If you’ve ever wondered how to make a real impact in the fight for obesity care and bariatric surgery access, this episode is for you. 

We are thrilled to host Dr. Renee Hilton to explore the power of bariatric surgery advocacy—what it takes to push for policy change, how mentorship plays a critical role, and why patient stories are the key to breaking down the stigma surrounding obesity. From the challenges of insurance coverage to the growing conversation around GLP-1 medications, this discussion sheds light on the hurdles and opportunities in bariatric surgery advocacy. Join us to learn how you can be part of the movement for change.

IN THIS EPISODE:

• (00:00) Opening and intro
• (01:37) Dr. Hilton shares her professional journey and why she is passionate about advocacy
• (07:12) Access to care and pursuing advocacy for bariatric surgery in Georgia
• (19:19) Patient's stories make a difference, the stigma surrounding the surgery, and the percentage of people needing the surgery is extremely high
• (28:15) The number on the scale is not as crucial as the comorbidities and how to get involved in advocacy
• (36:22) Insurance companies make obese patients jump through hoops
• (43:15) GLP-1 medications and discussion of who pays for the care needed

KEY TAKEAWAYS:

• Successful advocacy requires more than passion—it demands mentorship, strategy, and collaboration. Learning from experts and leveraging resources like ASMBS is key to driving policy change.
• The impact of patient stories on policymakers is substantial. These stories demystify the bariatric surgical procedure, make it relatable, and help to break down the stigma surrounding it.
• Despite widespread insurance coverage for bariatric surgery, utilization rates remain low. This discrepancy underscores the significant role of stigma in preventing individuals from seeking necessary treatment. While advocacy for obesity treatment is evolving and gaining recognition, the need to demonstrate a clear return on investment (ROI) remains a significant challenge. 

RESOURCES:

• BariNation Website 
• Join the BariNation Membership community meetups to support you on your journey with obesity treatment. https://barination.com/pages/join-our-community
• Want to see bonus content? Head over to https://www.patreon.com/BariNationPodcast to get more and support the podcast for as low as $5 per month!    

GUEST RESOURCES:

Renee Hilton, M.D. - Facebook

Renee Hilton, M.D - Instagram

Augusta University - Website

Renee Hilton, M.D. - X

BIOGRAPHY: 

Dr. L. Renee Hilton-Rowe is an Associate Professor at the Medical College of Georgia at Augusta University Medical Center and serves as the Section Chief of Minimally Invasive Surgery and the Director of the Center of Obesity and Metabolism. She is the past ASMBS State Access to Care Representative for the state of Georgia and is currently serving as the immediate past president of the Georgia ASMBS state chapter. She is the Access to Care Committee Chair for ASMBS. 

ABOUT:

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April Williams: You've just tuned into a podcast that welcomes you into a community, a resource center, and a safe place that powers your [00:00:15] journey towards personal wellness.

Natalie Tierney: Our goal is you leave us today feeling helpful, inspired, and ready to live.

your best bariatric life.

Dr. Renee Hilton: Absolutely, April. Thank you so much for having me.

Dr. Renee Hilton: Well, thank you for that.

April Williams: Oh, definitely [00:01:30] definitely before we dive into the conversation. Will you take a few minutes and introduce yourself to our friends that have never met you before?

And I'm also the surgical quality officer here, but my roles as pertains to this, uh, this podcast and within are probably more important in terms of advocacy. I am the [00:02:00] current access to care chair in my 2nd 2nd years chair and prior to that, I served 2 years as co chair. And prior to that, I was the president of Georgia ASMBS and the star for the state of Georgia.

April Williams: What drew you to bariatric medicine and obesity care?

He was like, why, why did you decide to do that? He's like, I thought she wanted to cure cancer or operate on hearts. And I, I [00:02:45] remember my answer because it still holds true today. And I said, no, dad, I want to prevent people from needing cancer operations and operations on their heart. And that still is probably what I think is the most impactful, um, opportunity that we have as [00:03:00] bariatric surgeons is this isn't just addressing the disease of obesity, which it is absolutely the gold standard for obesity treatment, but it also prevents patients from developing cancer.

April Williams: I think so many times people struggle to make the decision to undergo bariatric surgery [00:03:45] because they think it's only addressing their excess weight. Right? I, I look a certain way. I know I'm overweight. I'm super morbidly obese. My BMI is through the roof and you get so down on yourself because you really have tried everything to get to a [00:04:00] weight.

Dr. Renee Hilton: Absolutely. And I just had this conversation with a patient this week who was like, Oh, I just feel guilty for, you [00:04:30] know, putting my family and myself to a big operation just to lose weight. And I was like, hold on. I said, if I was offering you this operation to cure your diabetes. To cure your hypertension, to get you off your CPAP machine, because you have all of those diseases in addition to your obesity.

And I said, as sad as it is, um, you know, the stigma associated with obesity care is still present. It is why the utilization rate for this life changing operation and even medication is as low as it is, is that people truly feel [00:05:15] guilty about, you know, going and, and seeking care. They feel that they have failed and that they should fill all of these other things before they, you know, pursue surgery.

You're going to lose a lot of weight. Like, I, you [00:05:45] know, I'd probably have a, all of us would have a line, you know, around the block outside of our clinics. And again, I hate to market it that way. Because again, I do believe that even without any other comorbidity, obesity is enough. And to me, that's really why access is so [00:06:00] important is to me, access to care for the treatment of obesity doesn't mean access to some things.

And, you know, I compare us to cancer all the time. If you look at a patient who has cancer that gets neoadjuvant and adjuvant therapy, they're getting chemo and radiation up front, followed by surgery, and then [00:06:45] sometimes followed by additional chemo and radiation or medicine. Obesity is a chronic disease that we really should be viewing with that same mindset.

That's it.

April Williams: Yeah, and

But I do think that moving [00:07:30] forward, we have so many great treatment options for obesity. That we really have to look at the whole patient and really tailor our approaches to the individual patient. Make sure that they have access to everything offered.

When you want to go obesity surgery many times, it's not just access to surgery. It's access to a care team to a dietitian to mental health support. Uh, right. Sometimes it's [00:08:00] community. There are way more modalities of treatment that you get as a patient than just that singular procedure.

It is.

April Williams: Yeah.

April Williams: Yes, when you are a person who is struggling with obesity, and you feel like you don't have any options except surgery.

Dr. Renee Hilton: Absolutely. And, [00:09:00] you know, I think probably the most important, um, important thing for us to focus on as.

Like no surgeon says that. Right. [00:09:30] And sometimes our greatest opportunities come out of adverse adversary or, you know, when you get somewhere and, um, Things are not good. You see an opportunity to make it better. And, you know, I, I did my fellowship at Yale University and Connecticut is a state where, man, it's so progressive and they had [00:09:45] great obesity care and I left Connecticut and came to Georgia and this was in 2017.

Um, we were one of six states in the entire country that didn't have access for our state employees. So the largest employer in the state of [00:10:15] Georgia, so all of our school teachers, our police officers, um, our men and women on our fire departments, everyone who worked for the state, and there's so many more than that.

South Carolina remains today. 1 of 3 [00:10:45] states that still does not have access for state employees. So, when I got to Georgia, I'd never I'd done a little bit of advocacy work, but certainly was not an expert really had no idea what I was doing. But I walked into this [00:11:00] practice where I was like, you know, all these people that I'm seeing that are so sick that are taking care of our state don't have access.

Um on air so maybe maybe people won't think i'm a complete [00:11:30] imposter after this but Um, I I drove over to Atlanta with like no plan in place like i'm gonna go to the capital I had set up to meet with like one of the you know state You know, lobbyist and someone within our institution that was supposed to introduce me to people.

But I met this woman and I will say Kathy's last name. But Kathy is her first name and Kathy's amazing. So I. It completely fell through the other meetings that I'd set up. So, I'm in Atlanta. I've taken a day off from [00:12:15] work and I call Kathy and I'm like, hey, I'm here and, you know, I don't really know what to do with myself.

Which is that advocacy is something that you need mentorship in. It's great to have passion. And I tell everyone that's getting ready to start doing advocacy work, like [00:13:00] the most important part of this entire recipe is passion. If you don't want to do it, if you're not hungry to make change happen and don't want to do grassroots movement, go pound on some doors and hit the pavement.

You need a mentor. You need a teacher [00:13:30] and I'm hoping that through the through my role now and access to care that is a resource that we want to provide not just to providers, but to patients. And, you know, the title of this podcast is Advocacy 101, [00:13:45] um, that is the big initiative and the big push, um, for Dr.

We're very passionate about moving this initiative forward, which is to create almost a school Um, or a course that people can take an advocacy, uh, that way [00:14:15] they are getting the training that they need. And they have a plan because most people have already dabbled in politics a little bit. But they're like, man, how do I.

It took about 7 years from the time we lost the benefit until we finally got it added back into the benefit plan in 2021. and so advocacy, it was not fast, but over that time period, I learned a lot. [00:15:00] I was able to partner with our state chapter in Georgia, which I think is a huge resource. For physicians, practitioners, patients are kind of your local organizations, your state chapters through or the American College of [00:15:15] surgeons in your state through the a lot of them have regional kind of local resources to take advantage of.

Everyone who wants to go. This is going to be the day. Here's the sign up link [00:15:45] and we're all going to go. And we had a set agenda. It was planned. So, if you've never been to the, the hill, this was a great way to do it through your state chapter or through an organization, because you showed up. Here's your folder.

Like today we're gonna talk about TRO a, or we're gonna talk about state employee access to bariatric surgery. It really is a user friendly way to get your foot in the door rather than just going by yourself and trying to [00:16:30] break this. I think that organization through the state chapters is a great way to do it.

So a [00:17:00] white sheet is like a 1 page where after you go and talk to that politician and tell them how amazing bariatric surgery is, you leave them with the sheet and the sheet has like, you know, really important. Information on it, like, demographics about the state, like, this is the [00:17:15] percentage of Georgians who have obesity.

So, when they go meet later. You know, with with their staffers, or hopefully at the governor's office, or, you know, on the floor of the House and the Senate, they can take the sheet with them. And it refreshes everything that was [00:17:45] really important. Yes, and people don't have to do that. These organizations have already done it for you can literally go print them off and just take them.

That's one of the things I love about access is through policy changes, you have an [00:18:15] ability to impact millions of people.

Uh, that mentorship component, right? Like. We brought our, our colleagues with us, we gave them this action plan. So, even if that passion isn't necessarily there, there's a [00:18:45] pathway for you to be introduced to what advocacy looks and feels like and then that time component. I think oftentimes we are hardwired for immediate results and we think that as soon as I ask somebody, or I tell somebody about this life changing opportunity, [00:19:00] they're going to immediately act on it.

Dr. Renee Hilton: Yeah. And it's, it's so funny because the week before Georgia state health employees, that it went back into the benefit plan. I actually was on an ASMBS [00:19:30] leadership call with Joe Northrup and Mickey Seeger. I think Chris was on a phone, a few other people. And I literally. Said the words, God, advocacy is just soul crushing.

It worked. So there are highs and lows, right? You need [00:20:00] those highs because, man, when you get a win like that, and you immediately see the results because you have patients that have been in contact with you and advocating for themselves for the 7 years that we've also been working on it as physicians, I mean, overnight, [00:20:15] we had a list of people that we had kept.

And so I think that's another piece that I want to make sure that I really, really talk about today is the patient [00:20:45] advocate is the most important person in the room. I've been to the White House with and sat and watch the conversations, even with the Biden administration. We met last year with their domestic [00:21:00] policy council, and we took 3 patients into that room.

It's a real person saying I had to quit my job because the edema in my lower extremities is so [00:21:30] severe that I can't work. I now have Medicare. Because I can't work, so I'm disabled. Medicare supports treatment for lipidema, but not that it doesn't support care for my obesity. It doesn't support the medications that [00:21:45] I need because this was a patient who had had surgery and still required that adjuvant therapy.

[00:22:15] Very, very powerful when you take a successful patient, um, when you have that patient that says, you know, I started this journey and weighed 550 pounds. I was disabled. I had diabetes, hypertension, now I weigh [00:22:30] 250 pounds of, you know, I've gone back into the workforce. I'm doing all these amazing things. It doesn't always have to be a sad story.

It can also be a really positive story. And I feel like there's positive experiences and the negative ones. They're both equally empowering for different reasons.

And and the process that she went through. But up until that moment, bariatric surgery was not something I ever considered for. Various different reasons, but when patients have the ability and a platform to share their [00:23:15] story and to talk about the impacts that the disease of obesity has had on their life prior to, and then the impact surgery has made right afterwards, the most amazing thing happens.

So, you know, the advocacy piece absolutely goes 2 ways. You can have the professionals doing this. Very important work that you are doing, but as a patient, I also have to be open to hearing the stories to understand what's going [00:24:00] on and to shift my mindset when it comes to what this disease is actually all about, because if those things aren't happening, then it's almost for not, it's wonderful that it's now available to somebody, but if they're not going to access it,

And, and that's what, you know, I, when I talk about access to care, I have a slide that I show a lot and I talk about the difference between access and utilization, because if you're new to access to care, sometimes people don't understand these words. Right? So, the, the [00:24:30] example that I use that most everyone understands is my Peloton bike.

Is we have this amazing life [00:25:00] changing saving operation that we know works and 1 to 1. 5 percent of people with coverage actually use it. If you actually look at insurance coverage across this country, over 90 percent of Americans have access to metabolic surgery. Which is just [00:25:15] staggering. Like, we only have about, you know, less than 10 percent of the country without access to surgery.

And I think that once we get. Even physicians to stop shaming themselves, because I have a lot of shame, even as a person who's boarded in in this specialty, it's still like, you're a little embarrassed to tell people I'm on a medication for weight loss. Like, no 1 [00:26:00] ever wants to talk about that. But until we all do, and we openly address the stigma associated with this disease.

April Williams: Agreed. It's it's why we 1 of the reasons that we created very nation is we were seeing this this lack in people utilizing the care. I underwent surgery and had a wonderful surgical team, but my aftercare [00:26:30] was not what what I needed.

Even if they didn't understand exactly what it was or why they were doing it, they could find a [00:27:00] safe place that they could find the information that they need to make the informed decision to undergo bariatric surgery. And then that mentorship. Component kicks in, we're going to guide you every step of the way.

You have an inclusive place to go. So, no matter how old you are, no matter what kind of bariatric surgery had men or woman does not matter. Right? This space, this community is built for you because that [00:27:45] patient advocacy piece we saw was missing just like that. Only 1 percent of people are accessing this life saving surgery.

Why, why is it this way? It's frustrating.

Uh, for [00:28:15] me personally, I think that education again, it has to be about education. So, um, other things that I would encourage providers and patients to do within their own communities is, you know, everyone's like, well, where can I start? Like, maybe you're not ready to take that big leap. I [00:28:30] talked about, like, maybe you're not ready to go to the state Capitol or come to DC, uh, start locally, start your own healthcare system.

And I'm like, big enough. Like, that's not it's not about big. It's not [00:29:00] about size. It's about the comorbidities. And everyone, I think, thinks that the bariatric patient, Is the patients that you see on a lot of the popularized TV shows, right? Like, and, you know, I actually have a slide and a deck that I use a lot says, this is not my 600 pound life for most of us.

So I'm going to do one or the other because, you know, I'm a mom and I've got two young toddlers and I know where this disease goes. Like, it's not magically going to get better. I have tried for years to lose weight [00:29:45] and everyone was like, Oh, but you're not that big. Like, what are you, what are you talking about?

But, uh, there's, there's no bad place to start. If you want to get engaged with [00:30:15] advocacy, do something local, you know, we're doing some pretty cool stuff in Augusta right now, where we're actually going to work with some of the community centers to do things like cooking demos for families. So, we'll have, like, an information session where [00:30:30] anyone in the community can come parents, kids, like, they all come to this place.

Like they can actually get a prescription through some of their insurance companies to get fresh fruit [00:31:00] and So, I mean, you can advocate. In a local way, that is incredibly powerful within your community, and then through partnership with organizations like the, I really think you can then move to that next level of your journey.

I think that we have an opportunity to really increase utilization through direct to consumer marketing right now. You see a lot of kind of [00:31:45] popular. Um, you know, medical, uh, whether it be medicine or surgical industry partners, they're starting to direct market to consumers. And what I've wanted to see for years, and I really hope that ASMBS makes it happen under Dr.

And I want it to be as catchy as the little jingle that you hear, you know, where people are singing the O, O, O, O, O, O, O, O, O, O, O, O, O, O, O, O, O, O, O, O, O, O, O, O, O, O, O, O, O, O, O, O, O, O, O. I want a commercial that really promotes bariatric surgery and the treatment of [00:32:30] obesity, and I want it prime time for all Americans to see, because until we start making this like mainstream, I mean, when have you ever seen a commercial and bariatric surgery?

When you tell patients we have this, it's available to you. Come use it. That's when I think the patient will be the most powerful advocate for themselves because they're either going to utilize the benefit, or they're going to realize they don't have it and get involved in this [00:33:15] advocacy fight. And which is really what we need.

We have thousands of members who can speak to the impact of it. And the more work, time and energy we can put into [00:34:00] shifting that conversation, the, the better, even this weekend, we were entertaining friends and my husband struggles with his weight. And many people in our friend group struggle with our way.

And the advocacy work, I think, when it comes to patients is you have to be open to understanding what you're dealing with from a different perspective. [00:34:45] You have to be brave enough to step back and go. Maybe this isn't 100 percent my fault.

Dr. Renee Hilton: Yes, that that is absolutely probably 1 of the 1st things that has to happen is it's really hard to advocate for yourself when you have that shame and guilt.

Obesity has been defined as a medical [00:35:15] condition. I mean, for literally hundreds of years, I was actually astounded to see, like, in some of the oldest medical books, you can see people already talking about the disease of obesity hundreds of years ago. And it's been recognized by major medical [00:35:30] societies for upwards of 20 and 30 years.

And again, I, that's 1 of the things I love the most about my role in a S. M. B. S. With access to care is I hear from [00:36:00] people across the nation from all 50 states and every state and every hospital, every region. They're all having their own, like, little unique struggles, right? Like, what what's happening in California is not the same as Georgia, but this position has just been mind [00:36:15] blowing and opening for me to see how many obstacles still stand in people's way to get the care they need because.

So you got to pay out of pocket for your site visit and we're going to let you have surgery. But your deductible for bariatric surgery is 3 times [00:36:45] higher. Then the deductible you would have to pay if you were having cancer surgery. We see all of these things. So just having access to obesity treatment does not mean you have great access.

[00:37:15] Right. We shouldn't just be advocating for medicine, or just be advocating for surgery, or just be advocating for behavioral therapy. It should be everything altogether. Our patients deserve all of these modalities and combination. So, I'm again, I'm [00:37:30] very, I'm very passionate about leading people in this effort.

We have organizations that are begging for patient advocates that are again, your story is so powerful. So we really want to [00:38:00] encourage people to speak up.

April Williams: Yes, well, and it's 1 of our roles that we play in variation. We have members in our community who are thinking about having bariatric surgery. So they haven't committed to it yet.

And that learning that's needed to persist through treatment. Cause it's one thing to make the decision to have a bariatric procedure. It's another thing to really get yourself to, to the start [00:38:45] line. As we say, just for all those reasons that you mentioned, you could be looking at 12 months of. Work that you, the patient has to sustain through to get yourself to surgery.

Dr. Renee Hilton: huge agreed.

[00:39:45] And sometimes just don't say no, like, just be that patient. If you don't have coverage, you know what, go ahead and try to enroll in the program so that when you get that denial, you can now reach out to your insurance company and ask them why, why [00:40:00] don't you want to care for this medical problem that I have?

They don't know, like, they're just trying [00:40:30] to update their policies and keep up as well. But I've had several recent successes as access to care chair where we've had meetings as an organization with these insurance companies and when we show them the new guidelines, and we tell them, like, here's your 2022 guidelines of what should be covered.[00:40:45]

I swear that policy changes like, every, every day. I feel like I need to go check the blue policies in California because they change frequently, but they just made huge changes. You know, if you're listening in California, they just made huge change to their policies where they got rid of their 12 [00:41:15] month requirement.

Hey, guys, like, this is a big change. They call patients and patients that have been waiting for months for no reason. Just an arbitrary number set by an insurance company of 12 months [00:41:45] pre op immediately got to come to surgery because they were ready. And that's that's the other part of this. Advocacy journey that I don't think will ever be over for me, nor should it be for any surgeon or provider or patient is, yes, you have [00:42:00] access to care, but we can always make it better.

And to me, that is still a barrier and something that needs to be broken down. So just because 90 plus percent of the country has access to surgery, it's not all great access. And I'm truly not going to be [00:42:30] happy as a champion for access and advocacy until a patient can walk in, have a conversation with their provider.

April Williams: Yes, would not be an amazing future. It would be care. Absolutely. Dr Hilton, we've been asking our guests [00:43:00] kind of what their bold predictions for obesity care in 2025 will be.

And it sounds like yours would probably be rooted in advocacy, but I'd love to know what what you think. Do you see something big changing in this realm for patients this year?

L. P. [00:43:30] 1s. This was a massive news drop at the end of the Biden administration. If that went into effect, it takes a while for Medicare ruling to kind of trickle down and happen. It would be about 2 years. But for CMS, when they [00:43:45] make big changes like this, they only have 60 days before they have to do it. So, if this rule stands, and CMS is now forced to cover GLP 1s, then you could be looking at patients with Medicaid potentially [00:44:00] having access to GLP 1s as early as March of 2025.

And the reason that I do that is I truly believe that these medications are a gateway for many [00:44:30] patients. We have tried for the past 50 years to move that needle on the one in one and a half percent for surgery, and we have failed. Yet, all of a sudden you look at who's on a one. It's everyone. I mean, you get you all through the grocery [00:44:45] store.

Um, and they're going to get them excited to start talking about obesity treatment. Medications are not for everyone. These medications are wonderful. But if your BMI is above [00:45:15] 40 and you have comorbidities, really surgery is probably the best long term solution for your obesity. It can be combined with medication.

We don't know how long patients are going to need to stay on a lot of the early data saying forever. So, when you start looking at the bariatric surgery, it's incredibly cost effective. And I [00:46:00] do think also patients should hear up front all of their options for treatment, because if given the choice between an injection every single week for the rest of my life.

And you're talking to someone who is on 1 of these drugs. I love them. I think they're great. There is no substitution for bariatric surgery in terms of treating morbid obesity. It is the best. It has the longest [00:46:45] effect. It's safe. Um, so it's, it's not going anywhere. Bariatric surgery is always going to be, in my opinion, probably one of the best options for patients with obesity.

April Williams: I think the exact same thing, [00:47:15] uh, that, that you just said, and it's kind of re related to your bold prediction. If my primary, if any of my primary care physicians in my entire life before surgery had said, I, I wanna refer you, or your next [00:47:30] appointment is going to be with, uh, an obesity medicine specialist with a, with a metabolic.

It absolutely is going to open the door. And if you start on medication, and then you progress to surgery phenomenal. If you start on medication, and it works, or if you start on medication, and [00:48:00] it doesn't work side effects, whatever reason. You progress on to surgery. It's starting the conversation. It's shifting that shame and stigma that surrounds obesity is a you problem to obesity is a disease decision that you're making.

Dr. Renee Hilton: and the conversation. I'm already seeing this conversation evolve even at a national level. So, in meetings that I had last year in D. C. at obesity summits and diabetes summits, and even in the White House, [00:48:30] 10 years ago, when I started doing this, and even 5 years ago, I was still telling people what bariatric surgery was, like, I would meet with governors or representatives and senators and be like, wait, what do you do?

How do we [00:49:00] pay for it? Those are all of the conversations I'm having around access to care and advocacy right now is everything is expensive. How can we make these insurance companies and other people that are paying for these benefits? How can we make them see that the investment [00:49:15] is worth it in the end?

And I long for the day when that no longer is a conversation. But the reality of my job right now is that still is a conversation. And the good news is we are incredibly cost effective. It's [00:49:45] it's absolutely a conversation that. Um, you know, I, I differ with one of my mentors, Joe Northrup, a little bit on this.

I mean, if you want to go buy a car and you only have a certain amount of money in your checkbook, you can't go write a check for the car or use your, you know, it's, we can only pay for what we have in the [00:50:15] bank. And the reality is. If right now we forced Medicare to go out and cover GLP ones and pay for all this medication for everyone who needs it, it would bankrupt Medicare.

Because as someone who's an advocate, you want everything for every patient, but we also want to be able to pay for all of our patients to have care. And so there has to be some financial responsibility. That is discussed as part of advocating [00:51:00] for patients. So, um, I do think you, you have to have a little bit of conversation and knowledge about financial, um, state, uh, of when you're talking about advocating for coverage.

[00:51:30] Deadly cancer runs on both sides of my family. Fatty liver disease would have had me in and out of the hospital. My quality of life would have drastically decreased. I probably couldn't have remained a classroom teacher. I, like, all of these things would have [00:51:45] continued to deteriorate in my life. That would have taken me out of the workforce and out of my ability to provide for my family and pay taxes.

As a whole, so I, I do understand it money talks and if that's how you get people to listen fine, because. The end result is the same people are going to get the care that they need and [00:52:30] deserve.

Dr. Renee Hilton: And that's where it gets really tricky, right? Is how do you quantify the return on investment? Like, what is it worth to extend your life by 14 years?

She sent me a picture of it. [00:53:00] It was the 1st time she had walked her child into the 1st day of school. Every other year, she'd been in a wheelchair and she said, I was always the sick parent with my kid. And she said, it just, she said, I have, you have no idea how much you've changed my life by giving me [00:53:15] the ability to walk my child into school.

It has never been about the [00:53:45] weight loss for me. It's wonderful to see that, but it's so much more than weight loss. When I look at, you know, we've told you, I'd talk about this a little bit. We have something novel here in August. So we have a women's health initiative where we truly take it. Upon ourselves [00:54:00] to not just address weight.

These are all things that no one's ever looked at the cost of this, right? Like, how much cost savings do we get when we take a 25 year old who [00:54:30] has stage 1 endometrial cancer? And we give her bariatric surgery and all of a sudden, instead of her having to go down a road, which is probably a hysterectomy and other major, just life changing things, things for her.

It's just it's it's really hard to quantify these things, but I do think that it is an area that has been immensely understudied looking at very specific patient populations. And the cost of [00:55:15] not treating these patients with their obesity and when you look at women's health care and you start looking at things like obstetric mortality, like, when women with obesity go on to get pregnant and have complications during childbirth or.

Like the reward that you're going to see in the patient's life, um, is just going to be so impactful and so tremendous that I just don't think you'll ever be able to put a price tag on that.

Natalie Tierney: Join us at berrynation.

Jason Smith: And just remember at the end of the day, you've got this, we've got you, and we'll see you next time. [00:56:30] Bye everybody.