This month, we’re thrilled to recognize Rachel Allio, MS, RD, LDN, one of our valued Orgain Healthcare Advisory Panelists. Rachel has been an active Orgain Healthcare Ambassador and currently sits on our Healthcare Advisory Panel where she provides consulting support, insights and expertise to the Orgain Healthcare team. She specializes in bariatric and metabolic surgery helping patients realize their health and functional goals with nutrition.
Rachel Allio, MS, RD, LDN – Interview
- Please tell us a little bit about yourself personally and professionally so that our readers will be able to “get to know you.”
I am a Registered Dietitian Nutritionist specializing in Bariatric Surgery. My background is a bit eclectic. I have a degree in fashion and textile merchandising, and I’ve worked as a bartender, a radio DJ, and a bank teller. My favorite memories from my past jobs center around interactions with other people. I enjoy working with people, so when I made a career change, that was very important to me. I’ve been an RDN for almost 15 years now and have spent the last 10 -11 years specializing in Bariatric and Metabolic Surgery in West Virginia and southwest Pennsylvania. It’s such a unique specialty in that I get to follow along with patients on their journey and help them explore how nutrition impacts how they feel and function. I love that I get to keep my patients forever!
Beyond professional life, my 2 kids in elementary school and my college-sports loving husband keep me hopping! When I’m not busy with sports, you can usually find me at my local Crossfit gym or working on some kind of textile art.
- How has your work in Bariatric and Metabolic Surgery been impacted with the rise in popularity with GLP-1 medications?
Firstly, it’s great to have these new tools- especially for those who can see the improvements in health they need or desire with modest, but still significant weight loss. West Virginia has the highest prevalence of obesity in the US- 41.2% reported by CDC for 2023!
While I don’t have the specific numbers to quote, increased availability of GLP-1 RAs decreased our surgical volumes. Over the past 1-2 years, my team has seen fewer patients in the BMI 35-45 range seeking surgery. We have relatively more patients with a BMI >50 considering surgery, many with complex medical histories.
Toward the end of 2024, many patients with commercial insurance in WV and PA lost coverage for these medications. Payers are limiting coverage for obesity and tightening criteria on “medical necessity”. I know individuals that have been stretching out doses or purchasing compounded versions from Med Spas to maintain their loss. Inevitably, it becomes too much to pay out of pocket. I am starting to see those folks back in my clinic- struggling both physically and mentally with weight recurrence. Obesity is a chronic disease-if you stop treatment, you lose most of the benefits of that treatment. And so, medication access impacts the ebb and flow of Bariatric and Metabolic Surgery. Surgery remains our most durable option for long-term weight loss.
- For those of your patients on GLP-1 medications, have they experienced nutrition related challenges and if so, can you share about interventions that have been working, and have any of those included Orgain products?
Many of the nutrition challenges for individuals on GLP-1 RAs mirror the concerns for my post-op bariatric surgery patients. Early satiety and decreased hunger cues are expected. While those are welcome side effects for those that struggled with hunger/fullness and food noise prior to medications, significant undereating or chronic sub-optimal eating has negative effects. The first step in my intervention is to discuss the “why”. Why do you want to lose a significant amount of weight? Nine times out of ten, the answer involves some type of functional or physical change: do more with my kids or grandkids, walk without getting short of breath, lose enough to have knee replacement. Yes, it’s awesome to lose weight, but if you can’t function and you don’t feel better, the goal is still not realized. That really opens the door to discuss how nutrition impacts those goals. Whether medications or surgery – I discuss their most basic needs- enough energy to do what they want to do, enough protein to keep as much lean mass as possible, and (of course) adequate fluid. There is a lot of motivational interviewing, goal setting, planning, and problem solving that goes on in clinic. Many patients come to their own conclusion: that they just cannot eat the amount of protein that they need, so we talk about alternative sources. Nutrition supplements are an easy, time-effective solution for many patients. I’m really excited to see Orgain’s 30g protein shakes and powders now available!
