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Doctor’s Orders: Get educated, get support when you’re on a weight-loss journey

A yo-yo dieter for many years, Felicity Cunningham considered herself to be overweight for most of her life and tried many different weight loss options.

“I had moderate success,” she said. “I could sustain a program like Weight Watchers or the Atkins plan for about four or five months. I would cut out sugar and carbs, reduce the calories and get on a high exercise plan.”

But then, after a few months of hard work, she would “fall off the wagon.”

“And then I would go back to my old habits, except it was always worse,” Cunningham said.During those strict dieting months, she would lose up to 40 or 50 pounds.  

“Then, I would gain it all back and more,” she said. “I could regain 60 or 70 pounds. And then I would be back to starting all over again.

A turning point, a new beginning

When she turned 51 last year, Cunningham said she was struck by the fact that her mother had suddenly died when she was 51 of a blood clot in her lung.

“That was very jarring emotionally for me,” she said. “To think I was going to be as old as my mother when she died, and that my numbers, like my blood pressure and A1C (which measures blood sugar levels over time), were creeping up into unhealthy places. I was really struggling with that.”

Her son’s father also had died, and she said she realized that she needed to be there for her child.  

“That was my catalyst,” Cunningham said. “I lost my mom, and my son lost his father. If I was gone, he wouldn’t have anybody, so I needed to do better for myself and my family.  

Cunningham knew she needed a more definitive solution but she was hesitant to try surgery.  

“That is how I landed at UTMB and started my process,” Cunningham said.

Emotional and overall health considerations

Cunningham was evaluated by the medical team at the University of Texas Medical Branch’s Metabolic and Bariatric Surgery Program, most notably Dr. Sarah Samreen, a bariatric surgeon and assistant professor in UTMB’s Department of Surgery.

“I spoke with Dr. Samreen and her nurse practitioner, and we determined that for me, the definitive solution was the bypass, and that was the beginning of my process,” she said.  

Her evaluation results showed that her BMI was over 50, and she had several other health considerations due to her weight.

Felicity Cunningham before surgery“They are called co-morbidities, and mine include high blood pressure, high blood sugar and other things like swollen ankles, backaches, poor balance and sleep apnea,” Cunningham explained. “All those things contributed to my overall poor health.”

There also was the psychological effect brought about by the yo-yo dieting, having made so many attempts to keep weight off and being unsuccessful, Cunningham added.

“I think you have to do a lot of psychological and emotional work, talk to a psychologist and understand completely what you’re committing to,” she said. “You’re changing your anatomy with this surgery. They’re going to remove a part of your stomach. You must understand what you’re doing, and you have to see it as something you’re going to do for the rest of your life.”

Cunningham spent a lot of time working with a psychologist, physical therapist and cardiologist to demonstrate her ability to commit to a diet and lifestyle change, she explained.

“There’s a myth that the surgery just ‘fixes it,’ but you don’t just lose weight when you do this,” she said. “You change the way your body will process food, so food choices are even more important. Your food absorption changes, and you must establish a protein-forward diet. And you’ll eat much less, so it also has to be a nutrition-forward diet. And that means no chips and no more emotional eating.”

Cunningham lost 60 pounds prior to the surgery— just to show she could eat the right way on her own.  

“It does not change after the surgery,” she said. “The surgery is just a tool, but it’s not a free pass to eat what you want. You get two cups of food a day, and you must choose well.”

'Obesity is a disease’

The U.S. Centers for Disease Control and Prevention reports that the prevalence of obesity in the U.S., from 1999–2000 through 2017–2018, increased from 30.5% to 42.4%, and the prevalence of severe obesity increased from 4.7% to 9.2%.  This increase is also reflected in a rise in obesity-related conditions such as heart disease, stroke, Type 2 diabetes and certain cancers—all leading causes of premature, preventable death.  40% of adults 20 and older had obesity during August 2021-August 2023 according to the CDCSamreen said the key to her patients’ successful weight loss outcomes begins with education, followed by a spectrum of health care support at each stage, before and after the gastric bypass procedure.  

“The first message for everyone to hear is that obesity is not about a person’s weakness, laziness or lack of willpower,” Samreen said. “Obesity is a disease. It is extremely important for our patients and their families to understand that. We have a team of highly trained professionals who specialize in the overall treatment of obesity, and that is not just surgery.”

Begin your weight-loss journey with education   

Patients seeking bariatric surgery start their journey with a thorough evaluation process that takes three to six months.  

“Our team teaches each patient about food,” Samreen said. “It is not just about how much to eat. It is about what to eat. In most cases, it is a total lifestyle change in terms of food choices. Each patient must collaborate with our in-house nutritionists who are trained specifically in consulting with patients who are undergoing bariatric surgery.”

Each patient must demonstrate openness to receiving the nutritional and overall health education and information vital to their success.  

“It’s been scientifically proven that our brain has a set point for our weight, and this is why traditional dieting and exercise often fail,” Samreen explained. “The more you exercise, the hungrier you get. The body goes into starvation mode and holds on to the energy instead of losing the weight.”

Bariatric surgery positions patients for success as they change their lifestyle. They’re more likely to be successful because of healthy biochemical and hormonal changes in the body that lead that set point in the brain to a new level where maintaining a lower weight becomes possible.  

“We specialize in the overall treatment of obesity, not just surgery,” Samreen continued. “We are an accredited Center of Excellence based on these factors, approved by the American College of Surgeons. We meet the highest possible standards that are needed to set up patients for success.”

The medical team looks at the patient’s complete medical profile but also focuses strongly on mental health.  

“We have to ensure the patient is prepared for a significant dietary and lifestyle change to complete this journey successfully,” Samreen said. “We take pride in our compassionate care.”

Samreen said she will often hear from patients that say that they have suffered with obesity their entire lives and have often felt that there is a bias against them.  

“We are sensitive to these issues, and we understand that many of our patients have been struggling with this for many years,” Samreen said.

Non-scale victories

The story of a patient’s weight-loss success goes far beyond the number on the scale. Non-scale victories are health and lifestyle improvements that are the result of small changes and might go unnoticed if patients and doctors remain completely focused on the scale.  

The scale only shows a momentary measure of a person’s weight on a given day. It could change the next day or even later the same day. But the overall picture during a weight-loss journey is much more detailed and cannot be reduced to a single number.   

“There is so much more that has nothing to do with the scale that shows great improvement after the surgery,” Samreen said. “Improvement of blood pressure, fatty liver disease and the resolution of diabetes and sleep apnea are some medical conditions that improve greatly.”

But then there are obstacles that patients have been struggling with, sometimes for years or even most of their lives, that they suddenly begin to see diminishing.

“Now they are seeing they can get on an airplane without any problem,” she said. “They can bend over or go up the stairs and their knees do not hurt. They can buy clothes off the rack in any store.”

Surgery vs. medication

Although there has been a substantial increase in the number of monthly prescriptions for weight-loss medications over the last two years, the difference in outcomes for the two options is clear, Samreen said.

“Surgery does naturally what the medications do by introducing an external hormone,” she said. “That medication must be taken for life. Unlike the surgery, the medication is not just one treatment.”

Additionally, bariatric surgery has been thoroughly studied and researched for decades, she said.

“We know the safety of the surgery, we have minimally invasive techniques, and we know the surgery is safe,” she said. “These medications are new, so it’s not possible yet to know their safety profiles for the long term.”

UTMB utilizes robotic surgery consisting of just two small incisions.  

“It’s much less invasive and much safer,” Samreen explained. “The risk of complications is low. There are several options for bariatric surgery, and we do not believe one size fits all. We would discuss all risks with each procedure with the patient beforehand.”

Depending on the patient’s starting weight, the loss can be between 50 and 150 pounds.

“When patients regain weight, it’s likely because of a lack of support and the necessary follow-ups not being in place,” Samreen continued. “Patients who have their surgery at UTMB will be following up at least once a year for life and more as needed. They can always avail themselves of guidance from our nutritionist. We strongly encourage the follow-ups because no matter what challenges may arise, we can help.

Post-surgical victories—on and off the scaleA before and after picture of Felicity Cunningham before her surgery and after when she lost 175 poundsA year post-surgery, Cunningham has lost about 160 pounds, she said. Her blood work is normal again, and she’s scheduled to come off the C-PAP machine she used for her sleep apnea.  

She’s now down from a 5XL dress size to a 14, which she can find easily in any shop.  

“It’s amazing,” she said. “I can just go in any store and find something that fits. And I don’t have to buy a seat belt extender when I fly, and I can fit in movie theater seats. I can get up and move, and it’s not a big deal for the people sitting in my row.”

She’s off her asthma medication, her legs aren’t swelling, and those blood pressure numbers aren’t creeping up anymore.  

“It’s life changing,” she said.  

But above all, she said, she can experience life with her 17-year-old son.  

“Before, I was constantly wondering if I could fit in the rides with him at Disneyland and anticipating how embarrassed I’d be if I didn’t,” she said. “He had to go a lot of places by himself before, but now I can go with him.”  

Those are the non-scale victories Cunningham said she values.  

Aftercare support

Felicity Cunningham possing with a pair of her old blue jeans

UTMB offers several support groups, and attendance is part of the qualification for the surgery.  

“It reinforces the process,” Cunningham explained. “They are educational sessions, with topics about nutrition or exercise. It helps you understand the process of what you’re getting into, understand you’re on this road, and this is how you will be able to commit to this.”

Classes reinforce what she needs to be doing and give her added information.  

“It also shows me how I am succeeding for myself,” she said.” We get bogged down in not being perfect, and we look at people coming into this on the pre-surgical side. That helps me remember my experience, and it’s nice to be able to offer insights from my post-surgical experience to others.”

Cunningham said she received great support at UTMB and from Samreen.

“She takes the time with you and makes you feel she is only there for you,” she said. “My main message to everyone is that surgery is a wonderful tool, but you still must make the choices and the commitment. And you’ll get all the help you need at UTMB.”

View Dr. Sarah Samreen's  profile

Dr. Sarah Samreen serves as the director of Metabolic and Bariatric Surgery in the Department of Surgery at the University of Texas Medical Branch. She uses a minimally invasive approach through laparoscopy and robotic surgery.

UTMB Health Bariatric Weight Loss Surgery

Sense of community comforted new mom

Nervous first-time mom Audrey Solomon found out her OB-GYN doctor was leaving—something that did not help her concerns in the moment.

Audrey, an organized human resource manager, processed the news then asked for a random pick of another OB-GYN at UTMB Health, figuring she could make it work.

The random doctor turned out to be perfect for Audrey and her concerns.

“She made me feel right at home,” Audrey said. “She heard everything I said.”

Audrey has a rare genetic condition, something she needed this new doctor to understand from the beginning. Her doctor researched the condition—nail patella syndrome— to know what to look out for, then set Audrey up with numerous precautions to follow. The doctor monitored the baby a little bit more regularly than normal.

“She made sure that I was comfortable and had exactly the care that I needed to make sure that my baby and I were both safe at all times,” Audrey said.

Nail patella syndrome is an uncommon genetic condition that affects joints and can cause bone deformity. Later, it can cause possible kidney problems or eye problems.

close up of Audrey Solomon's hands placing braces on Maisie Solomon's feet to help with her club foot condition. Maisie has on gray socks & the braces are light blue with brass buckles. They are connected by a metal rod across the bottom of Maisie's feet

It can also be inherited.

“My daughter did inherit it,” Audrey said. “I was the first in my family to have it. It was just kind of a random mutation.”

It wasn’t just this OB-GYN who reassured and cared for Audrey. Many UTMB providers have brought the same level of kindness and attentiveness to Audrey, who describes herself as someone who will be forever grateful to UTMB.

“We've had nothing but great experiences with all of our doctors, and I couldn't be more thankful for it.”

Maisie Solomon was born in 2021 at UTMB Health Clear Lake Campus. Her mom Audrey was born at John Sealy Hospital 30 years ago on the UTMB Health Galveston Campus.

“My daughter and I were both born with bilateral clubfoot,” Audrey said. “I am very familiar with the genetics team and the orthopedics team at UTMB, and we love everybody—all the teams. They're awesome.”

As a child, Audrey spent time in the hospital because of a club foot and other bone-related issues. She saw Dr. David Yngve, a UTMB Health pediatric orthopedic specialist, throughout her childhood.

“My daughter sees him now,” she said. “He doesn't accept new patients that I'm aware of for a case like hers, but he did because she was like a legacy patient. I really couldn't have been more grateful. We love it.”

Dr. Yngve is now chief of Pediatric Orthopedics and Scoliosis Surgery at John Sealy Hospital.

“Mom was my patient as a baby and now her baby is my patient,” Dr. Yngve said. “That is pretty special for a doctor.”

At 16 months old, Maisie started to stand a little bit with support and then took her first unassisted steps.

“She's a little bit more behind with the mobility stuff because of her feet,” Audrey said. “But she's getting there and getting stronger, and she's starting to cruise holding on to coffee table and couches.”

Cory Solomon, Audrey’s husband and Maisie’s dad, kept a close eye on his daughter’s movements around their living room.

“Growing up, I never had a family of doctors that I could always rely on, but as soon as I married Audrey and we started this journey with UTMB, I did,” Cory said. “I never knew that you could have a sense of community with your medical professionals.”

Both Maisie and Audrey have slightly crooked fingers and fingernails as well as bilateral club foot. “She is a carbon copy of me,” Audrey said.

Audrey knows Maisie will face challenges throughout her life. Maisie has already had to wear casts on her feet and a brace for part of the day. Her kneecaps might not develop.

“I've always felt like I could do anything I wanted to do,” Audrey said. “And I hope that Maisie feels the same way. With our care team at UTMB, we are confident that we will have the support we need every step of the way in any challenge she might face.” 

During Audrey’s final performance as a drum major when she was at Texas City High School, the pain in her elbow grew so intense, she told her parents she needed to see Dr. Ygnve right away. A month later, she had surgery on her elbow.

“UTMB is definitely part of my story,” Audrey said. “For me, it's all I've ever known.”

Even in college, when she was away from home, she didn't go to a doctor where she lived at that time. Instead, she made trips home to see family and also to take care of medical appointments.

When she got pregnant with Maisie, Audrey thought she already knew and had done her own research about her condition.

“When Maisie was born, I kickstarted my own self-care that I should have truly been doing all along for nail patella syndrome, and we both started seeing the genetics team,” Audrey said.

One of the first things her doctor did was set up a bone density scan. 

“I didn’t know that bone density was a concern, and I didn’t think anything would come from it,” Audrey said. “My scan showed that I have very low bone density—osteopenia—that is not very common for my age but more common for nail patella syndrome patients at my age.  Most folks don’t find out about bone density issues until they have broken a bone, but my plan of care allowed me to find out now and start corrective action now.”

Audrey will have a new bone density scan at the one-year mark to see if it has improved. 

“To have my daughter join this community and for it to be a part of her journey is all really special,” Audrey said.

“We have such a great care team and the community behind it. I keep saying community, but it really is just like a family. People I've known my whole life, we are now bringing into her life. And there are new care teams. Everybody's great. There's a very, very high level of comfort with UTMB that makes me not want to go anywhere else.”

 

Student athlete healed by UTMB Sports Medicine team

Priest Simpson jumped high to catch a football during a game, but he fell to the ground fast when his muscles pulled the still-growing part of his tibia away from his leg and turned it upside down. His leg looked crooked.

image of UTMB Health patient Priest Simpson stretching on the sidelines of a football field in his football uniform with a coach assisting him with his leg

“I thought it was dislocated because it was still connected to other part of my knee,” Priest said. His worried parents got him to the emergency room at UTMB League City Hospital.

But his leg wasn’t dislocated. Priest had a displaced avulsion fracture of his tibial tubercle.

“This is a big injury for an athlete but also for anyone who expects normal function of their leg,” said Dr. William Weiss, an orthopedic sports medicine doctor with UTMB Health who treated Priest soon after he arrived at the hospital. “This injury completely disrupts the extensor mechanism of the knee that is the primary mechanism for generating power for running and jumping, which are some of the things Priest does well!”

Priest’s injury was on the more severe end of the scale, requiring an operation with screws to reduce and secure the fragment with patellar tendon tensioning. Dr. Weiss anticipated Priest’s continued growth.

“He recovered well and was discharged from the hospital with the expectation he would return to sports. This injury can end athletic careers for young athletes, but that is not what Priest or his parents – or me – wanted of course.”

The fracture happened in April 2021, and three months later, Dr. Weiss cleared Priest for full training. By September 2021, he cleared him to return to full sport without restrictions. That fall, Priest competed as part of an elite football team representing Texas on the national level.

Then Priest and his family temporarily moved to Africa as part of his family's missionary commitments, Dr. Weiss stayed in touch.

“What stuck out with us, and the reason why we stayed in contact even out of the country, was how Dr. Weiss spent an extreme amount of time with Priest,” said Ariel Simpson, Priest’s mother. “He didn't just rush. We know he's busy. We know he has a lot of patients. But he took his time with Priest. He saw him multiple times before we left the country again. He gave advice beyond the surgery and showed extreme care for Priest.”

Some of Dr. Weiss's advice was to get physical therapy for Priest to strengthen his muscles and tendons around the bones and the ligaments.

“And that really helped with pain,” Ariel Simpson said.

“I started this physical therapy, and then I went to the gym and started working on my legs until I felt strong enough to get back into sports,” Priest said.

He continues working with a trainer on a well-rounded routine that includes running, balancing, band work and weightlifting. He works out with the trainer every other day for 90 minutes in addition to his sports practices and games.

“Bottom line is that this is a great young man who has overcome a significant injury and continues to be very active in various sports with great potential for his future,” Dr. Weiss said. “I expect great things from him in all aspects of his life, not just sports.”

Priest, now 14, and his family visited friends [extended family] in Texas in December. They visited with Dr. Weiss in person before they returned to their missionary work in Africa.

“As a parent, it's difficult to watch your child in any kind of pain at all,” Ariel Simpson said. “We didn't know how he was going to recover or what that was going to look like. But it's incredible if you are surrounded by a medical staff and specifically a surgeon who cares. It made a difference to us very deeply in this stressful, heartbreaking moment.”

“To see how strong he is today really takes your breath away when you think about how he's recovered,” said Sean Simpson, Priest’s father. “Now he's 6 foot. He's healthy. He's 170 pounds. Seeing what he can do and work out his full body— it's just impressive.”

Priest, who plays soccer and basketball too, has a strategic game plan for when he returns to live in the United States.

“I want to come back to play high school football and get a scholarship to play college football,” he said.

And he’s still growing.

Closing the loop on breast cancer

UTMB Health nurse practitioner Jill Resendez helps patients close the loop on breast cancer, one strategically placed tattoo at a time. She and her former patient Tina Herring joined Meagan Clanahan of Houston Moms for a recent chat where Herring shared her personal story and how reconstruction helped in her healing process as a cancer survivor.

Jill Resendez, MSN, RN, AGACNP-BC

Jill Resendez is a nurse practitioner with Plastic Surgery. In addition to traditional cosmetic and filler work, she also assists with reconstructive work for breast cancer survivors.

Reconstructive Surgery

Nipple tattoos bring patients closure, help them feel whole

UTMB Health Nurse Practitioner Jill Resendez plays an important role in the lives of breast cancer survivors who opt for reconstructive services through the UTMB Health Division of Plastic Surgery.

To help bring closure to the journey these patients have undergone while fighting for their lives, Resendez offers nipple and areola tattooing services. The goal: help patients feel whole again.

Resendez had wanted to be a fashion designer. But watching her own mother fight and lose her own battle with breast cancer motivated the then high-school senior to go into health care. She got the idea to offer this service when she graduated as a nurse practitioner just as the world was shutting down due to COVID.

With traditional training programs on hold because of the pandemic, Resendez perfected her technique at a local tattoo shop during an eight-month apprenticeship before providing the service to patients. Today, she regularly has the privilege of closing the breast cancer chapter for UTMB Health breast reconstruction patients like Norma Garcia.

“I forget when I look in the mirror that there’s even reconstruction going on,” Garcia says. “She made me feel very whole.”

UTMB Health patient Christal Kuehler just reached what she calls the end of her journey this October, when Resendez completed her tattoos. Just before the procedure, Kuehler had only one thought. “I’m going to be complete,” she said.