Patient Who Had No Luck With GLP-1 Drugs Found Success With Surgery

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Sandra Sio weighed 300 pounds and couldn't diet it away. For years she tried with no luck.

The 35-year-old San Diego-area dental office manager and single mother of two said she went to her doctor in 2022 asking for bariatric surgery. She wanted the extra pounds gone.

Instead, he convinced her to try injections of semaglutide (Wegovy), one of the newer GLP-1 receptor agonists prescribed for weight loss that have received so much media attention and praise for their ability to suppress appetite and slow digestion.

But the weekly injections didn't work for her. "I was just very nauseous and sick. I would wake up nauseous and go to bed nauseous and be nauseous just all day," she said. She went back to her doctor who put her on liraglutide (Saxenda), a different GLP-1 drug that she injected once a day, but it made her sick as well, although not as sick.

Her doctor explained that as a patient with a Medi-Cal HMO, it might be tough for her to be approved for surgery. But Sio said he told her that when the HMO realized the difference between "spending $1,400 a month for the drug versus spending $5,000 one time for the surgery -- and it's done -- your insurance will see the monetary difference and approve you for surgery a little easier."

Sio did lose weight on the drugs, but just 14 pounds. "For me, it wasn't enough to hold off on bariatric surgery and continue with the medications," she said.

The other problem was that the drugs were in short supply, "back-ordered," she was told by Walmart and Walgreens. She also was hearing some scary stories about the drugs' side effects, and at one point had to have gallbladder surgery, although she doesn't know if the drugs provoked it.

"I'm not saying it was because of the medication, but I did get fearful, and wondered, you know, is this going to cause other issues?" said Sio.

It took quite a while for her to go through the requirements for bariatric surgery, however. Her HMO required 12 weekly appointments with a dietitian, and many other trips around the county for tests. The hurdles were numerous, she said.

Luckily for her, earlier this year she started a job with a new dental group that provided health coverage through Kaiser Permanente.

With Kaiser, she had to start the process all over, although it was much faster and easier this time. "There were 10 weeks of classes that I could do via Zoom. Then I interviewed with the Kaiser Permanente surgeon," William Bertucci, MD, who scheduled her for a sleeve gastrectomy on September 10 at Scripps Mercy Hospital. That's where Kaiser surgeons have a contract to perform bariatric surgery on its San Diego enrollees.

The story has a happy ending. As of December 8, Sio proudly said she has lost 66 pounds.

"It's nice," she said. "What I wanted all along was the surgery without the medication side-effects. And, I mean, who doesn't want to lose weight fast."