Not Your Surgeon’s Bariatrics: The Rise and Risks of Dallas’ GLP-1 Craze

ShantaQuillette Carter-Williams was having one of her better days. The stroke and heart attack survivor had just wrapped up back-to-back pulmonology and cardiology appointments. Though she faced heart valve surgery, her doctors cleared her to resume daily life, just nine months after a massive heart attack at 39. But the Internal Revenue tax accountant began to feel dizzy at her desk. Her face began to droop, her arms weakened, and her speech slurred. She was suffering a second stroke.

“It's definitely something that you can't prepare for,” Carter-Williams recalls of her 2019 stroke.

The then-40-year-old spent two years in cognitive, physical, occupational and speech therapy. During recovery, her depression, overeating and inactivity led to a 75-pound weight gain. Alarming blood work results pointed to an impending Type 2 diabetes diagnosis. She needed a miracle, fast, if her heart was going to survive. In December 2021, her doctors prescribed Saxenda, a $1,600-a-month medication in a class called glucagon-like peptide-1 agonist (GLP-1). After a diabetes diagnosis, Carter-Williams was able to get Ozempic, a form of GLP-1 that is a semaglutide injectable, for $25 a month, which she credits with saving her life.

“I started it, and it completely did a 180,” she says.

The era of GLP-1s ascended with lightning speed into mainstream media in 2024. Hollywood stars have shrunk in the blink of an eye. In Dallas, patients have ditched surgical weight loss and medical supervision in favor of once-weekly injections that seemingly melt off weight.

Approved by the Food and Drug Administration in 2005, GLP-1s are injected into the fatty layer underneath the skin. Common types include semaglutide, liraglutide, tirzepatide, dulaglutide and exenatide. Ozempic has become a household name for the drug category, though Wegovy, Mounjaro and Zepbound have also skyrocketed in demand for their weight-loss effects.

Between February and April 2022, Carter-Williams lost 30 lbs and has since lost more than 100 lbs. Her transformation, documented in real time, earned her 1.3 million followers on TikTok and 1.1 million on Instagram.

“I went viral because I showed up in the middle of a mess,” she says. “... People saw me at 300 pounds, and now they're seeing me at 150 pounds. They saw me sad, now they see me happy.”

As HeyShantaQ, Carter-Williams uses comedy and candid storytelling to advocate for health equity. She also authored an e-book, Grow & Glow with GLP-1.

“These medicines are a tool. They're a very powerful tool,” says Dr. Ian Justl Ellis, founder of Voafit, a medical concierge service overseeing GLP-1 use for hundreds of North Texans. The membership-based program offers a GLP-1 prescription, diet and exercise counseling, weekly check-ins, dose management, on-demand access to a physician and more.

GLP-1s’ promising weight loss effects have created shortages, affecting diabetes patients like Carter-Williams, who went three months without the drug. She gained only 5 pounds in that time. In addition to scarcity, GLP-1s have dethroned surgical weight loss.

The Fall

“GLP-1s are a great drug. It's a great wonder, but without supervision, it could be a killer,” says Dallas plastic surgeon Dr. Carlos Raul Barceló.

Barceló has practiced medicine for more than 35 years and has expertise in cosmetic surgery. He has won international praise for breast lifts, body contouring, butt lifts and liposuction. He says he’s seen a notable decline in educated post-bariatric patients and a rise in malnourished ones who lost weight solely with GLP-1s.

“Nationally, a lot of people claimed that they were down about 40% in bariatric surgery volume because of the GLP-1s. I would like to say that we probably decreased a good 50 to 60% during that time,” says Crystal Sadler, owner of Total Wellness and Bariatrics.

Total Wellness and Bariatrics offers surgical and medical weight loss options. With 12 years of experience in bariatric surgery, Sadler says that while the Dallas-Fort Worth market remains competitive, GLP-1s are undeniably reshaping bariatrics. Increasingly, bariatric surgeons are leaving the specialization to pursue concierge medicine, a membership- or retainer-based medical model that provides greater access to primary care physicians or general practitioners. Others are shuttering clinics.

“My goal is to be one of the last ones standing,” she says.

A Dallas Bariatric Center spokesperson confirmed a 50% drop in bariatric surgeries. The center has added GLP-1s to its services. Dr. Nirmal Jayaseelan, the center’s surgeon, was unavailable for comment.

In December 2024, Medpage Today reported that Norman Regional Health System’s “Journey Clinic” in Oklahoma closed after seeing a nearly 50% drop in bariatric procedures and noted an increase in bariatric surgery cancellations nationwide.

Ignorance Is Bliss

Barceló says 2024 marked a shift. He observed a steep decline in patient education, mainly driven by patients relying on social media rather than physicians for information.

“Having a shot with no surveillance or knowledge is more dangerous than surgery,” he says.

He cites rare conditions like multiple endocrine neoplasia Type 2 (MEN2), a genetic disorder that causes susceptibility to glandular cancers. The overlap of MEN2 and GLP-1 use could be deadly, Barceló says.

Sage Plastic Surgery, Barceló’s practice, has seen an increase in GLP-1 patients seeking cosmetic procedures. Many arrive emancipated, malnourished and without medical oversight. He’s turned many of them away due to safety concerns and a lack of basic medical clearance.

“Patients should be our priority number one, and if patients don't have true knowledge of what could happen with GLP-1s, that's a big gap in the responsibility of who is selling these medications to the public and trying to keep them away from the medical decision,” he says.

For many, TikTok, Instagram and Facebook have become the new-age medical experts. Anonymous posts in neighborhood Facebook groups ask, “Any rec’s on a medspa that does semaglutide?” Facebook users sound off in the comments. Others GLP-1 seekers turn to longstanding weight-loss programs like WW (formerly known as Weight Watchers), which began offering a “no clinic visit required” compounded semaglutide program in 2024, or health and wellness platforms like Hims and Hers that market “100% online” GLP-1 programs.

“These medicines need oversight,” Voafit’s Ellis says. “They're like a loaded gun, or if you point in the wrong direction, you could really get hurt.”

On March 19, the U.S. Food and Drug Administration restricted the use of compounded tirzepatide. Unlike FDA-approved GLP-1s, compounded versions mix in additional ingredients and purportedly sidestep patent protections for GLP-1 drugs. According to a March 17 FDA release, the administration has received more than 775 adverse events related to compounded semaglutide and tirzepatide. Some may be linked to overdosing.

WW filed for Chapter 11 bankruptcy on May 6. BBC reports the weight-loss program had a net loss of $346 million, with subscription revenue down 9.3%. However, its clinical program revenue was up more than 57%.

“These meds are not magic pills,” Carter-Williams says. “They can be life-changing for some, but you need to know that they're right for your unique health profile.”

The Skinny-Fat Era

Ellis, an emergency room physician, says his lifelong battle with “the appetite problem” fueled his creation of Voafit.

At 14, Ellis vowed to overcome generational obesity. As he grew older, he became obsessed with chiseling his body into a real-life version of Michelangelo’s David through dance, bodybuilding, extreme calorie deficits, bingeing and grueling workouts.

In adulthood, Ellis found that marriage, home, medical school and life’s endless demands replaced the gym and meticulous food prep. He graduated from his residency 60 pounds heavier in 2016.

In 2023, a colleague handed him the cure to his lifelong struggle: an Ozempic prescription. The drug was a paradigm shift in medicine — a new class of drugs simultaneously affecting obesity, diabetes and cardiovascular health that rapidly melted off Ellis’ weight.

“If you turn it up to 11 and take too much, you literally will just stop eating and you'll have an aversion to food,” he notes. “Of course, you'll lose weight because you're literally starving yourself, but you're not even feeling it. That's what's weird about these medicines, is they drive you to that.”

Appetite suppression isn’t permanent, either.

“Usually you're not wanting to eat because you're too nauseous or your stomach is already upset or uneasy, and so it doesn't do anything with the true hunger producing hormone, so the moment that you get off, I’ve heard from a lot of patients, their hunger and their cravings come back with a vengeance,” Sadler says.

Ellis was assured there’d be no side effects. The drugs are “wonderful,” his provider said. Unknowingly, he traded his muscle mass and energy for an idealized number on the scale, only to experience life-interrupting gastrointestinal issues he mistook for a persistent stomach bug. Though his body mass index was normal, he was “skinny-fat,” low in muscle mass and high in body fat.

“There’s no point in having an entire population of skinny, fat people who are emaciated and sick all the time,” he says.

The emergence of GLP-1s as an obesity treatment is so new that long-term data isn’t available. Still, doctors are heavily recommending the drug’s use.

More than 70 percent of U.S. adults are overweight or obese, UT Southwestern Medical Center internal medicine Dr. Jaime Almandoz said in a 2023 blog. “However, anti-obesity medications are prescribed to only about 4% of eligible people due to concerns about safety or effectiveness, lack of health care provider training in weight management, excessive costs due to insurance companies refusing coverage, and a toxic stigma that portrays obesity as a lack of willpower. Advising a patient with obesity to simply ‘eat less and exercise more’ is like telling a patient with depression to ‘cheer up.’ It’s ineffective and often quite hurtful.”

The blog stated that the UTSW Weight Wellness Program is “the only academic medical center in North Texas with a dedicated multidisciplinary weight management team of obesity medicine physicians, advanced practice providers, dietitians and mental health professionals.” UT Southwestern declined to comment.

The oversimplification of GLP-1s on social media has transformed medicine into a fad, leaving users unprepared for the side effects and enchanted by the allure of advertising.

“This is the only country where pharmaceutical companies actually have to advertise medicine,” Barceló says. “It doesn't happen in Europe or in Canada, and so this creates a very uncomfortable situation for physicians because you have to fight the social media and let people understand what the truth is about this.”

Ellis estimates 99% of his GLP-1-prescribed emergency room patients arrive with gastrointestinal complaints such as extreme abdominal pain, diarrhea, nausea and constipation.

“I've had two [patients] come in that are ready for surgery recently that have experienced GI bleeding,” Sadler says. “I've had a lot that just can't handle the nausea and vomiting, the constipation, the bloating, the heartburn, reflux. Those kinds of symptoms are very typical.”

Ellis’ attributes his issues to overdosing. Like many of his Voafit patients, he was prescribed the standard incremental dosage that begins at 0.25 milligrams and increases to 2.4 milligrams.

“Nobody's doing this right,” he says. “Everyone's overdosing. No one's getting information on how this changes your physiology and slows your gastric emptying and how to avoid these side effects.”

Going Nuclear

Dallas father and husband Greg Pinn was unpersuaded by GLP-1’s glamour. Nine months ago, after decades of yo-yo dieting, he chose the “nuclear option,” gastric bypass.

“Your body will fight you, tooth and nail to maintain what it has decided is your set weight, and for a lot of people, that set weight is unhealthy, and it's insidious,” Pinn says.

His comorbidities included diabetes, high blood pressure, high cholesterol and non-alcoholic fatty liver. His doctor warned against GLP-1s because of their effects on muscle loss.

Terms like “Ozempic face” and “Ozempic butt” describe facial and body volume loss caused by rapid weight and muscle loss. Users often show signs of hollowing and accelerated aging.

“Your face has its shape not because of fat. It's because of muscle tissue, ideally, but if all you have is a skeleton and layer of skin over top of it, it's not gonna look great,” Ellis says.

The decision for Pinn was simple math. The gastric bypass cost $13,000, just two and a half years' worth of medication costs and significantly less than lifelong GLP-1 usage.

“The risk of weight loss surgery nationwide, it's about 3%. With our complication rate, it's less than 1%,” Sadler says. “If people were more aware that surgery is really not that scary, and you could only have two incisions, then maybe they would be more apt for looking into it, since it's more long-term and more cost-effective.”

A 2024 study by the American Society for Metabolic and Bariatric Surgery found that bariatric surgery patients lost an average of 31.9% of their body weight after one year and maintained a 25% loss for up to a decade. In comparison, GLP-1 users lost 10.6% to 21.1%, but regained about half within a year.

Total Wellness and Bariatrics specializes in the patented Mini Sleeve, a minimally invasive gastric sleeve developed by the late Dr. Todd McCarty. The 30-minute outpatient surgery requires two to three incisions. Patients from as far as Dubai and the United Kingdom have traveled to Dallas for the approximately $10,500 surgery. (Gastric bypasses and sleeves are surgical methods that essentially reduce the size of the stomach.)

Gastric sleeve recipient Courtney Paige says that, in hindsight, neither surgery nor GLP-1s are worth it.

Words Cut Deep

“The surgery doesn't make you lose weight, the surgery prevents you from operating as a responsible human being,” Paige says.

Paige, who has type 2 diabetes, dropped from about 300 to 230 pounds after her 2019 surgery. She now struggles to consume enough nutrient-dense calories and experiences hair loss, dull skin and has forcefully given up carbonated drinks, even a celebratory glass of Champagne. She relies on 12 vitamins a day, drinkable protein and wigs. Eating often triggers a runny nose, a telltale sign among sleeve patients. Since gastric sleeve surgery, she’s had emergency gallbladder removal, skin removal and breast lift, all of which she attributes to the procedure.

Even with her life-altering surgical experience, Paige opposes GLP-1s.

“The fat is on the outside, but there's a whole system inside of us that we're changing with a substance that we're forgetting about because the focus is, ‘I want to lose fat,’” she says.

Paige believes it's a crisis in the making. Many people around her have lost weight on GLP-1s, yet remain unhappy.

“One of the big things that I had to deal with was that I am not my weight,” Paige says. “I had a personality built on being fat. It was amazing. You love me, and it's mostly because I was fat, the best fat person you ever knew your whole life. I opened doors for heavier people.”

At 300 pounds, Paige was a top-rated ballroom dancer in Texas, a feat she says was extraordinary because of her size. Her weight became a defining part of her identity.

“They reduce your value because now you're skinny. So yay, skinny. When I'm fat, they also can tell you how smart I am, how funny I am, how fun I am, how great I dance, because they don't accept fat,” Paige says.

Therapy and nutritional counseling helped Paige untangle her identity from her weight.

“It's [GLP-1s and surgical weight loss] just a cheap way of not having a nutritionist and a therapist,” Paige says.

It’s a permanent decision with no backpedaling.

“There is no off switch, there is no pause,” Pinn says. “And that's great, because it means that you get the results that you need for your health. It can be unfortunate, because sometimes you just want to go and eat a whole bunch of nonsense.”

Like Ellis’ experience with GLP-1, Pinn endured extreme fatigue. A month after Pinn’s surgery, a half-mile walk at a Vegas hotel felt impossible.

“Every step was like, ‘All right, you're almost there. You can make it. Don't sit down. You sit down, you're gonna fall asleep. You're almost there,” Pinn recalls. “I would hit the wall on an energy basis very, very like, very suddenly, where I don't have the energy to function.”

Introducing Sadi-S

Influencer Remi Bader, who built her following based on her size, has since lost more than 100 pounds through GLP-1s and surgery.

"I tried Ozempic before it was even a thing," she told Khloé Kardashian on a podcast in March. "My doctor was just like, 'Oh, you're pre-diabetic, you should try this.' I lost probably, like 10 pounds, but I was really sick and threw up a lot from it."

In December 2023, Bader underwent single anastomosis duodenal-ileal bypass, or Sadi-S.

“Sadi-S is more of a malabsorptive procedure, so it's designed to be even more dramatic than a gastric bypass,” Sadler says.

The newer-to-the-market surgery, offered by Total Wellness & Bariatrics, is a hybrid of gastric bypass and the sleeve. It is comparable to a duodenal switch, a complex bariatric surgery that reduces stomach size and reroutes the small intestine.

Sadler says Sadi-S significantly limits the body’s ability to absorb nutrients, making a strict, lifelong vitamin regimen critical.

Bader described the surgery recovery as “brutal” to SELF Magazine. For six weeks, she couldn’t eat or drink and vomited constantly. According to SELF, her experience is an outlier.

“It's designed to bypass a large amount of intestine so that you're not absorbing the calories and sugar, nutrients and things like that, so that's how people lose such an extreme amount of weight with that procedure,” Sadler says. The procedure is ideal for those around 300 pounds with a body mass index of at least 35 to 40.

“We still see those same kinds of weight loss goals and achievement with just the sleeve or mini gastric bypass as well,” she adds.

The Trifecta

After losing weight on GLP-1s, Ellis began a self-administered case study. He intentionally regained weight, then introduced a targeted plan combining GLP-1 microdosing, resistance training, increased protein and a balanced calorie deficit. The results were drastically better.

He reached his goal weight again, but this time he maintained muscle mass, improved energy levels and avoided debilitating side effects. The approach became his basis for Voafit.

“My practice is to evangelize this method of taking these incredibly useful and powerful tools, but in a way that actually is helpful, avoids the side effects, doesn't sacrifice all your muscle mass, and you don't end up nutritionally depleted,” he says.

Ellis partnered with Recess Fitness Club, owned by fitness specialists and trainers Taylor Metzger and Evan Duncan, to launch Recess Rx. This program combines Voafit’s comprehensive GLP-1 management with a state-of-the-art fitness program.

Carter-Williams’ doctor managed dosage carefully, resulting in a slow, steady loss that prevented sagging skin. Her self-disciplined regime focused on protein and vegetables, walking, Pilates and low-impact weight training.

Paige’s trifecta is therapy, nutritional guidance and exercise regimen. For Pinn, it’s protein, family support and mental rewiring. His comorbidities are gone.

Ellis says only one Voafit patient needs the full GLP-1 dose. His patients are seeing results they’ve never seen before. He checks in weekly to oversee their journey.

Carter-Williams ended her three-year GLP-1 journey on March 14, the latest GLP-1 being Mounjaro. She lost 160 pounds. “I'm excited, but I'm also nervous because I want to be able to live without the medication, and I want to see how far I truly have come,” she told the Observer shortly after.

On May 9, the content creator posted an update on Instagram. Despite her appetite returning “with a vengeance,” she has not gained a pound. She credits her discipline and mindset.

“Remember the medicine helps you, it aids you, but it's not a magic wand. You have got to do the work,” she said online.