Welcome And Guest Introduction

Dr Andrew Greenland 0:00

Welcome back to Voices in Health and Wellness. This is the podcast where we explore the people and ideas shaping the future of healthcare, especially at the intersection of clinical excellence, lifestyle medicine, and sustainable patient outcomes. Today I'm joined by Dr. Seun Sowemimo, a board-certified bariatric and gastrointestinal surgeon, founder of Prime Surgic are, and an expert in both surgical and medical weight loss, including GLP1 therapies and lifestyle medicine. With a background that combines clinical expertise and business insight, Dr. Sowemimo brings a really valuable perspective on how we approach obesity, metabolic health, and long-term patient care in a rapidly evolving landscape. So with that, Sean, I'd love to welcome you to the show and thank you very much for joining me today.

Speaker 0:44

Thanks for having me, Dr. Greenland. Happy to be here.

From Training To Bariatric Surgery

Dr Andrew Greenland 0:48

To start, would you mind sharing a little bit about your journey into bariatric surgery and what led you to build prime surgic care?

Speaker 0:55

Yeah, uh, thanks for that. I originally trained in Lagos, Nigeria, and then I took a trip to the UK, started my surgical training there, and around that time was when bariatric surgery, you know, was starting to take hold, uh, especially with new technology around laparoscopic surgery, which was intriguing to me. So I went into that field, and uh I actually didn't start out just really wanting to take care of people with weight loss. It was the technology that attracted me to it because literally you were doing surgery on the biggest people you could find with the smallest incisions. So after getting into that, you know, you find out that bariatric surgery in itself is not, you know, a one fix for everything. And people still had to, you know, eat a proper diet and everything. And I found out that what we were following um more protein, less carbs, and all this wasn't really working that well for everybody. And this hit home when I myself started to put on a few pounds and develop high cholesterol, pre-diabetes. So that is what led me down the rabbit hole of finding out what truly works for health, for wellness, you know, for maintaining a healthy weight. And that is why my practice, Prime Surgicare, sort of focuses not just on the surgical aspect and bariatric surgery, but the wellness aspect, the nutritional aspect, uh, exercise, and all these other pillars that I'm sure we will get into. So that's how I got into it.

Dr Andrew Greenland 2:41

Lovely,

Prime Surgic Care Patient Pathway

Dr Andrew Greenland 2:42

thank you. Always good to have some background and context for what we're discussing. So tell us a bit about the practice itself, prime surgic care. What does it look like today? How is it set up? And maybe talk a little bit about a typical patient journey. I know there is no such thing as a typical patient journey, but how does it look like from a patient using your service?

Speaker 2:59

Yeah, so we get our patients that primarily either coming to us for uh weight loss surgery or they're coming to us for weight loss medications. So right now I'm uh the sole physician in the practice. I'm supported by physician assistants and medical assistants. Uh so we intake all these people, and then we're either guiding them down the path of you know getting a bariatric surgery procedure or being on weight loss medications more recently. But on top of all that is what I've learned that you know 20 years plus of being in this field of trying to get people healthier and lighter, all that you know, experience uh to guide them in terms of changing their lifestyle to support uh a healthy weight and health in general, because we get people coming in with all the usual chronic diseases, heart disease, diabetes, high cholesterol, even people finding out that they have some cancers. And uh the shocking thing is that these cancers are also related to lifestyle, and in a large part to what we eat, how we move, how we sleep. And uh that is very interesting because the the every all of those things coming together uh tie into the fact that people tell you, oh, you changed my life at the end of the day when they've come through this journey. And it it is because weight and the things surrounding that affect every other aspect of life and living. So the practice is sort of set up in that way where we're we're trying to sort of uh touch people's lives in in a profound way. We also do some general surgery, hernia's uh surgery, gallbladder surgery, but the center of the practice is around transforming people's lives around weight and health.

Dr Andrew Greenland 5:05

Thank

GLP-1s Impact Surgery And Access

Dr Andrew Greenland 5:06

you. Now there's obviously been a huge shift with the GLP1 medications. How are you seeing that impact the role of surgery in weight management from your perspective?

Speaker 5:15

Well, I think there's the initial sort of excitement about uh GLP1s that like it's a cure all. Um, but I've found that like everything else in life, to do anything properly or achieve a good result, you're gonna have to do more than one thing. So it's gonna, even with people on GLP1s, it usually requires more than just uh the medication. But it's had an impact in as much as we've seen numbers of bariatric surgeries drop. However, we still have some people who cannot tolerate the medications. We have some people for whom um access to the medication is a problem because uh here in the United States a lot of insurance is tied to employment. Employment changes, or they change the policy around uh the coverage for these medications, and then people find themselves, you know, starting and stopping the medication. So there's there's access problems uh like that. And then the medications right now are more expensive, you know, at uh at a level that people cannot afford. And it may actually be cheaper in the long term right now to get the surgery than to have to take the medication, which for a lot of people, what people don't understand is that once you get on these medications is not something that you do, get to a certain weight, and then stop the medication. You indeed have to continue the medication to maintain your weight.

Dr Andrew Greenland 7:00

Got it. So do you see the medications as a comp as competition in a inverse commons or more of a complementary tool? So I guess I guess because you have a more holistic approach, they're in your in your toolbox, but how do you view them?

Speaker 7:14

Well, initially it it it was uh competition because once we started seeing the medications come on board, uh a lot of um uh our surgery numbers started to drop, and you could see that people were asking uh the any physician they knew, hey, do you prescribe uh GLP1 medications? I'll be in church trying to you know worship, and someone will be nudging me and saying, Hey, Dr. Sean, do you do those medications? So it's uh interesting in that way, but as time has gone on and these other factors that I mentioned have come into play, um, we're seeing that people are mixing both. I I personally have given medication to a fair number of my patients whom, after their surgery a few years on, have started seeing some weight creep back on. Um, some people have used them as a complementary strategy with the surgery in people that have uh super morbid obesity, meaning that their BMI is so high that we know that even though surgery will have a significant impact, we would really like more weight loss to bring them back towards a normal weight. So it's becoming more of a combination now. But where exactly that balance settles actually depends on the uh individual and the local circumstances.

How Patient Demand Is Changing

Dr Andrew Greenland 8:40

Thank you. I guess um what major shifts are you seeing in how patients approach weight today compared to a few years ago? I'm guessing the drugs are a feature of that, but I just wonder if there's any else, any other shifts that you're seeing in their approach.

Speaker 8:54

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 is probably still the case, uh the most powerful and effective tool that we had was surgery. People had a barrier to use that tool. People were fearful sometimes, even though weight loss surgery is really safe, uh, but people were fearful. So now that barrier has been lowered significantly, given that it's medications uh that bring people to the point that they they accept the fact of uh doing an intervention. It's also brought along with it some people who do not necessarily qualify, you know, due to uh by the standards that are set. You have people with BMIs that are close to normal and they're only slightly overweight, you know, wanting to take the medication, people uh wanting to take the medication before an event or the wedding or something like that, you know, to lose some weight to fit in a dress, that sort of thing. But by and large, it's brought more people into the fold, which is a good thing, because one of the things that I believe is we have a finite period of time that we're here as human beings. You owe it to yourself to be healthy for the most part of that and be able to do what you know what gives you pleasure, what allows you to enjoy your life. So whether it be weight loss surgery, whether it be medications, whether it be a combination of those and lifestyle changes, I encourage people to do whatever is needed so that they're not uh ending up like some of my patients say, Oh, I wish I had done this 10 years ago. Because there's there's life that they're missing on the people, simple things, even like taking a ride with your your kids and at a park, you know, that some people have to be on the sidelines and be on the outside looking in. Uh, these are interventions that can help you to get that back and get your life while you still have it, you know, uh and not spend all you know your best years trying to lose weight.

Daily Practice And Lifestyle Foundations

Dr Andrew Greenland 11:24

Thank you. So, what does a typical day um for you look like in practice at the moment? I do accept that there is no such thing as a typical day, but trying to get some sense of how things 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'm just seeing patients. Or on an operating day, I'm in there either doing bariatric surgery, example, the gastric sleeve, which is our most common surgical procedure, um, or doing some general surgery, fixing hernias, taking out uh diseased gallbladders. So that those are that's a surgical 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 new patients, you know, uh offering them weight loss solutions, whether it be surgery or getting on a GLP1, making sure that they qualify for that, and telling them what the process is like. I always like to give them a comp an overview first, in terms of these are the strategies for weight loss. It always involves uh exercise, physical activity. It always involves uh dietary changes, for which I advise the patients mainly on a plant-based uh with natural foods, whole foods uh-based sort of diet. I'm a firm believer that you know the diet is really central because a lot of the information that is out there, people never tell us how much diet contributes to the problems around weight and chronic disease. So, diet for me is a key one that people need to pay attention to. So I really like to try and drive that home. And then the procedure that they're trying to uh do, whether it be surgery or the weight loss medications, how it works and how best to prepare for it, and how to make sure that you're working in tandem with the intervention that you've chosen rather than doing something that is uh against uh what that intervention is trying to do.

Dr Andrew Greenland 13:42

Thank

Matching Patients To The Right Tool

Dr Andrew Greenland 13:43

you. Now, I guess it's highly complex, but can you give us a sense of how you determine whether a patient is best suited for bariatric surgery, GLP1 therapy, or a combination of both?

Speaker 13:54

Oh, that's a simple one. Uh Dr. England because most people come in and say, This is what I want. So it's a matter of trying to qualify them or making sure that they are appropriate for what they want. Uh, I mean, we live in a society there's so much information out there. A lot of my patients come in telling me, hey doctor, I've done my research. So this is what I want to do. So I take what they want to do and I look at their BMI, I look at their lifestyle and their profile, and decide if that's appropriate for them. If it's not appropriate, then I would, you know, uh introduce them to a solution that is better suited. But for most people, what they'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 medical chronic diseases going on, and um the risk of surgery is significant. Now we have, you know, it might be easier for you to go or safer for you to go on one of the weight loss medications to achieve the weight loss that you need, you know.

Dr Andrew Greenland 15:14

And what about psychological readiness for surgery? How do you um prepare patients psychologically?

Speaker 15:21

Yeah, so part of the process, or one of the things that is prominent about the process is a psychological review. So we do get clinical psychologists or psychiatrists to evaluate patients. And the idea is to first of all weed out if there is or find out if there's any sort of pathological eating disorder that is uh the case with the patients. If not, then we would proceed and find out that they are an appropriate candidate, that they can follow the kind of instructions that would help them to be successful around the time of surgery and even for the long term. Um thankfully, very few patients are uh have the psychological profile that they don't qualify uh for the surgeries. We also do some medical tests, cardiac uh uh clearances to make sure that from a cardiac standpoint they're a good candidate for surgery, pulmonary as well. So that's the whole gamut of uh tests that we do to make sure people are ready for that sort of intervention.

Dr Andrew Greenland 16:32

Thank you. And on that note, what characteristics do your most successful bariatric patients tend 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've tried different things and uh have had some limited amount of success, and people who, when they come into our program, we introduce them to some of the lifestyle changes. And between the time that they start the program and get their surgery, if they're able to apply those lifestyle changes and lose some weight, that is the best predictor that after the surgery they're going to do very well at losing a significant amount of weight.

Dr Andrew Greenland 17:18

And you talked

Staying Successful After The Escalator

Dr Andrew Greenland 17:19

about weight regain a little bit earlier on. I mean, what separates patients who maintain weight loss for 10 years from those who struggle to sustain the results?

Speaker 17:28

Yeah, uh, the analogy I give my patients is that the weight loss is like going on an escalator. You go on a from a weight that is up here to a weight that is down here, on this escalator going down for a limited period of time. Typically a year to two years, they're actively losing weight primarily because of the procedure. While you're on that escalator, you want to be walking down the escalator. And that you do with lifestyle changes that are mainly dietary in terms of the uh impact and exercise. Exercise is fantastic, but the impact on weight itself is not as much. Um, the impact of exercise is more on keeping away chronic disease. But in any case, those lifestyle changes are like walking down that escalator so that you go down further and faster and that you're able to keep going after you're off the escalator. So the escalator of the surgery, you know, acts as something that multiplies your lifestyle change over a period and gets you to a lower, healthier weight, but you have to use the lifestyle changes to keep going along that journey.

Dr Andrew Greenland 18:44

And how important is ongoing follow-up after bariatric surgery? I guess it seems like an obvious question, but I'm just interested to hear your perspective 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 different and varying and confusing information on diet and lifestyle. So that to keep them on track, uh you really have to keep reinforcing this message. So for the first two years after someone has a bariatric surgery, we believe that we would need to see them pretty frequently to keep reinforcing this message. And I it's worked because where we used to see people um, you know, have the surgery and they go and they come back, and they're always telling you, oh, you know, I'm following the diet, I'm eating more protein and less carbs, which is not what we preach. Um now, with reinforcing this constantly on our messaging, on our social media, and with patient visits, people are beginning to understand that, you know, uh changing your diet, you know, not necessarily in line with the culture that we find ourselves in modern society, but changing your diet where you're eating mostly whole foods, mostly natural foods as opposed to processed foods, half your diet being fruits and vegetables, fresh and fruits and vegetables. The other half consisting mainly of whole grains and complex starches and uh legumes, beans, lentils, chickpeas, and the like, and minimizing animal protein, you know, eating a little bit of nuts and seeds that summarizes, you know, a well-rounded, healthy diet that can help you to maintain a good, healthy weight and keep off uh a 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 your patients? Obviously, the frequent visits that you've alluded to, but what what else is in that kind of program 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 my patients, you know, with the diet, also with exercise. I I I bike and uh do some road biking uh during the season, and I encourage people, whatever sort of form of exercise that you you can do that you enjoy, that you do mostly in a social setting, you have uh people that enjoy 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 it on the front end. And as long as they keep coming back, we see patients on a yearly basis after the second year. As long as they keep coming back, we're just reinforcing these principles, we're making that the kind of thing, making sure. That they're staying on track. And uh the messaging that we sent out on send out on all our channels is supporting that. A lot of our patients, you know, are on those uh channels and receive our emails, our newsletter letters. So we're trying that way to kind of keep in touch, and hopefully, we've already put them in communities where they know people who are adopting this sort of lifestyle. And that's something hopefully that can follow them for the long term. Um it all comes down to, for me, uh, from my perspective, a lifestyle change that is enduring, you know, and once you've welded that healthy way of living into your life, you have um things in your day-to-day living that makes it easy and convenient for you to follow through with this kind of lifestyle, then then that I think I've done my job.

Metabolic Health And Lifestyle Medicine

Dr Andrew Greenland 22:59

Amazing. So we've been talking a lot about bariatric surgery for weight reduction. Um, but could you speak a little bit to the metabolic benefits that are often overlooked by patients and you know, things like type 2 diabetes, cardiovascular risk factors? Could you speak to that a little bit?

Speaker 23:13

Yes. Um a lot of people think that those things, uh, the chronic diseases, follow weight and weight loss, and that is true, but in a lot of instances, it is actually not because of the weight and uh obesity per se. It is it follows more tightly with the kind of diet that we're consuming and lifestyle. And one example that I can easily describe is that when we've moved to uh become a society where animal products are at the center of our diet, and a lot of the animal products that we consume are manufactured in a factory kind of setting. It's called uh, you know, uh this concentrated animal farming operations. So we're producing animals, for instance, take chicken, we produce this in the billions. And it takes a shorter time now to get a chicken of a certain weight compared to when they naturally mature. It takes about three months. Now we do it in about three weeks. That chicken is not there lifting weights and building uh muscles and protein. That chicken has more fat content, more saturated fat. And consuming this at the center of our diet translates into a situation where rather than our blood flow being, you know, more fluid with water-based, your blood flow has more saturated fat in it. And the places in our arteries where uh arteries divide is a source of friction in that flow. And the accumulation of fat in these places essentially is what leads us to heart attacks. Because when it happens in the heart where the vessels divide, you can get blockage there. And it also leads to stroke, where it happens in the blood supply going to our brain where the vessels divide, and there's friction, and you have more saturated fat, you have more cholesterol growth flowing through your vessels, can lead to stroke. So I've just given this example how heart disease and stroke, brain disease can be connected because of what we're consuming and what we're eating. If you can reverse those situations by eating better, the body can heal. And this is the very basis of uh the American College of Lifestyle Medicine, which teaches people uh how to live according to six major pillars, which let me try and recall if I can mention them dietary changes, uh, exercise, good sleep, uh, reduced stress, social connection. So these are the major uh uh pillars, and if you can turn these things around in a healthy direction, your body can actually reverse any of these chronic diseases that you may find yourself uh having, including obesity.

Private Practice Pressures And Technology

Dr Andrew Greenland 26:52

Thank you. So turning now to the business side of the practice, what's working particularly well in your 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 of major changes here in in the US. I mean, uh we've talked about one thing, which is uh the change the coming in of the GLP1 medications. Here they have also um uh government regulations uh around uh practices and people receiving uh you know uh bills from uh physician practices. There have been a lot of changes in that area. Um there's also been a paradigm shift in that independent practices like my own, prime surgic care, are becoming relics of the past. And a lot of practices are being bought up either by hospital systems, large hospital systems, or um the marketplace, private equity VC firms. So there is a lot of tension there, it's become more difficult to run individual private practices like what we have. You know, it used to be before that 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 big challenge, and we're having to make a lot of changes, try to uh do some things like uh the big uh players do, and try our best in that regard, negotiating contracts with insurance companies, uh getting attorneys to help us with billing services and things like that. So uh it's it's been more of a struggle, 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 of major um hurdles, roadblocks, bottlenecks that you have to face day to day or are navigating at the moment, aside from 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 of technology. You know, uh everybody knows that AI is the new thing around the corner. So we're trying to see how we can leverage that um to leapfrog some of these problems that we've talked about that we're having. So implementing AI in a small practice that you know is uh it's sort of a good thing because AI has become so democratized, and you have this technology that everybody can apply. So we're just trying to see where in our workflows, in terms of seeing patients, uh delighting the patients in the services that we have, and uh, you know, also running the business side of things, you know, uh getting reimbursed for our services and trying to see where 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 MBA influenced the way you approach healthcare and practice ownership? Because you have that sort of added business strand to your bow. And how's that um influenced things?

Speaker 30:13

Yeah, it's it's it's helped me to be able to assess the bigger picture of healthcare and uh where uh practice like my practices like uh mine fit in. So in the bigger picture, you know, healthcare is a big industry, billions of dollars are spent there. 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 insurance company and those kind of things? We found out that they're middlemen that uh uh reap a lot of profits in the healthcare industry without uh giving more access, more or providing better care. Uh so here in the in the US, especially our healthcare is so complex and the prices are high. So that really, my MBA helped me to open my eyes to the entire uh the entire industry and the complexity of the industry along its entire value chain. You know, and what it it has personally helped me to see is where do I want to engage more in the health system and where are the areas that I I don't want to uh uh apply myself. So it's giving me a bigger and better perspective of the entire healthcare industry, and it's helping shape how I make decisions.

Dr Andrew Greenland 31:57

So I guess your total addressable market is huge for the problems that you help patients with. If you experience a sudden influx 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 some room to expand. Um I've had uh you know a practice where there have been two surgeons, so that's an expansion slot that we can always um uh explore. Should there be sudden unleashing of lots of patients that I can't personally handle myself or with the physician assistance that I have? Um so we're still at a place where I wouldn't say we're at capacity, we can take in more patients. And if that sort of situation, there's a tsunami of patients, we we definitely have uh some means of expansion that we can explore.

Dr Andrew Greenland 33:03

And what about um things like group programs, digital education, telehealth or technology to support patients beyond the one-to-one consultations? Clearly, you can't replicate yourself for surgery, but all the other aspects of their long-term treatment program. Have you thought about any of those kind of um medalities?

Speaker 33:19

Yeah. Yeah, we've always had a presence on social media, and I believe social media is more important now. Um, if you can get your message out there, because part of my um passion is just getting out the education, especially on the nutritional or dietary piece. Because as a society, we're moving more towards uh more processed foods, more factory farmed animals uh that is leading to the chronic diseases that we see. So I like to get the word out on that, you know, not even just to patients that I might encounter, but as far as I can reach uh throughout the world, the entire globe, I'd like to get that message out. So I think social media is very important for that. The internet is very important for that. So we want to engage more in those spheres. A podcast like yours is important for that as well. Uh, if we can get the message out into you know the areas that you influence into where you are, that's what we want to do. We want this is a global message that I think would help lots of people. Um, and uh we have the tools with 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 help um you know raise awareness and promote your message with this, we will do.

Culture Prevention And Future Plans

Dr Andrew Greenland 34:52

Um, so what about the future then? What how do you see the future of obesity care evolving from a business and delivery perspective going forward?

Speaker 35:00

I think more of it is gonna be determined by the culture, which is a factor that we we uh often overlook. But culture drives a lot of things, it drives the messages that get out there, uh, it drives how people actually behave, because having the knowledge sometimes is not enough. If the person opposite you uh on a table is eating in a certain way, the chances are that you're more likely to eat along that way. People don't want to be uh isolated, you know. We thrive in communities. So changing the culture uh in our lifestyles is very important if we can if we're going to see the change that we desire in terms of obesity. Uh beyond that is the tools. It's a good thing that we're getting more tools to treat things on the back end when people have already fallen off the cliff, as it were. You know, um, that is a good thing because ultimately we're all as humans only going to be here for a while. You need to use whatever you can to fix the problem so that you have a great life. But a lot more emphasis needs to be paid to making sure people don't fall off the cliff, to preventing the problems of obesity and the other diseases that we know are associated, diabetes, heart disease, cancers, those sort of things. So if we are able to change the culture to prevent these things, uh then that's that's that's where we want to be. And I hope people across the entire spectrum of uh lay people, physicians, uh lawmakers, governments all get on board with that message because to shift the culture, it will require everybody along the entire spectrum of influence.

Dr Andrew Greenland 37:08

Thank you. And thinking about the future for you and prime surgic care, where would you like the business to be in the next six to twelve months' time? Anything on the cards for you? Anything you're hoping to achieve, looking to do?

Speaker 37:19

Yeah, with prime surgic care, seeing more patients, uh offering our services, changing lives, transforming lives. I would also like to, from the business perspective, be more vertically integrated. Uh, we're thinking about you know, uh surgery center, having our own surgery center, which I think is quite ambitious as I explained to you that you know we're becoming relics as uh uh independent practices, but it's it's something that I would like to get into before I you know hang 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 and insightful conversation. So thank you for sharing what a bit about what you do, uh what you're seeing in the space, and a 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.