we continue to educate and support them. But it’s during their meetings with the providers—whether with a medical bariatrician or a surgeon like me—that we can take a deeper dive into their expectations and medical history to recommend the best course of action.

You’ve been doing bariatric surgery for 25 years. Now that GLP-1s are becoming mainstream and driving down the number of surgeries, do you see bariatric surgery continuing to decline, or do you think it will rebound in the future?

Dr. G: I believe we’ll see a significant rebound in surgical cases. Even medical bariatricians would agree that there are patients on GLP-1 medications who would be better served by surgery, especially those with high BMI and multiple comorbidities. Surgery can be a better first-line approach for those patients. We also know from multiple studies that many patients stop the medication within six months to a year. It might be due to side effects, insufficient weight loss, or cost. I think there will be a balance in the future, with medical therapies and surgery complementing each other. Some patients may start with medication and then move to surgery if they don’t respond. Likewise, some patients who come in with surgery as their first choice may be better served by medical therapy, depending on their medical history. So, while we’ve seen a dip in surgery numbers, I believe those numbers will rise again. I’m already seeing this in my reports. The number of patients choosing surgical options is increasing.

What excites you most about the future of healthcare, whether it’s directly related to what you’re doing or broader trends you’re seeing?

Dr. G: What excites me the most is seeing the outcomes of our patients. The quality of care we provide has significantly improved, especially in the realm of obesity. This is a population that was historically marginalized in healthcare, and we’re seeing major strides in how we approach their care—both compassionately and effectively. By offering comprehensive care, we’re not just improving their medical conditions but also their quality of life. To me, that’s what keeps me excited about this field.

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Photo source: UW Health - Michael Garren, MD, FACS