NUTRITIONAL CONSEQUENCES OF
BARIATRIC SURGERY
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Episode 258:
Show Notes
In this week’s episode of The Real Health and Weight Loss Podcast with Dr Lucy Burns, Dr Lucy is joined by nutritionist and dietetics medicine expert Jacqui Lewis, who is also the host of the Australian Weight Loss Surgery Podcast. Together, they explore Jacqui’s journey from personal trainer to leading innovator in bariatric nutrition, and discuss the complexities of weight loss, nutrition, and the evolving landscape of medical interventions for obesity.
Jacqui Lewis’s Background:
- Jacqui Lewis, BHsc in Nutritional and Dietetic Medicine, has worked in the health and wellness space for nearly 30 years. She is the Co-founder and Clinical Director at BN Healthy, a leading provider of bariatric nutritional solutions across Australia and New Zealand. Passionate about education and contribution, Jacqui uses her platform to support patients through every step of the weight loss journey. She hosts the Australian Weight Loss Surgery Podcast (with over 90 episodes) and co-authored Not A Bariatric Cookbook.
Identifying a Gap in Bariatric Nutrition:
- Jacqui and her husband noticed a lack of suitable multivitamin options for bariatric patients, who were often given generic or pregnancy vitamins. Recognising the unique needs post-surgery—such as drastically increased requirements for nutrients like B, iron, and calcium—they developed specialised products, becoming the first to have such products sold directly from surgeons’ rooms.
Impact of Bariatric Surgery on Nutrition:
- Bariatric surgery alters digestive anatomy and function, leading to malabsorption and increased nutritional needs. For instance, the daily B requirement post-surgery can be up to 100 times higher than before. Different surgeries (e.g., sleeve vs Roux-en-Y) affect nutrient absorption in distinct ways, with Roux-en-Y impacting fat-soluble vitamins more significantly.
Challenging Diet Culture and Weight Stigma:
- The episode highlights the persistent societal pressure on women—particularly those aged 45–65—to be thin at any cost. Many patients have extensive dieting histories and feel trapped by repeated failures. The conversation calls for a shift away from focusing solely on the number on the scales, encouraging broader measures of health like body composition, non-scale victories, and overall wellbeing.
Protein and Supplement Education:
- Jacqui recommends a protein intake of about 0.9 grams per kilogram of ideal body weight per day, with adjustments for activity and goals. She emphasises the importance of reading labels carefully, as marketing can be misleading. BN Healthy products are designed with higher protein content and quality ingredients, and education is central to their approach.
Product Adaptability and Ingredient Quality:
- BN Healthy uses very low lactose whey and includes pre/probiotics and digestive enzymes to support gut health. Vegan options are challenging due to taste and manufacturing constraints, but the company remains agile and responsive to feedback and changing needs.
GLP-1 Medications and Emerging Trends:
- There is a growing use of GLP-1 injectable medications for weight loss, but long-term nutritional needs and risks (such as muscle loss and malnutrition) are still being studied. The hosts caution against “careless prescribing” and stress the need for holistic, supervised care, including education and ongoing support.
Responsible Care and Support:
- Both surgery and medication require responsible, multidisciplinary management. There are concerns about patients not receiving enough psychological or nutritional support post-intervention. The importance of addressing the psychological side of eating and habit change is emphasised—not just what people eat, but why they eat.
Main Takeaways:
- Weight loss and metabolic health require a nuanced, individualised approach.
- Bariatric patients have unique nutritional needs that must be met with tailored products and ongoing education.
- The focus should shift from weight alone to holistic health, habit change, and psychological wellbeing.
- Both surgery and medications like GLP-1s should be prescribed and managed responsibly, with adequate support and follow-up
🌐 Website: bnhealthy.com.au
📘 Facebook: BN Healthy ANZ
🎧 Listen to the Podcast: Australian Weight Loss Surgery Podcast
Episode 258:
Transcript
Dr Mary Barson (0:04) Hello, my lovely friends. I am Dr Mary Barson.
Dr Lucy Burns (0:09) And I'm Dr Lucy Burns. We are doctors and weight management and metabolic health experts.
Both (0:12) And this is the Real Health and Weight Loss podcast!
Dr Lucy Burns (0:21) Good morning, lovely friend. How are you? It's Dr Lucy here, and I've got a guest this morning. So, Dr Mary—hopefully she's, you know, well, I was gonna say tucked up in bed, but she won't be. She'll be out, you know, eating some sweets and whatnot. But instead, I have the beautiful Jacqui Lewis with me, and you're gonna love her chat because, well, Jacqui's sort of a similar vintage, I think, to me. We were just having a little chat about leg warmers before we came on air. But she has a degree in Nutrition and Dietetics Medicine. She has gone the whole gamut—starting life as a personal trainer and then, you know, maybe ditching the leg warmers and becoming, maybe getting a little more information. And now she actually works very intensely in the health and weight loss space, the medical weight loss space. And so I'm excited to talk to her today. Jacqui, welcome to the podcast.
Jacqui Lewis (01:12) Thank you. Thanks for having me on. It's interesting for me to be in this seat, so at least I know what I also put other people through on my podcast.
Dr Lucy Burns (01:22) Yeah, absolutely. And I didn't mention in the introduction that you are the host of the Australian Weight Loss—
Jacqui Lewis (01:28) Yeah, Australian Weight Loss Surgery Podcast.
Dr Lucy Burns (01:33) Yep. Yeah, fantastic. So again, I think for people out there, there's always tons, you know, there's information—there's information everywhere. We do not have an information shortage. But what we have is—we need curating, so that we know that people are getting the information from reputable sources. So certainly happy to recommend your podcast.
Jacqui Lewis (01:54) Thank you. I appreciate that. And likewise, we talk about yours quite a lot as well. And it's, um, yeah, it's nice to have those places to send people when they're lost or looking for good information that we know is safe. So that's the main thing.
Dr Lucy Burns (02:05) Yeah, absolutely. So I just thought we'd start, lovely, by just talking a little bit about your background, where you came from, where you are now, why you ditched the leg warmers.
Jacqui Lewis (02:18) And there was good reason for ditching the leg warmers. Let's just say that. And park it, I think we all know why we ditched leg warmers—we woke up one day and went, this isn't it. So yes, I did start my journey in Melbourne; I was a Melbourne girl. And I was in the fitness industry. I finished my schooling and just went straight into that. And that took me to Queensland briefly, and then back to Sydney, where I stayed for more than 20 years. So I worked in the fitness industry, and I had my own massage therapy practices there that kept me out of trouble for a little while. And then my husband was doing these multivitamins for bariatric patients. And I went, oh, have a nice time—we still talk about that—have a nice time with that, good on you, like as if there's not enough multivitamins in the world. And I was halfway through my nutritional medicine degree. I decided that I wanted to do something different—still in the helping space, but different in that regard. So I thought that would be really easy, and I’ll just pop off and do my degree. And here we are. So yeah, we started BN Healthy nearly 12 years ago. And it’s very niche—we support patients who’ve had weight loss surgery, and we develop and innovate nutritional solutions for those people. And now, obviously moving into medical weight loss and just general weight loss. So we have a range of solutions for the range of those different groups. Yeah, so it’s been quite a journey. And we’re kind of one of the largest in Australia, New Zealand. We have business in America and China and have distribution in the UAE and Malaysia.
Dr Lucy Burns (04:00) Oh, amazing. Amazing.
Jacqui Lewis (04: 01) Absolutely not what I expected.
Dr Lucy Burns (04:05) No, no. So did you see a need or what—what drove you or your husband to?
Jacqui Lewis (04:11) Yeah, I think it was that we saw that we're not getting to have less obesity in our world. And we know that after surgery, there weren’t many solutions that were suitable. So patients at that point were being recommended a pregnancy vitamin or a general multivitamin, and we’ll just kind of see how you go. And we know, there’s enough evidence to show that there’s certainly a big change in what patients need as far as B12, iron, calcium, due to the malabsorption of bariatric surgery. So yeah, we certainly saw that. And it was also that—I don’t know if there’d been another group who had delivered a strong enough message. And then once we were able to do that—and we were actually the first product ever to be sold from surgeons’ rooms. So a bit of a game changer. And so yeah, we did see the need. And we saw that patients were struggling on general multis or they were spending a lot of money on like, bandaid approach to putting something together that was suitable for them. So that’s kind of what we did.
Dr Lucy Burns (05:19) Yeah, wonderful. And I think it's interesting, isn't it? Because, you know, when we talk about weight loss surgery, you know, there is a change in people's anatomy, you know, the size of the stomach is different, depending on which particular surgery they've had, the passage through the small intestine is different. And people forget, or we forget—doctors forget—that, you know, actual stuff happens in these organs, that when you change their architecture, you change their function.
Jacqui Lewis (05:47) Yes, yes, well put. I think that's a really good description for it. And we do. And as a patient goes on, often they forget that it's actually lifelong. So we know they get a lot of care in the first year. And it's very—the message is very clear that you need a multivitamin that's specific to a bariatric patient that will help to give them enough of what they're needing. So just an example is like the—I guess the regular dose of B12 that we need in a day before surgery is about four micrograms. And the ASMBS, who did all the research and put together the literature for the nutritional care of bariatric patients, has shown that they need 350 to 500 micrograms because the whole mechanism, like you say, changes. So that's yet why it is a different product and how it does support that kind of outcome for patients as well.
Dr Lucy Burns (06:41) Wow, 100 times the dose.
Jacqui Lewis (06:43) 100%—yeah, the whole transport is changed.
Dr Lucy Burns (06:46) Yeah. Yeah, that's incredible. Do you see much difference between patients that have had a sleeve versus, say, Roux-en-Y with their nutritional needs?
Jacqui Lewis (06:55) Yeah, we do. We see the fat-soluble vitamins can be affected with a Roux-en-Y. With a sleeve, we have—the two surgeries will generally show B12, iron, calcium, and vitamin D as a feature. And there's a whole lot around vitamin D and calcium. So, but yeah, with the Roux-en-Y patients, we do see some fat-soluble vitamins because of that, as you say, bypass and the whole way that the digestive enzymes and the chyme, they call it, mix together at a different time. And we miss absorption of some of those nutrients. And overall, the goal of bariatric surgery is some malabsorption. So it's a way of managing calories and protein absorption and all that sort of stuff. But with that comes the malabsorption of some nutrients as well.
Dr Lucy Burns (07:45) Yeah, yeah. I think it's really important because I know, you know, for lots of people, and particularly maybe women who are, you know, my age—in their 50s, most 60s—being thin is like the ultimate. You know, we used to talk about, you know, it was weight loss at any cost, didn’t matter what happened. In fact, I have this cringe moment in my life where I had one of my best friends develop lymphoma, you know, which, you know, is a terrible disease—she actually died from it. But leading up to it, we were just spending all this time, you know, sort of going, "Oh, well, at least you’ll be thin." And it was like, what? So ridiculous. Like that was, as a 20-year-old woman, that was our most important thing.
Jacqui Lewis (08:32) It’s amazing, isn’t it?
Dr Lucy Burns (08:34) Yeah. And I think it’s—it’s just conditioning in society that, yeah, being thin is virtuous and amazing. And, you know, being in a bigger body is terrible and hideous.
Jacqui Lewis (08:43) And that's what we're trying to change—is the stigma around. And it is—we, the patients we're dealing with are women our age. So without talking out of school, 45 to 65 is generally where the demographic sits for bariatric surgery. And they are excellent at dieting, and they are excellent at restricting calories, and they are excellent at counting calories. And so that's where it all comes from—is this diet culture. And not only that, they're doing all of that stuff, and nothing works. So at least when you're in a body that's kind of cooperating, restriction of calories results in weight loss. But also, that's where the regain comes from, because there's that muscle loss. So the yo-yo—and then you've got all of the other drivers: the endocrine drivers of like polycystic ovarian syndrome, and insulin resistance, and genetic obesity, and all of those different components that come together to create that whole milieu—was the word we used in a podcast recently—of just this endocrine disruption. And one plus one doesn't equal two anymore. You can't be caloric deficit and bring about weight loss easily. And if you do, you're just working so hard to sustain that. And the rebound is incredible. So it's just that cycle. Yeah, it's incredibly frustrating. And a lot of the patients talk about how trapped they feel and nothing works.
Dr Lucy Burns (10:12) Yeah, it's interesting. We recently had on the podcast one of our members who has lipoedema as well. And she had bariatric surgery—she had a sleeve—and she's spoken about it on the podcast, so I'm not breaking confidence or anything. But interestingly, her surgeon was very much still around the goal is weight loss. And he kept saying to her—she was worried about her nutrition, she's worried about losing muscle mass, she's worried about her vitamins, she's worried about the minerals and her hormones and how undereating might impact all of that—and he actually said to her, Stop trying so hard to not lose weight.
Jacqui Lewis (10:59)That's hectic, isn’t it?
Dr Lucy Burns (11:01)That was hectic. Yeah. So I think that there's still some components or people within the weight loss space who are still very much just focused on losing weight.
Jacqui Lewis (11:12) Yeah, the number on the scales. And there's a huge movement in our community, in the bariatric space, where we talk about de-stigmatisation and really looking at what is weight loss? Are you losing? So some women are like, oh, I'm on a stall and I've not lost any weight. And the only parameter they have is the scale, which is very 1980. And so we're trying to kind of bring in this habit of don't use that as your only measurement. Use, you know, how do your clothes fit and feel? And if you've been gaining muscle and you're working out, you're not going to be losing weight. You'll be just changing your composition, which is a really positive thing. And particularly for metabolic issues, it's a huge thing. So it's looking at, yes, we still use BMI, which is a bit antiquated for actually qualifying, I suppose, for bariatric surgery. But then we want to come out of that and use other ways of measuring health. Like, can we look at what are your non-scale victories and, you know, those kinds of things? It's really important.
Dr Lucy Burns (12:13) Yeah, I think I totally agree. And I see the expectations as well that people have. And based often on the, you know, you'll lose a kilo a week. And that's not even true. That doesn't work like that. It's not linear. But I think the issue around weight management these days is that everyone thinks they know how to do it. Like you've got completely unqualified people giving advice. And it creates confusion and it creates, as I said, unrealistic expectations. And it still fosters that belief of, you know, well, as long as you're losing weight, it's good.
Jacqui Lewis (12:54) And as long as you're doing my program, my challenge, my whatever it is, do you know what I mean? It's like everyone's got a three-week program or a 12-week whatever it is. And particularly in our age group, there's these high intensity, you know what I mean? And for a woman who is in that age bracket, that could be catastrophic if they're limiting calories and exercising on coffee and doing all those things. And then they're in peri or they're into menopause. That's a huge problem because that's never going to work.
Dr Lucy Burns (13:29) Absolutely. And in fact, you know, we are one of the people that has a 12-week program. But then as it's called the 12-week Mind Body rebalance. And I reckon we spend probably the first four weeks reminding people that it's not a challenge. It's not a race. There's no prize for the biggest loser. There's nothing. It's not actually about how much you will lose in this 12 weeks. It's an education program.
Jacqui Lewis (13:54) Yeah, it's habit change.
Dr Lucy Burns (13:56) Yeah, it happens to take 12 weeks to deliver it to you. All the components that you need for long-lasting, you know, weight management. So I think one of the things then I like that you guys are filling is that nutritional element that people, perhaps like the surgeon who's not interested in my patient's concerns about nutrition, are not filling. So I guess one of the things I'm interested in then is your thoughts on protein and protein requirements and how people get their protein and all of that stuff.
Jacqui Lewis (14:29) It's a big topic and it can, like you say, it can be very confusing. And there's often no one-size-fits-all approach. But we work on a basis of 0.9 grams of protein per kilogram of ideal body weight per day. And that's a nice little way to think about it. So roughly, if you weigh 70 kilos, you're looking at just under 70 grams of protein. But that's more for like a standard human who's not going to the gym or doing too much in the way of exercise or looking at really building. So it depends on your goals as well. And then you've got all the different types of protein now because we're looking at the very easy-to-use collagen supplements. And they're lovely and they do great things in one area, which is more to do with skin and hair and connective tissues like tendons and joints and that sort of stuff. So they have their place. But if you're someone who's looking at building muscle and changing their shape or even metabolic health, or staying fuller for longer, you'd be looking at the complete protein, which would be a whey-based. So we work in both realms, we have both those kinds of products, but we're big on providing enough. And so a lot of off-the-shelf solutions, like the supermarket brands, you'll find, they'll have 20 grams of protein in their meal replacement because that's the bare minimum that you can have to qualify, whereas we'll have 34. So it's basically you'll get more bang for your buck. And we try and keep things at kind of that higher end and we're a premium brand. So we look at really quality ingredients that are going to get the results that you're looking for. So a lot of it's looking at goals and what you're trying to achieve and then providing the solution for that. But also like reading the back of the packet is a really important thing. And that's where I actually do a little work in our group too with label reading, and looking at marketing on the front and facts on the back. So I encourage them not to just look at the front and go, wow, that's amazing. But pick it up and have a look at and know what to look for in a supplement or shake or whatever it is. And look for food-related items rather than numbers and words you don't understand is probably my recommendation.
Dr Lucy Burns (16:54) Oh, absolutely. And you know what, like I feel so embarrassed because just yesterday, I did a quick Woolies online order, which I do all the time. And I decided I felt like a bit of a granola. And look, I would normally make my own, but I just—I'm a bit of a time sandwich at the moment. So I just ordered one. So, and normally I'd go and I'd scroll through and I'd have a little look. Anyway, I do know that Carmen's make one, so I just quickly ordered that. Anyway, I've got it home. And I'm going, the packet looks different. And yeah, on the front, low carb granola split all over it, two grams of sugar. But if you actually read the label, for starters, it's got oats in it, which I thought, ah, what low carb granola has oats? And the carbs in it— It's 48 grams per hundred.
Jacqui Lewis (17:44) So it's half. Yeah, it's not low carb at all.
Dr Lucy Burns (17:47) Carmen's normal carb granola is what it should be called.
Jacqui Lewis (17:51) Or Carmen's high carb granola. Yeah, well, it is about that, isn't it—looking at the back of the [packet] and knowing, like, how many would you accept in a day? What else are you going to eat? So if you do that in the morning, are you pretty much done, if you're looking at weight management in a lot of ways?
Dr Lucy Burns (18:09) Yeah, yeah, that leaves you with cheese and meat for the rest of the day. Yeah, so it's easy to be fooled, even for someone experienced, by the marketing hype.
Jacqui Lewis (18:23) And I quite—it's a bit of sport for me—I look at some labels and I go, Oh, I see what you did there. So we're looking at doing a shake that suits different countries. So we have the guidelines for making a meal replacement in Australia; we have certain rules that you need to follow, which is fantastic. And they're roughly the same in different countries, but they're slightly different. And looking at some brands in America, there's one brand that has like eight grams of protein in their mix. And I'm like, how are you doing that? Because you mix it on milk, and then you're the one who's adding the expensive part, which is the protein. So it's tricks and it's marketing. So it is looking at getting to understand what's on the back of the label and looking for things that you know are health-producing rather than attacks on your health, like glucose or fructose, which we know exists in a lot of the meal replacement shakes too.
Dr Lucy Burns (19:16) Ah, totally. In fact, you know, the main one that you know, everybody will know About that is often recommended pre-bariatric. I just look at it and think, Oh, come on, come on, how? And it's often the surgeons—and I'm sorry, any surgeons who are listening—but how are you recommending this?
Jacqui Lewis (19:35) And have you done that? Like, have you actually said, I can do this for two weeks? It's a big ask. It's a very big ask.
Dr Lucy Burns (19:42) Well, a couple that I look after, the wife was having an upper GI process. So she was having a diaphragmatic hernia repair. And as part of that, they again, they needed to empty the liver out. And he said to her, you'll need to go on to Optifast. And her husband said, Oh, well, I'll go in solidarity. I'll do it with you. Except he has type two diabetes. And yeah, terrible—terrible for him and his sugars. So I just think, you know, again, it's all marketing, isn't it? That company got in early, markets, it's cheap.
Jacqui Lewis (20:21) They were actually quite instrumental in the change to the guidelines to suit their needs. The claim for very low energy diet was all driven in the background by a certain group. Yeah, so it's quite interesting.
Dr Lucy Burns (20:33) Ah, you know, look, again, without sounding like a complete conspiracy theorist, and I'm not, but I certainly can see influence, particularly of ultra processed food companies, on the health star ratings, the dietary guidelines, to some extent. Supermarket protein powders are full of fillers that are cheap. And they're not actually interested in your health, they're interested in selling you something. And most people will buy on price if they don't, if they aren't educated about it.
Jacqui Lewis (21:09) That's right. And yes, that's right. It's more about what you know you're getting, and what your perception of value is — that sort of stuff. And kind of education is the key. And we do a lot of that with the podcast and with our group and our communications from BN Healthy. It's like, particularly because we know after bariatric surgery, we're like, here's your surgery, here's your life — I'm just going to turn that upside down. Like, your diet, everything has to change. And they have to learn really fast. So that's kind of our goal — to help them along the way and do the education as well. We know that when they're with the dietitian, they've got maybe 25 minutes of a consult to turn their life upside down. So it's pretty hard. And a lot of the support we offer is, you know, filling that in so that they're getting that constant stream of education along the way. It's a big — it's a big part of what we do — is also that umbrella of support and education, and kind of keeping things top of mind. Like you say, when someone's had surgery five years ago, they have to be reminded that, you know, when you go to the doctor, you need to tell them that, because you need to be treated slightly differently. So it's all of those things. It's really important.
Dr Lucy Burns (22:18) Yeah, absolutely. And I think you're right — people do forget they've had surgery, especially if they don't have that same sort of level feeling of restriction or satiety, which does change over time. Do you have products that, if people are, you know, dairy — allergic to dairy or stuff like that? What do you do for that? How do you manage that?
Jacqui Lewis (22:39) Yeah, so in our products, we use very low-lactose whey. And it's interesting — we've just been to the States, and there's a whole lot of things working in the protein world and how they're manipulating things. But the whey that we use is like 0.2 of a gram of lactose per 100 grams. But also, in the shakes, we, as a standard, use pre- and probiotics and digestive enzymes, which you don't often find in a meal replacement. So that also helps with that issue, if there is one, with managing lactose or dairy — very hard to make. And we do get it occasionally, people wanting a vegan shake. And same, I just was down in Melbourne this weekend, and there were a couple of vegan options. And I was like, it's just peas — it just tastes like peas. So it's very hard to either get a solution that's lovely. But it's also very hard because manufacturers want us to buy a massive load of it. And each batch is quite large. And so it's a very tricky one to kind of meet the needs of a very small population with a really large batch of products that they may or may not like, because that's very individual. So we go down the path of whole protein, particularly because we deal with pre- and post-surgical.
Dr Lucy Burns (23:53) I guess it's going to be interesting because, you know, with the increase in, like, anaphylactic allergy — which doesn't, you know, most people our age don't have anaphylaxis, but it's all the young kids. So now it's all the teenagers and early 20s — much higher rate of anaphylaxis. So I guess it'll be interesting to see how our society and how the health of our people progresses, because if they develop obesity and need things, interventions, then I guess it'll be coming up then with a solution for them.
Jacqui Lewis (24:30) Yeah, and that's kind of how we've also become so versatile in the way that we run our manufacture — that we initially started with the ASMBS guidelines as far as what should be in a multivitamin for these patients. And we're very much led by that because we knew it was evidence-based. And then we have a cohort — obviously we deal closely with dietitians and surgeons, and the patients are getting their bloods checked, which is great for us because we get to see how it works. So then there might be feedback on one particular nutrient, and it depends on what they're eating. But it's also, like, per country, the mineral supply is different. So there's slight tweaks to formulas that we make. But yeah, we're very agile like that. Now we've been around, we can sort of tweak and change things based on industry feedback and that sort of thing. So yeah, it'll be interesting to see which way that goes.
Dr Lucy Burns (25:22) Yeah, I love that about your company, because it's still sort of a small enough company that the founders are very much involved in the product. You know, again, unlike a big multinational where the CEO barely probably even knows all their products. So yeah, yeah, it's wonderful. And tell me, you know, again, GLP-1 — so injectable weight loss medications — do they have a different need to the surgical people? Or is it similar? Or how's it working?
Jacqui Lewis (25:51) It's interesting. And we don't know is the answer. So it's not early-early, because we know that the medications have been around and BN use use for quite some time. But we are finding that it's more the evidence that's current is more around, like, muscle loss after taking GLP-1 long term, and just side effects, I guess, when they're feeling nausea and they're not — and obviously, the medication's working if they're not feeling hungry. But there's that impact of, oh, I'm not hungry until 2 p.m. And so they've had no nutrition for that other part of the day. So it's like, how do we get enough in that they're not going to be malnourished and get to do their weight loss and, as well, you know, stay healthy. So the answer is short. And it's that we don't know yet if there's a particular trend in the nutrients. And we were talking about it yesterday — we're working with a few of the groups who see a lot of these patients and pooling the data and looking at the bloods from, like, a longitudinal approach. So until then, we've come with two solutions for these patients, just more as a broad brush and a preventative measure.
Dr Lucy Burns (27:02) Yeah, that sounds good. I heard a phrase the other day, which I totally love, which is called careless prescribing. And there's a lot of careless prescribing of GLP-1. So people are either, you know, just getting it on a text-based subscription service, or maybe a telehealth service where they get a very brief assessment. Or for some people, they're maybe seeing their GPs, whose area of expertise isn't necessarily metabolic health. And so it's like a quick, at-the-end-of-the-consult, "Oh yeah, here's a script." And so they're not getting the education around: How do you manage side effects? How long are we going to be on this? Is this lifelong? What if it's not lifelong? There are people out there I've seen — and again, I stalk Facebook groups, because I think that's where you get really interesting information on, you know, just what people are saying. And yeah, there's lots of people out there who kind of start, but they can only afford it for three months, for example. And I just, you know, I feel bad for them, because it's like — it's like a waste of your money, honestly, it so is. But, you know, it's careless prescribing. So it's on the health practitioner, not the person, to really make sure that when they prescribe these medications, that they do it with care and holistically, with all of the things in place — and not just focusing on your weight loss again. Yeah, weight loss numbers on the scale.
Jacqui Lewis (28:30) Yeah, I totally agree. And I think that's what we're up against — we've got this incredible tool for the first time, which we know works. And we know really helps produce significant weight loss and some other benefits. And we're like, just go and give it a go. Or we've got the total supervised. And I think without supervision, it's fraught — in 10 years’ time, we'll have the bone density, you know, group, and we'll have the early adopted online subscriber GLP-1 lot who will have their own set. And a lot of it is it's just that they're not being given that extra care in that multifaceted approach to knowing what they're up against and the other responsibilities they have when they take this medication. Whereas a bariatric surgery patient is so closely looked after for that first 12 months that you would look at even, like, what you guys are doing is offering that — and what a great result you would get, like, it's a no-brainer. So I think you're right. It's like, unsupervised — we just go, whoa. And yeah, I think until that — even Dietitians Australia looking at, you know, should we have one dietetics appointment with the prescription of a GLP-1 medication. And that was interesting to me, to see that it was being viewed as another obstacle to care. But it would be that opportunity to say, you know, this is what you're going to do. This is what you can expect. It'll be great. But you need to do all of these other things. Because that's the part that people are missing.
Dr Lucy Burns (30:07) Yeah, yeah, yeah, the other things. And yeah, absolutely. Right. We don't want to have in 20 years time, a whole bunch of frail, osteopenic, sarcopenic people who yeah, might might have lost 20 kilos, but at what cost? Yeah, yeah, yeah, the other things.
Jacqui Lewis (30:23) Yes, you're right. And then what happens when they stop? Because we actually—I read just this morning—there's loss of fat, which is fantastic, from around the organs, but also some of that really important part of the organs. So when they start, they stop taking it—we kind of know that that fat is just waiting to happen. So it's that, you're right, the three-month trial of "let’s just see how this weight loss thing goes"—that, yeah, is a big deal. I think it's going to be that thing that everyone goes, "All these medications are no good," but they are. It's just the application of them. So it’d be amazing to see you get cloned and keep—you know, we have all these groups popping up, because that's what we need: people who specialise in that metabolic picture and understand it, so that they can have the foresight. I think that is really important.
Dr Lucy Burns (31:15) Yeah, absolutely. And I think the same thing — responsible prescribing and, interestingly, responsible deprescribing. Because again, you know, I pop in and these groups, and there are these people who are saying, "Oh, well, my GP has told me once I get to my weight, that's it, they're not giving me another script." I'm thinking, yeah, it's not heroin — like it's not meth — we don't need to do that.
Jacqui Lewis (31:39) And it's not like you'd say to someone, "Well, you've got to the right blood pressure — we'll just take you off." And it's the same thing with the multis. We find that bariatric patients are going to the GP and getting their bloods done, which is amazing, and we want them to be doing that. But when they get the results and they go, "Oh, that looks brilliant — you can stop taking the multivitamin now," and it's like, no, that's why it's good. So it's the same thing. It's looking at what are we testing, and what kind of future outcomes are we expecting?
Dr Lucy Burns (32:09) Yeah, absolutely. Look, it's interesting. And you mentioned blood pressure. And the only reason I want to bring attention to that is that sometimes we do get people off their blood pressure tablets once they change the underlying cause. And again, I think this is tricky with the GLP-1s, because as you mentioned with that lovely word milieu, there are so many causes and so many factors that all kind of conglomerate to cause that — you know, people's bodies to store excess fat. And sometimes they might be able to get to the point where they have addressed the underlying issues. Maybe it's, you know, binge eating or emotional eating or whatever was driving it in the first place. But not always. That's the other thing. It's not a failure if you need to take medication — like, you haven't failed.
Jacqui Lewis (32:57) And that's true. It's like we look at, you know, when can we get you off this medication? Is that a goal? Or is it a, this is a management plan? Because we know obesity is either in remission or it's wide awake. And so it's like, if we can keep it in that state where it's manageable — and even our bariatric patients are like, well, I had the surgery, I should be good now. And I'm like, yeah, but it's a sleeping period. And so then this is why the GLP-1's brilliant — we can bring that in when there is that next need. It's watch this space, isn’t it? It's not brand new, but it's not a magic pill.
Dr Lucy Burns (33:34) No, no. And you're right. I mean, the people that have been on it long term are people initially with diabetes because they're the ones. And so for them, it was never a question of, oh, well, you're going to just take it short term. Yeah, that's right. So we have got long-term data. What we've also got is a fair bit of data from, particularly in Australia, on when the shortage was on — the really devastating effect for people stopping and starting. And you know that they often don't get a response second or third time round, for whatever reason. And also, I think just people's expectations that they're somehow going to potentially lose all their weight on those meds, when we know the evidence is really it's an average of, you know, depending on which one, somewhere between 16 and 24 percent — which is significant, but it might not be enough.
Jacqui Lewis (34:24) And that's the question is, then are we sending them down one path to only need to go down another? And there's two sides to that. I think it's amazing that we'll open up this conversation because we know that when people are really battling with I can't lose weight, they're reaching out eight years later than they started to have that problem because they've tried again and again and they're like, Oh, I'll just give it another go. And then there's the shame of turning up and saying, I can't do this, which is terrible and it shouldn't exist. And so that's eight years later from having this problem in the first instance. And then to have someone turn around and go, Well, I think it's time you just exercised, eat a little bit less and move a little bit more. So they've worked up the courage and then gotten another hit. So it's like they're all a bit gun shy. And I think this is part of it. It will be an easier, open conversation that is being had outside of any medical appointment because everybody's talking about it. It's not normalising it, but it's giving access to something that was less so before. And I think that's a key. And if that starts the conversation and they're in that situation where surgery would be a better option, at least that would be an earlier conversation. And certainly we see it change so many people's lives. It's amazing. So it's horses for courses like anything else.
Dr Lucy Burns (35:48) Yeah, absolutely. And I think probably a little bit like responsible prescribing, there's responsible surgery. People need to just have all the information before they make decisions. And I think sometimes, again, like everything, I'm sure there are wonderful, holistic, incredible surgeons out there. In fact, we had Arun Dhir on the podcast recently. Oh, yes. He's a very lovely, good friend of ours. Lovely, lovely, holistic man — you know, the yoga-doing bariatric surgeon.
Jacqui Lewis (36:20) You don't get that mix very often, I have to say that.
Dr Lucy Burns (36:24) No. And he made this great comment that, you know, when you have a hammer in your hand, everything looks like a nail. Love it. So yeah, I'm sure for some surgeons, they probably feel everyone should have surgery. And again, it's about that responsible use of a very powerful tool.
Jacqui Lewis (36:43) Yes. And that's where the bariatric physicians are amazing, because they'll give all the things on offer, rather than you, like, if you go to a vet, you'll get veterinary care. So you need to know that, yes, that's part of it, but there might be other parts of it you can seek out. So it's a more rounded approach as well, which is brilliant. But yeah, it's been an incredible time, I think, particularly in our realm, as we haven't had something change like this for such a long time. So it's exciting. And then we look at, okay, what do we need to consider?
Dr Lucy Burns (37:12) Absolutely. Well, we have rabbited on forever. So this was meant to be a little podcast, and here it's now 40 minutes. So yeah, Jacqui, if people want to connect with you, your company, your products, where do they find you? Sure.
Jacqui Lewis (00:27) We're everywhere. I don't think you'd be able to miss us. bnhealthy.com.au is our website. You'll find certainly the solutions for bariatric patients, but also for the new shake we've formulated for supporting the side effects and the gut bits and pieces and the protein needs of a GLP-1 patient. And we've certainly got all of that covered. So yeah, website, we've got Facebook, we're BNHealthyANZ. My podcast is the Australian Weight Loss Surgery Podcast or awls.com. There's a website, and it's on all the other platforms as well. And I'm lucky enough to have your company again soon, Lucy.
Dr Lucy Burns (38:08) Yes, indeed. Indeed. Well, you know, I think one of the things that we see a lot is, particularly when people have had surgery but haven't necessarily had much psychological support. So they will often see a psychologist beforehand, usually to make sure they sound the one, but then they don't get a lot afterwards. And there's buckets of psychological stuff that comes. So, you know, unpacking a bit of that is really helpful. And so yeah, that's pretty much—we do a lot of that in our programs—that it's not just what you eat, but why you eat.
Jacqui Lewis (38:41) A hundred percent. Yes. And I think that's where yours sits, is in that beautiful balance of mindset and habit change and sustainable. And that's ideal. It's that getting in and looking at the why and setting up new habits and supporting it along the way. Perfect. Good. Lovely.
Dr Lucy Burns (38:57) All right. Well, have a fabulous day. And my beautiful listeners, you too, go out and have a beautiful day, and we will see you next week on the Real Health and Weight Loss podcast.
Dr Lucy Burns (39:11) The information shared on the Real Health and Weight Loss Podcast, including show notes and links, provides general information only. It is not a substitute, nor is it intended to provide individualised medical advice, diagnosis or treatment, nor can it be construed as such. Please consult your doctor for any medical concerns.
