Managing Obesity as a Chronic Disease
In this interview, Jaime Almandoz, MD, MBA, FTOS, endocrinologist and obesity medicine specialist at UT Southwestern Medical Center and medical director for the Weight Wellness Obesity Medicine Program, previews his presentation at AACE 2025. Dr Almandoz emphasizes the importance of treating obesity as a chronic disease, even after bariatric surgery, and explains how pharmacotherapy continues to play a critical role in sustaining weight loss and addressing comorbid conditions such as diabetes, cardiovascular disease, and sleep apnea.
Reference:
- Almandoz J. Continuing obesity medications post-bariatric surgery: navigating the pros and cons. Talk presented at: American Association of Clinical Endocrinology 2025 Annual Meeting; May 15, 2025; Orlando, FL. Accessed May 13, 2025. https://am.aace.com/
TRANSCRIPTION
Jaime Almandoz, MD, MBA, FTOS: My name is Jamie Almandoz. I'm an endocrinologist and obesity medicine specialist at UT Southwestern Medical Center in Dallas, where I'm also the medical director for the Weight Wellness Obesity Medicine Program and an associate professor of internal medicine.
Consultant360: What are the key themes of your presentation, “Continuing or Discontinuing Anti-Obesity Medications Post-Bariatric Surgery: Navigating the Pros and Cons?”
Dr Almandoz: The broad concept is around obesity as a chronic and complex disease. People often treat it episodically, expecting medication or surgery to be curative, but we need to reframe it—like hypertension or diabetes—as something requiring ongoing management. When an effective therapy is stopped and disease recurs, that doesn’t mean the therapy failed; it means it was working.
So what is the role of pharmacotherapy after bariatric surgery? While not curative, bariatric surgery is one of the most effective treatments for obesity. However, weight recurrence is common. Weight loss responses are highly variable, and pharmacotherapy can help optimize outcomes—whether by promoting further weight loss or preventing weight regain.
Additionally, many obesity medications are now being explored for conditions like type 2 diabetes, cardiovascular disease, obstructive sleep apnea, and steatotic liver disease. These comorbidities are highly prevalent in individuals with a history of significant obesity—especially those who have undergone bariatric surgery. So even beyond weight, these treatments offer broader health benefits.
C360: Why is this topic particularly relevant right now?
Dr Almandoz: A few things make this especially timely. First, the number of people qualifying for and undergoing bariatric surgery has grown. Nearly one in ten Americans now has a BMI over 40. Among women aged 40 to 60, it’s closer to one in seven. And every year, a quarter million people undergo bariatric surgery.
Given this volume, post-bariatric weight recurrence is a growing issue. Add to that the fact that pharmacotherapies have become more effective—semaglutide and tirzepatide can lead to 15% to 22% weight loss, approaching surgical outcomes—and we now have powerful tools to manage post-surgical patients more effectively.
C360: What are the most important takeaways for clinicians in practice?
Dr Almandoz: That obesity is a chronic, complex disease that requires lifelong management. Over a patient’s lifetime, multiple interventions will likely be necessary. We should not define success solely by weight loss, but by overall health, quality of life, and prevention or treatment of obesity-related conditions.
Pharmacotherapies are a key part of that, especially since emerging data show they can improve cardiometabolic outcomes and possibly even reduce mortality. We need to shift away from the idea of “either/or” between surgery and medication. It’s not binary—it’s additive.
C360: Are there any gaps in knowledge or areas you’d like to see explored further?
Dr Almandoz: There’s still so much we don’t know. After significant weight loss, people undergo metabolic adaptation—hormonal changes that decrease the likelihood of maintaining weight loss. Finding ways to counteract that would be invaluable.
We also see changes in body composition—especially reductions in muscle mass—that could increase frailty or impair mobility. There’s growing concern about potential adverse effects on muscle from GLP-1 therapies, so we must emphasize lifestyle support alongside medications: adequate nutrition, protein intake, hydration, movement, and resistance training.
Post-bariatric patients may be at even greater risk of malnutrition or body composition issues, and we need more research at that intersection—how anatomical changes from surgery interact with pharmacotherapy. But what we do know is that we must focus on long-term, holistic management, not just numbers on a scale.