Continually evolving to respond to increasing demand, new care recommendations and emerging treatments, Duke Health’s experienced bariatric specialists offer patients in Durham and Raleigh access to the latest in comprehensive weight loss services tailored to their individual needs and condition.
 
“We have a true multidisciplinary team working together across our system to help the patient come up with a care plan,” says weight loss surgeon Dana Portenier, MD.
 
With more evidence supporting obesity as a chronic, resistant disease process, Portenier and colleagues emphasize a multifaceted treatment plan. Duke Health offers the full spectrum of treatment modalities for weight loss, which includes behavioral interventions, the latest weight loss medications and bariatric surgery.
 
“It’s common to have to layer these therapies on top of one another,” says Portenier. “We have many patients who require all three approaches to finally achieve a reasonable goal. If the least invasive modalities are effective, then we're going to stop with that. If not, then we'll progress up the treatment chain.”

At Duke Raleigh Hospital, patients have access to all non-surgical weight loss treatments, which are the treatments of choice for a majority of patients referred to the Bariatric Surgery Program. “When patients are referred, they can choose whether they want to be seen for medical weight loss, surgical weight loss or both, and well over 50% choose medical weight loss,” says Portenier.
 
Medical weight loss therapies designed to complement or exceed behavioral interventions include two new injectable medications for managing obesity that have been approved by the FDA:

• Semaglutide (Wegovyâ, Novo Nordisk, Plainsboro, NJ)
• Tirzepatide (Mounjaroä, Eli Lilly, Indianapolis, IN). Approved to treat type two diabetes mellitus, this drug is now being prescribed off-label to help patients lose weight. It has been granted “fast-track” review by the FDA and is soon expected to gain approval for obesity treatment.

 
Adding these drugs to obesity treatments offer significant opportunity for patients with a BMI of 30 or higher, or a BMI of 27 or greater with at least one weight-related health condition. “We’re seeing 15% to 20% total body weight loss with these drugs, which doesn't sound that significant, but it's about three times what any other weight loss medications could ever do. The results we're seeing with these newer medications is really impactful,” says Portenier.
 
Providers may initiate treatment with one of these medications, but Portenier reinforces the value of a multipronged approach to obesity management available at the Bariatric Center of Excellence.
 
“We have the resources to help support necessary behavioral interventions, including nutritionists and psychologists. We can monitor drug dosage and effects and, if a patient is not meeting their goals with that treatment alone, our team can help prepare them for surgery and support them through recovery and beyond,” he says.

If surgery is required to help patients in Wake County reach their weight loss goal, the Duke Raleigh and Duke Regional Hospital teams collaborate to offer treatment at the right place, at the right time. Patients receive pre- and post-op care close to home in Raleigh, while surgery is typically performed at Duke Regional, with a same-day discharge home in most cases.
 
Looking ahead, the Duke Bariatric Surgery Program is set to expand services and access for patients as demand for bariatric surgery continues to rise. The pool of patients eligible for weight loss surgery is greater than ever due to the issuance of new clinical guidelines for bariatric surgery in 2022 by the American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO).
 
“The guidelines drop the BMI requirement down to 30 as an indication for surgery for patients with obesity-related comorbidity. For patients of Asian descent, the BMI requirement drops down to 27,” says Portenier. “As a result, the number of eligible patients has really gone up.”

Primary care providers and specialists have an ally in Duke Health’s bariatric surgery team. The specialists strive to help patients achieve weight loss goals and reduce obesity-related health risks.
 
“We encourage referring providers to send patients in with any weight loss needs, then our team can help them figure out what modality might be best for them,” says Portenier. “Whether it's for medical weight loss or surgical weight loss, our program makes a lifelong commitment to these patients.”