From Bariatric Surgery To GLP-1s, Zach's Story

Zach Niemiec is Vice President of Patient Advocacy of ProCare Health which is a supplement store focusing on caring for patients living with obesity treated with metabolic & bariatric surgery; now expanding to cover patients taking GLP-1 medications.

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https://procarenow.com/blogs/resources/questions-before-starting-glp-1

We talk with Zach Niemiec about living with obesity from childhood through bariatric surgery, GLP-1 medications, and the confusing reality of long-term maintenance. We focus on fatty liver disease remission, stigma-free language, and how building the right care team makes progress safer and more sustainable.

• childhood obesity and diet culture pressures
• lap band removal sleeve surgery complications and weight recurrence
• unexplained symptoms leading to NAFLD and steatohepatitis diagnosis
• GLP-1 therapy decisions including semaglutide and tirzepatide
• why maintenance feels unclear and why protocols vary
• shifting focus from scale weight to body composition and health markers
• mental health support for body image dysmorphia and stigma recovery
• building a care team with primary care dietitian therapist and specialists
• using DEXA and other scans to track fat loss and muscle gain
• improving access cost education and patient advocacy resources

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Transcript

Dr. Lindsay Ogle, MD 0:00

Welcome

Welcome And Medical Disclaimer

Dr. Lindsay Ogle, MD 0:01

Welcome to the Modern Metabolic Health Podcast. With your host, Dr. Lindy Ogle family medicine and obesity medicine physician. Here we learn how we can treat and prevent modern metabolic medicine, such as diabetes, peace of happy liver disease, metabolic syndrome, sleep apnea, and more. We focus on optimizing lifestyle, utilizing safe and effective medical treatment. Please remember that while I am a physician, I am not your physician. Everything discussed here is provided as general medical knowledge and not direct medical advice. Please talk to your doctor about what is best for you.

Meet Zach Niemick

Dr. Lindsay Ogle, MD 0:45

Welcome back to the Modern Metabolic Health Podcast. Today I have a wonderful guest, Zach Niemick. He is vice president of Patient Advocacy for ProCare Health, which is a supplement company that focuses on supporting patients who live with obesity. They've focused on patients who have gone through metabolic and bariatric surgery and are also now helping support patients who are on GLP1 medication treatment. And so he is here to share his story and some about his work. So thank you, Zach, for being here today.

Zach Niemiec 1:22

Thank you for having me, Dr. Ogle. It's uh great to be here. I'm always happy to share. Um, I'm a big subscriber to the thought that you might one thing you might say might, you know, eventually roll down the hill like a snowball and turn into like the the big thing that helps someone else on their journey. So um if I help one other person, then it was worth sharing.

Dr. Lindsay Ogle, MD 1:43

Yeah. Well, I'm sure that you will. And I would love to just give you the opportunity to uh share a little bit about your story with my audience.

Zach Niemiec 1:52

Yeah,

Childhood Obesity And Early Surgery

Zach Niemiec 1:53

well, I mean, like many other people living with obesity, um, my story doesn't start just like when I started the medication or when I had bariatric and metabolic surgery. Um, it starts a long time ago, but to to fast forward, I was a child living with obesity. Um, it started to creep in in my like uh, you know, 10 to 12 year old range, and it kind of rapidly ramped up from there. And I remember a lot of um diet culture interventions in in my youth, um, including ending up at Weight Watchers at one point. Uh and then I had my first uh metabolic surgery at 16. I had the lap band. Um and I was successful with it for a while. And um it did have to come out in my early 20s, though, because it had slipped and um it was deemed that it was safer for it to come out and convert me to um one of the other procedures at that time. Unfortunately, I had a lot of scar tissue, so I couldn't um be converted at the time when it came out. So uh I had to go a whole other year now without a tool, and of course, without the tool, what happens with the disease weight reoccurrence happens. So um my I gained the weight back that I had kept off with the with the band, and um I was then later converted to a sleeve about a year later, um which I did fantastic with the sleeve uh for for a while as well. And then um unfortunately I mine was done with a hiatal hernia repair and my sleeve actually kind of came undone, and my stomach went back to virtually its normal size, and the same story kind of like uh continues with uh weight reoccurrence happening. Now um I considered getting a gastric bypass. There was a lot going on during the the COVID years, and um that's when I was exploring that. Then I was uh I had to get a reflux procedure done, which is ultimately what I opted to go with during that time. And um that really helped, but it didn't do a lot with for the weight side of things, unfortunately.

Fatty Liver Disease And A Turning Point

Zach Niemiec 4:12

And then um in like 2021, um, I started getting really unexplained digestive health symptoms. And I actually ended up going to four different gastroenterologists, and no one could figure out exactly what was explaining it until I got to the last one. And he goes, I don't think I'm the doctor for you. I think you need to go see a liver doctor. Um, but I'm gonna test my theory, and you know, um, he prescribed a medication that was for something else, but it would confirm to him that the problem was actually with my liver. And lo and behold, my symptoms of like almost three years at that point seemed to have resolved, but it was really just a band-aid. Um and he got me with a liver doctor, and that's when I found out that I had uh kind of like a mid-stage non-alcoholic uh fatty liver disease uh with uh statohepatitis, I believe is uh proper phrasing there. Um but the uh doctor then, you know, was you know, like, well, unbeknownst to me, I had started a GLP one while waiting to go and see the liver doctor because there was a weight. And the doctor said to me, Well, you've actually started treating your disease um without kind of intentionally knowing it because the treatment for you right now is about diet and exercise. And I hate that uh terminology, but but that's the that's what it was you know communicated to me as. And um she at the time said to me, Well, you can continue with uh the GLPs, or I would advise you to go and get a gastric bypass and you know, have the the weight loss um that help you resolve your liver condition. Um I uh was in the process of moving, so I got a new liver doctor when I moved, and we continued on my GLP1 therapy um and basically uh agreed together that well I'm still losing, so let's uh follow this intervention till it's you know a peak and then see what we have to do from there. And well, if we have to use another another tool in the toolbox, then we will. Um so uh I thankfully uh didn't have that problem. I hit I kind of hit a peak on uh semaglutide. So then working with my care team, we switched over to trazeptide, and the rest of my weight that I was, you know, um kind of deemed that was like the range left to lose, I lost. And um my liver enzymes and everything are now regularly normal. And uh this past May I was declared in remission but under monitoring. Um, so just to make sure that you know, if my enzymes do go back up, it's not because the liver is actually sick, it could have just because my liver was under stress for one reason or the other. And um, so I'm glad to have the constant monitoring, I'm glad to have that uh available to me.

The Messy Reality Of Maintenance

Zach Niemiec 7:21

But I kind of hit maintenance um last May and I did not know what to do with that. Um, and and it's not no fault of I think a lot of practitioners either. For weight management, these are still very new. And uh I think we're all figuring out maintenance uh right now, a bit. It seems like every day there's a new news article or um new uh abstract study coming out about maintenance. And uh at Obesity Week last year, there was one about um patients uh moving their dose instead of weekly to every other week, uh, but keeping the same dose. So it's there's a lot of stuff out there, and I think we're all trying to figure out what is proper. And you know what? I honestly don't know if there's one singular proper protocol. I think that's what we're all gonna figure out at the end of this, is there might be something that works group good for this group of patients who have similar type of obesity here, and then this group that has a different type of obesity over here, and so on and so forth. There might be different guidelines and and protocols to to try and help manage it because it is an ongoing relapsing um condition, and I just uh I'm trying to navigate that myself, and uh people say to me, Oh, it sounds like you have maintenance figured out, and I'm like, No, I don't. Um, I still struggle with like some of the things that other people do of not eating enough sometimes, unfortunately. And like I as I have increased my physical activity and been re-working on my body composition, nutrition, not that it wasn't important before, it's become even more critical because I'm burning more with heavy resistance training, and I'm trying to add lean tissue and you know, reduce body fat percentage to a reasonable level and um just kind of overall work on my total system health, and that changes almost uh regularly. There's um, you know, every six to 12 weeks I'm revamping my workout routine based on body composition scans to see where I'm putting too much on and where I'm lacking behind. Like I'm a very now like a multiple data point guy. It's not just my blood work, it's not just the tile on the floor, as some people on social media have been referring to it as. Um, I've gotten to this point where it's life beyond actually the number on the scale, and I actually think it's a lot more complicated. Um, because I think when we are in that losing phase, we get very tunnel focused on just that number on the scale. And it is a dopamine hit for us when we see the scale go down, and that's our goal. But a lot of people aren't thinking about all of the other stuff that goes with it. And I don't blame them. It's a lot to it's a lot to put on your metaphorical plate. Thinking about um, do I have the right macros? Am I doing the right kind of movement? Like that can be overwhelming, especially when you're already trying to lose, and that's stressful enough. Anyone who's tried before knows how stressful um uh a journey like this is. So yeah, that's kind of it in a nutshell for you.

Dr. Lindsay Ogle, MD 10:49

Yeah,

Obesity As A Chronic Disease

Dr. Lindsay Ogle, MD 10:50

and I appreciate you uh taking the time to go over all of that because it is a journey and it's not linear. And I think that really highlights a couple of things. One, that obesity is a chronic medical condition and it's multifactorial, and there are different treatment options, and we often have to combine different treatment options with lifestyle and medication and surgery, and that'll look different from person to person and what that combination will be or what the order will be, but many people do need that combination of treatment to treat their underlying disease. Um, it also highlights that um, or it goes against um what some people still think is you know using uh a tool like that, like or a treatment like GLP1 medications or surgery as um, you know, cheating or the easy way out when that's definitely not the case. Um you've clearly um before you started those treatments were trying lots of different things that were not effective. And now you use those effective treatments and have made a lot of progress um in your journey. Um, and then all you also mentioned how um obesity can lead to other metabolic conditions like fatty liver disease. And that was what was identified that then got you started on the GLP1 medication and with then treating obesity that also treated that um obesity-related condition with the fatty liver disease. Um, so that's a really great over um a great um overlook and highlight of what obesity actually is and what long-term treatment looks like in real life.

Zach Niemiec 12:44

Yeah, and um I am someone who has subscribed to the thought that like this is very much a treatment for life. Um I I do struggle a bit with when I um have conversations with some people, and you know, if I reveal I'm on a GLP one, some of them like who have not known me in my larger size in the past are like, well, you don't need them. And I'm like, well, actually, I've lost X with it, I've changed my body composition, I've uh I'm well managed, like my disease is currently well managed. If I stop it, my disease will likely reoccur. And um like trying, I've I've been shifting a lot of my conversations away from just the weight loss aspect of this and uh talking with a lot of people in uh daily life who aren't part of my usual circles about uh you know changing language softly and not like scolding them on it, but like I like I go, well, you know, it is actually a recognized disease, and go through it and then um talk about all the different things that go with it. And uh oftentimes I like to ask someone well, do you know someone who uh you know has struggled with their weight their entire life? And the the answer is usually yes. And I then I go, Well, what did you think their uh like quality of life was? Did they have any other conditions like diabetes, sleep apnea? And the then the answers start stacking up, and it does help move people. Um, I do kind of feel like when I'm in this smaller body and people uh have not known me ever in the larger body, that it is like coming out a bit, it's like I hi, yes, I suffer uh with the disease chronic condition of obesity. Um, I'm Zach. Um but I honestly, as much as it frustrates me at times, I don't mind it because um if it means that in especially for the youth, um, another generation that doesn't have to struggle in the same ways that I had to with childhood obesity into my earlier years. And uh you know what, I know this is a lifelong struggle. I might need another to reach for another treatment option down the road in order to continue to maintain it. But I'm just excited for those to come after me as well. Um, but but right now I very much see my role is one, to continue to obviously uh keep my condition uh as controlled as possible, but to uh try to advocate for better access to care, better cost, um better education, and uh reducing the stigma as much as I can while I'm uh fortunate enough to have a platform in this space.

Dr. Lindsay Ogle, MD 15:45

Yeah, absolutely. And sharing your story is so powerful. Um, so I appreciate that you do that, and it can be challenging and it can be uh vulnerable and scary, especially in um rooms or with people that you are not familiar with. Um, so but it it makes an impact. So I'm glad that you are able to do that. And I absolutely can imagine how, you know, with uh disease like obesity, that is outward-facing for the most part, and people um can typically, you know, it you can just you can look at somebody and then I guess we can make assumptions about it. Um but when somebody, like you said, when their disease is controlled and their body looks different, then you might not know that somebody has had all of those challenges and struggles before and have gone through everything that you know, someone like yourself has gone through um to be in in maintenance now. And like you said, that is a fluctuating state um with that that maintenance phase. Um, but it can be, yeah, it's that is quite challenging to navigate in the world today.

Zach Niemiec 17:03

Yeah,

Mental Health And Body Image Healing

Zach Niemiec 17:04

and I just a quick shout out to mental health. Um, mental health is a huge part of the the total package of someone's weight loss journey. Um if you're listening to this, don't discount it. Find someone you can talk to about it, whether it is, you know, a psychiatrist, a therapist, uh, you know, a trusted friend, you know, that type of thing. Um I've been fortunate enough to come across um, you know, clinicians like Dr. Robin Pashby who uh are uh doing work with the Obesity Action Coalition. And one thing that she said constantly sticks in my head, and I have to it's actually very helpful for me on my own journey is that the brain takes longer to heal than the adipose tissue. So we might have gotten ourselves back into this smaller body that blends in more, but often we still feel like the larger person. And um give yourself that time and grace and and don't be afraid to work through those things with um someone because again, talking about stress factors and things like that, mental health is very much one of the pillars in my belief uh in you know having a successful journey. So um I just like to remind people of that piece too. It's it's not again, it's not just about that number on the floor.

Dr. Lindsay Ogle, MD 18:31

100%. And it literally is one of the pillars of obesity medicine um for um uh the obesity medicine association, um, medical treatments, nutrition, physical activity, and behavior change and and mental health. Um, so it truly is a pillar and it's something I definitely um touch on with my patients. And there's a couple of organizations I uh refer them to um for um specifically for mental health in this space, because um, like you said, with body image and body dysmorphia, um, anxiety, depression, um like um, you know, gone through a lot of bias in in life and internalized stigma and shame, that's a lot to process into to get through. And so having a professional help you with that is so powerful.

Building A Supportive Care Team

Dr. Lindsay Ogle, MD 19:28

Um, and when you were just speaking earlier, I was thinking um about you you mentioned many people along the way that have helped you in your you know maintenance phase or along your journey. What are some of those people that you leaned on for like your care team that you could say, um, whether they're medical professionals or just people in your life who have helped um get get you to this place and to um maintain moving forward?

Zach Niemiec 19:59

Oh yeah. So I've got a big care team. Um maybe it's to my insurance company's uh, you know, disple uh pleasure that I have so many. But um the biggest thing when I can first I can say is don't be afraid to add or subtract to your care team. Um, you need to have the people around you that you're comfortable having conversations with to manage your health um and not hide things for like you like if you feel like the doctor has a stigma against you, go find the doctor that you can vibe with. Like, there's no harm in that. It might be complicated to switch your medical records over and all of that, but it's worth it, it's very worth it. Um so I my my primary care doctor was a huge part of my journey in terms of monitoring labs uh on a on a frequent basis. Um, I'm in the large percentage of Americans that don't have insurance coverage for GLP ones. So I had to seek alternative routes outside of you know getting coverage from insurance. And um, I wanted to make sure that while yes, I was utilizing a telehealth service, which is under the supervision of a doctor. I wanted my doctor looped in on that care. Um, because if she had written the prescription for me, she would have been looped in that care. And she did, she tried, we tried to get it approved, and it there was just no coverage, unfortunately. And so it's it's unfortunate. But she was there every step of the way. I was getting my labs done every like three to six months, depending on if something was off, if I started feeling any, you know, sort of way, uh, energy levels, you know. She wanted to make sure that everything was uh staying in order. And so that was a that was a big part of it for me. Um, the other big parts of it for me were my dietitian. Um And getting nutrition advice at the different stages for me as well. Um, my macros have changed so much. My act because my activity level has changed so much. So you might be, you know, meet with a dietitian once, and you get macros for the snapshot that you're existing in in that moment. And that's why I encourage regular uh visits with a dietitian or nutritionist so that you can continue to update to where you're at. Um, because I've heard people online go, oh, I've just been staying eating my 1600 calories a day and I'm in maintenance, but I'm still losing, and I don't know why. And or there's other folks who were saying, I I've stalled out, uh, but I'm working out five days a week and I'm not moving anymore. And I'm like, you need to talk to the dietitian because it might not, you know, it it might be beyond what you're doing, actually. Like, we know that types of exercise will either cause, you know, not necessary plateau, but muscle gain. And, you know, that might cause the scale not to actually move, but your composition might be changing, or you might not be eating enough, and your body is going starting to go into like a like a starvation hype hibernation type of mode, and it's trying to hold on to everything because that's what it's built to do. Um, so I always like, you know, I I I tell people you just gotta check in with your dietitian, even if it's twice a year. Like if you're once you're in an active maintenance, if you're not changing things on a regular basis, then maybe you can reduce it. But it's been it was a such a big thing for me. And my dietitian is checking in with me regularly through messages and um you know, making sure that uh as my activity increases, that I'm getting more nutrition. Like I'm supposed to be up to like 2400 calories a day now and like 180 grams of protein because of how much I'm lifting. And um that's a that's a lot. Not not everyone is gonna be on that when they're in the losing phase or maintenance phase. It's like it's all dependent on you, and that's why like personalized care is so important, and I preach about that as well. Um, and then my my mental health, my therapist has been a huge part of this uh journey as well. Um and uh, you know, uh it's been helpful to me because I accidentally found a therapist who I well I didn't know that they had any connection to the life that I have lived, but through my uh time with them, they opened up about having gastric bypass, struggling with reoccurrence, and then starting a GLP one because of listening to my journey and then getting back to where they're in maintenance again and they've gone through skin removal, and I'm getting ready to go through skin removal. So I I accidentally found the right therapist for the right moment of time in my life and journey, but that's been so critical for me because it's been someone that has helped me work through um all aspects of the journey, whether I was losing, whether I was not, whether I was in maintenance, uh it's it's just been very, very helpful. So um, you know, that is my kind of care team. I'm actually expanding it again. Um, I'm adding a board certified obesity medicine specialist to my care team. Um, and uh, you know, I still have a liver specialist, I still have um a few other doctors that I go and see here or there, but uh I make sure that my total health package is good, and I make sure that my doctors all can communicate with each other, or if one sends me one thing, I send it to the other. And um I'm probably a more of a go-getter patient, uh based on you know just my life experience, but like other people can do this, and uh you can have a fantastic care team around you. Um, and it's it shouldn't be very daunting. And I think that doing that and knowing that stuff has um made me uh very successful on on this journey, and I'm truly fortunate to have beat the uh average uh weight loss that you know is expected with these medications. Um I try to remind people that I fell outside of the norm. Um, and please don't use me as like your benchmark or or comparison, um, like pointing them back to like what the actual averages are from the data of the meds, and um you know, encouraging people uh to change their mindset about it.

DEXA Scans And Better Progress Metrics

Zach Niemiec 26:59

Like and and you know, if you're losing, you're losing. That's that's great. But um, you know, my focus has now been on composition and maintenance strongly. So I only weigh myself now like once every four to five weeks, and I'll tell you the last three times I got on the scale, the number was up. The number was up, and I'm probably up about 15 from my lowest on this journey. And I've not panicked. Um I'm not panicked yet, I should say. Um, I don't feel like any of it is um like weight gain from fat. Um I've in an aggressive resistance training kind of workout routine five days a week. Um, and but that is why I'm frequently getting body composition scans now. So I'm getting another DEXA scan later this month, which would have been about six months from my last DEXA. So I'm um looking forward to compare. Uh that will be my third DEXA scan over the course of this journey. Um, and uh about a year since my first one, I had my first one last March. So it would be uh exciting to compare that data for me, but I won't take any action on that data just yet because I'm also next month in April getting another Sika scan. And um, I like to compare my Sika and my DEXA scans and then correlate the information and find commonalities between the two and then inform my decisions off of all of that data. Um so I, you know, I'm again I'm doing things a little bit next level because I'm a data nerd. But if you have, you know, the option of a Sika scan or a DEXA scan or an in-body scan, something that's not your home scale composition, because I'm gonna tell you a lot of those home scales will mess with your mind because they'll either say you're very high in your composition or low, and they're not the same as one of those clinical grades that are verified against something. So um, but if you can check in on your composition, and uh especially DEXA scans are already recommended for uh checking for uh osteoporosis in in people who are uh susceptible with it. So if you can even get it covered by your insurance, kudos to you. But um they are becoming a much more affordable cash option for body composition now, too. Um I'm fortunate that mine's under a hundred dollars whenever I want to go, which is fantastic because even a year ago when I started looking, they were over a hundred dollars to pay for cash. Um and if you live near an area that has a lot of like uh research uh colleges or medical schools, um, I've found out that a lot of those programs actually usually offer DEXA scans at lower prices as well for patients because they want the day, like they want data too for whatever they're studying and stuff. So sometimes uh if you happen to be in one of those uh college towns, you might be able to find something that's more affordable for you too. I never thought those are small things to throw out there.

Dr. Lindsay Ogle, MD 30:12

Never thought about that. That's really um a great thought. Um, yeah, and I know in my area I got a DUXA scan before, um, and it was $99, I believe. And it's something that you're you don't need to get very often. Um, so I think can be reasonable to incorporate. And I'm a big fan of um checking your body composition because as you mentioned, just following you know the number on the scale is not very helpful because ideally we're losing body fat and gaining um muscle mass, and that'll look like, or it could look like, you know, a neutral weight um on that scale, but really you could be significantly improving your health um, both metabolically and functionally. Um, so getting those body composition scans can be so powerful. It can be a little bit overwhelming or confusing, especially if you're early in this journey. And that brings us back to the importance of having a team around you. So um sometimes primary care doctors would be able to help you interpret this. Um, an obesity medicine physician should be able to, many dietitians could be comfortable with this. Um, you know, even fitness trainers, um, some of them really focus on it. So having those team members are so helpful to just interpret it and help you to take action on what those results are over time. Um, so again, yeah, tying in that team that you build around you. And I think starting with a really great um primary care doctor andor obesity medicine doctor is a great um place to start to build your team. And like you mentioned, if you're not getting the support from that person that you deserve or that you're looking for, it's okay to see somebody else and see a new doctor. And then adding on the dietitian and um, you know, therapist, counselor, um, then plus or minus a personal trainer or even a physical therapist if exercise is really new to you or you're having joint pain, um, starting with um physical therapy can be a really great um place to start. Um, so thank you for going over that.

Zach Niemiec 32:34

Yeah, of course. And

Resources Advocacy And Closing Requests

Zach Niemiec 32:36

um, I know uh we're coming up on our our time, um, but uh, you know, I'm very big on education and resources. I've I've started publishing some uh just personal blogs on um procarnow.com under our blog section. Um some of them are about advocacy. Um advocacy is very important to me in this space. Um and uh one of my recent ones is about why patient voices actually matter in ending weight less than healthcare. Um so if you're looking for just you know a quick read like that, um that is you know one I would recommend. If you're looking for some something more from me, why community and mental health support matter. Uh I even have one about things you should talk to your doctor about with if you're even remotely considering starting an OMM therapy, uh, obesity management medication. Um so uh, you know, I'm about putting resources out there for for people uh because I we need that. We need content that isn't clickbait and you know, just headlines. We need real tangible um evidence-based um material out there.

Dr. Lindsay Ogle, MD 33:53

So yeah. Well, thank you for doing that. And I will definitely include the link um with this podcast or on YouTube, however you're watching or listening. And I'll also include your um social media uh handles so people can follow you and you know follow your journey and learn more from you. Um, but yeah, thank you so much for being here, Zach. I really appreciate you taking your time and sharing your story.

Zach Niemiec 34:19

Absolutely. Thank you for having me. Um looking forward to uh working with you in the field uh in the future and seeing you out and about at conferences.

Dr. Lindsay Ogle, MD 34:30

Thank you for listening to modern world. If you found this information helpful, please share with a friend, family member, or colleague. We need to do all we can to combat the dangerous misinformation that is out there. Please subscribe and write a review. This will help others find the podcast that they may also improve their metaphoric health. I look forward to our conversation next week.