Travelling for surgery abroad: What to expect and what to keep in mind before making the trip

They're a great adjunct, um, so they work well in patients who are with severe obesity.

I suppose the, the question of whether to have GLP-1 meds or surgery is a very individualized discussion with patients.

They're excellent treatment options for severe obesity.

I suppose they have their limitations as well, in that not every patient who will take GLP-1 meds will respond to them.

So about 20 to 30% of people don't respond well or at all to GLP-1, and there is no single, there's no blood test we can do or a questionnaire we can ask people to fill to see if they are a responder.

They have to take the meds, try them for at least six months to see if they respond.

Um, more importantly, there's a huge cost barrier to not just starting meds, but continuing on them.

Um, the important thing about treating obesity is that it is a chronic disease, so it needs lifelong treatment.

It's, can't be in any way cured by a single surgeon or a cer- surgery or, uh, medication for a short time.

So I think there's a misunderstanding that taking GLP-1 meds for a few months to get near a goal weight or to a goal weight, then I can stop a medication.

There'll inevitably be weight regain within a year after that.

So patients have to understand that if they respond to GLP-1 meds, they need to stay on them lifelong.

And if patients, most patients in Ireland are self-paying for these medications, that they need to understand that lifelong financial commitment as well as the commitment to the medication.

So they're a great option, and we use them a lot in tandem with surgery, uh, to optimize people for surgery or to get treatment initiated maybe while waiting a long time for an operation.

And we sometimes use them after surgery to augment the response, especially if people were regaining some weight afterwards or hadn't got optimal control of conditions like diabetes, lipids, blood pressure.

Um, so they're a really useful tool to have in the armamentarium of treatments that any doctor who treats people with obesity has.

They're really useful.

And certainly, you're absolutely right.

Certainly in general practice that we see that that real rate-limiting factor is the cost, and not all of our patients, uh, will qualify, uh, for the public access to liraglutide, uh, and certainly may not be able to afford, uh, the newer agents that are coming out on the market.

Uh, and that continuum of care is going to at times be very difficult, uh, when we're cognizant of everything else that may be happening.

Alan, would you have explored those medications?

Yes, I would have.

One, I think four years ago, I don't think they were on the market or really known much about then.

If I had have known about them, I definitely would have been on them.

The cost factor, yes, is prohibitive, 180 euros a month, plus some of them are less.

They're a great adjunct, um, so they work well in patients who are with severe obesity.

I suppose the, the question of whether to have GLP-1 meds or surgery is a very individualized discussion with patients.

They're excellent treatment options for severe obesity.

I suppose they have their limitations as well, in that not every patient who will take GLP-1 meds will respond to them.

So about 20 to 30% of people don't respond well or at all to GLP-1, and there is no single, there's no blood test we can do or a questionnaire we can ask people to fill to see if they are a responder.

They have to take the meds, try them for at least six months to see if they respond.

Um, more importantly, there's a huge cost barrier to not just starting meds, but continuing on them.

Um, the important thing about treating obesity is that it is a chronic disease, so it needs lifelong treatment.

It's, can't be in any way cured by a single surgeon or a cer- surgery or, uh, medication for a short time.

So I think there's a misunderstanding that taking GLP-1 meds for a few months to get near a goal weight or to a goal weight, then I can stop a medication.

There'll inevitably be weight regain within a year after that.

So patients have to understand that if they respond to GLP-1 meds, they need to stay on them lifelong.

And if patients, most patients in Ireland are self-paying for these medications, that they need to understand that lifelong financial commitment as well as the commitment to the medication.

So they're a great option, and we use them a lot in tandem with surgery, uh, to optimize people for surgery or to get treatment initiated maybe while waiting a long time for an operation.

And we sometimes use them after surgery to augment the response, especially if people were regaining some weight afterwards or hadn't got optimal control of conditions like diabetes, lipids, blood pressure.

Um, so they're a really useful tool to have in the armamentarium of treatments that any doctor who treats people with obesity has.

They're really useful.

And certainly, you're absolutely right.

Certainly in general practice that we see that that real rate-limiting factor is the cost, and not all of our patients, uh, will qualify, uh, for the public access to liraglutide, uh, and certainly may not be able to afford, uh, the newer agents that are coming out on the market.

Uh, and that continuum of care is going to at times be very difficult, uh, when we're cognizant of everything else that may be happening.

Alan, would you have explored those medications?

Yes, I would have.

One, I think four years ago, I don't think they were on the market or really known much about then.

If I had have known about them, I definitely would have been on them.

The cost factor, yes, is prohibitive, 180 euros a month, plus some of them are less.