Jalisa and Arlisa Flores, 25, are identical twins and best friends.
The Charlotte women finish each other’s sentences and do nearly everything together – including being diagnosed with Type 2 diabetes when they were about 16. They were genetically predisposed; both parents have diabetes.
So, when Arlisa decided to make her health a priority and undergo bariatric surgery, Jalisa soon made the same decision.
Achieving a healthier lifestyle is an important, often overlooked, aspect of bariatric surgery. We’ve all seen dramatic “before” and “after” photos of people who’ve lost a lot of weight because of a procedure. But bariatric surgery can play a key role in setting patients up for a much healthier lifestyle and help them avoid or rid themselves of debilitating chronic conditions. That was the goal for Jalisa and Arlisa.
Helping you achieve a healthy lifestyle.
Arlisa, who works for Harris Teeter, was living with diabetes, high cholesterol, hypertension and polycystic ovary disease.
“I got tired of living the way I was living,” she said. “I was entirely too young to have all the conditions I had. I got tired of taking 2,000 milligrams of Metformin every night. And I wanted a healthier lifestyle. I would love to have a family one day, and I wouldn’t want to be huffing and puffing and unhealthy if I ever do have kids.”
Dr. David Voellinger likes to hear that getting healthy is someone’s motivation for bariatric surgery. “Our ultimate goal is not about weight; it’s about good health,” said Voellinger of Novant Health Bariatric Solutions – Ballantyne. “We want patients to have a better quality of life. Our goal is for patients to lose at least 75% of their excess weight and ideally for their body mass index, or BMI, to be under 30.”
Uncontrolled diabetes “can lead to problems involving the heart, kidneys and circulation and severely affect quality of life,” he added. “By managing these diseases early, we’re going to save them a lot of issues down the road. Studies show they'll live seven to 12 years longer by handling things early rather than waiting till they already have the end-stage disease.”
The twins knew what to expect from bariatric surgery. Both their mom and aunt have had it. They visited Voellinger separately. Arlisa came last August, and Jalisa came a month later. But they chose to have surgery at Novant Health Matthews Medical Center on the same day – Dec. 28, 2023. They wanted to start their new lives at the start of the new year.
There was plenty for the twins to accomplish before the big day. Voellinger tells his patients: “This is not just surgery. It’s lifestyle management, which includes nutrition, exercise, behavioral modification and sometimes medication.” (See sidebar.)
Some patients may need to add movement and physical activity into their routine before surgery. The twins were already fairly active; Jalisa, who works as a driver for Amazon, in particular, does a lot of walking for her job. But they can do even more now.
The sooner, the better
While Voellinger has performed many surgeries on family members, he’d never operated on twins before. He’s a big proponent of family support – it’s one key to long-term success.
“They got to go through the process together,” he said. “It’s not easy; you have to change what you eat and drink – and how. When family members go through it together, they can celebrate each other and – on bad days – comfort or vent to each other.”
That’s how it went for the Flores sisters. Jalisa said, “I call my sister for everything. After surgery, I’d call and say, ‘Are you feeling this type of way? Were you able to eat this or drink that? Could you finish a whole hot dog?”
As for Arlisa, she said, “Jalisa’s my buddy. I was happy to go through this with my best friend. She helps me get through every day.”
What’s more, Voellinger said the twins are at a great age to reap the most benefit from surgery. “They’re in the prime of their lives, and giving them back their quality of life now means they have decades to enjoy it,” he said. “One of the most frequent comments I hear from my post-op patients in their 30s and 40s is that they wish they’d done it sooner.”
Getting ready
Voellinger and his team view obesity as a chronic, relapsing, lifelong disease. Supporting patients with that chronic condition requires a “multidisciplinary” approach with access to various components of care and support from trained specialists.
“By the time patients go through surgery, they’ve already had three to four months of preparation,” he said. Lifestyle management is the foundation of what Voellinger and his team do. Surgery is just one component of a bigger plan. A counselor in the office can help patients with behavioral issues related to obesity. Registered dietitians are paired with each patient before surgery.
Both sisters were evaluated by these specialists and were cleared for surgery.
People in health care talk a lot about the mind/body connection. Nowhere is that more evident than in bariatric surgery. “If you don’t change the head part, the stomach change won’t be effective – at least not for the long term,” Voellinger tells patients. “Lifestyle changes go hand-in-hand with surgery. We can educate patients, but compliance is up to them.”
Arlisa and Jalisa had demonstrated their readiness to do whatever it took to get healthy.
And still, they found the pre- and post-op period challenging.
“Cutting out bad habits, like smoking and vaping, was hard,” Jalisa said. “So was going on a liquid diet for two weeks before surgery. But it was all worth it.” To make matters worse, they had to endure that during the December holidays, when many of us are gorging at parties and family gatherings.
The big day and aftermath
“With Arlisa going first, I was excited and nervous for her,” Jalisa said. “Seeing how she did eased my mind a little – and I knew I was in good hands – but I was still nervous.”
Bariatric surgery was initially an open procedure, but today it’s done laparoscopically – via a tube with just small incisions. “Sometimes, the surgery is assisted by a robot,” Voellinger said. “My preference is straight laparoscopy.”
Top scores for safety in NC
Novant Health just received the most ‘As’ for patient safety in North Carolina from The Leapfrog Group. With a focus on safety, quality and patient experience, the national, industry-leading nonprofit, evaluates and assigns letter grades ranging from A to F to hospitals across the country. Novant Health’s hospitals with “A” grades outperform 70% of hospitals nationwide for safety and quality.
With gastric bypass – which the sisters had – patients can expect an overnight hospital stay and two weeks of recovery. The surgeon seals off a small portion of the upper stomach and connects it to the small intestine. After surgery, patients feel full sooner, eat less and absorb fewer calories, because the food they digest bypasses most of the stomach and the upper small intestine. The gastric bypass also causes hormonal changes to the brain that improve hunger control and satiety, the state of feeling like you’re full.
After surgery, there’s also a dietary progression. It’s strictly liquids at first and then purees, soft food and finally solid food.
Voellinger said most patients lose 20% to 25% of their body weight in the first 12 weeks after surgery. Six to eight months after surgery, most patients have lost 60% to 75% of their pre-op weight.
It’s been about five months since surgery, and Jalisa is down 60 pounds. Arlisa is down 55 pounds. Both have been able to come off their medications – even insulin.
Although Jalisa struggled when she first quit smoking, it feels normal now. “My coworkers at Amazon are often around me smoking, and it doesn't even smell good to me anymore. It’s not something I want to do.”
She’s also finding it easier to do her job. She might make 200 stops a day on her delivery route. “I can handle that now,” she said. “I’m not even tired.”
Arlisa appreciates waking up in the morning and feeling rested and having more energy. “The biggest change I've noticed is going up the stairs without getting out of breath,” she said.
Their advice to anyone considering bariatric surgery?
“Do it,” Jalisa said. “It’s the best decision I ever made.”
Arlisa adds, “This is not the easy way out. You have to be committed to change.
Youare the one that will make your dream come true.
Youdetermine your story after surgery.”
Weight-loss drugs: They’re ‘not a no-brainer’
While Voellinger is a surgeon, not every patient who comes to him will be a candidate for surgery. Lifestyle modifications may be sufficient for some. Medication might be a good option for others.
Voellinger might put a patient on medication after surgery if their weight loss plateaus or they start regaining. He occasionally prescribes medicine to help a patient lose weight before surgery, although that’s rare. “Nonsurgical patients having satiety issues – meaning it takes a lot for them to feel full – might be good candidates for medication,” he said. “The newer injectable medications help with not eating as much – or at all – between meals.”
Those injectable medications are the ones you’ve likely heard about – Ozempic, Wegovy, Mounjaro, Zepbound. Oprah had success on one and is now a big fan.
This class of drugs, glucagon-like peptide 1 (GLP-1) agonists, can lead to dramatic weight loss.
The American Diabetes Association consider Ozempic and similar drugs a first-line therapy for people with Type 2 diabetes. The drug, Zepbound, was already FDA-approved under the name Mounjaro for the treatment of Type 2 diabetes. Now it’s approved to treat obesity, too.
While those drugs are effective for weight loss, they’re not as effective as surgery, Voellinger said.
“There are practical and medical issues to consider,” Voellinger said. “These drugs are rarely covered by insurance, and they can cost up to $1,300 for a one-month supply. That’s not doable for most people. Some people will need to stay on these medications for a lifetime. At the current price point, surgery may actually be more cost-effective in the long run.”
Supply is another concern. Their popularity has led to their scarcity. Voellinger also noted that side effects such as nausea, heartburn, bloating and constipation – are pretty common. In rare cases, people can develop gall bladder or pancreas issues.
“So, even though these drugs are effective and popular, they’re not a ‘no brainer,’” he said.
