Lorena Ramirez: Weight Loss with an Endoscopic, Non-surgical Procedure and GLP-1 Treatment
January 9, 2026
Lorena Ramirez struggled with obesity and the health issues that often accompany it. She'd undergone the Roux en Y gastric bypass surgery, but following surgical success, she regained 80 pounds after losing 110. Overcome by intense stress, she'd spiraled into food cravings to help placate her emotions around the many challenges she faced in life.
"I heard about the TORe procedure offered by triple board-certified physician Dina Ahmad, MD, ABOM. She specializes in gastroenterology, internal medicine and obesity medicine. I was surprised to learn I was a potential candidate for a reduction, so I was intrigued."
Lorena scheduled a consult with Dr. Ahmad and in the meantime, she started a GLP-1 through Anita Makowski, PA-C, of WakeMed Primary Care – Fuquay Varina Judd Parkway, to help curb her cravings and encourage weight loss.
The Decision to Move Forward with Transoral Outlet Reduction (TORe)
During her appointment with Dr. Ahmad, she was pleased to learn that she'd lost weight with GLP-1s. She then discussed with Makowski if it would be necessary for her to undergo the TORe procedure.
"Because I'd stretched my stomach when I overcame the gastric bypass, I was eating a good amount of food again. I wanted to curb my intake, so I felt the TORe would be important to help with that."
Lorena agreed to the procedure and began her prep work. The most notably positive aspect of the procedure prep for her was the accountability required. This level of support was not necessary with GLP-1.
"I had several appointments to physically, mentally and emotionally prepare for the procedure."
The Support of a Dedicated Team of Specialists
Lorena met with a dietitian who explained her post-procedure diet would involve progression over several weeks from a liquid diet to a soft foods diet and eventually to solids. Prior to the procedure, she was doing great with managing her preparatory weight loss because the GLP-1 was helping her curb her appetite, so she didn't have to go through a drastic change in diet in advance.
She had an assessment with a psychologist with whom she discussed why her gastric bypass failed and how to manage her emotions without turning to food.
Lorena also met with an exercise specialist who gave her tips to tone her body during her weight loss.
She visited a cardiologist to ensure her heart was strong enough to undergo the procedure.
Additionally, she visited her primary care provider to make sure her labs and vitals were in a safe range for the procedure.
"I was grateful for all the assessments and accountability. I especially appreciated the visits with a psychologist to help with my mental health and the opportunity to join a support group with others undergoing weight loss surgeries and procedures."
Procedural Success
Lorena's TORe was in August 2025 at WakeMed Cary Hospital. The entire process was just three hours — from the morning consult with the anesthesiologist to awakening from the procedure.
"I was really excited and nervous going into my procedure that morning, but Dr. Ahmad and the care team put me at ease. When I awoke from the procedure, I was extremely nauseous, but the nurses were incredibly attentive and offered me nausea medicine. I was discharged from the hospital just two days later."
Following her procedure, Lorena continued to engage with the psychologist, dietitian and support group to help her navigate post-procedure recovery. Within three months, she'd lost 23 pounds.
"I was pleased with my weight loss because it wasn't so drastic. I also felt a lot better while losing the weight. In fact, I got more compliments and recognition for my weight loss after TORe than after gastric bypass — that resulted in a much faster weight loss. The combination of GLP-1s and TORe were the ticket for me. GLP-1s helped mellow the craving a bit, and TORe helped reduce my appetite. The cravings for the wrong kinds of food are still there — even with GLP-1s, but TORe provided a great support system to help me make better choices during stressful times. The support I received with TORe helped me retrain my brain around eating."
The Courage to Keep Working
When Lorena experienced a plateau in her weight loss at 23 pounds down, she felt discouraged, but Dr. Ahmad and team reminded her to pay attention to other changes, such as if her clothes were fitting better and if she was seeing a continual loss in inches around her waist.
"After they helped me focus not exclusively on the scale, I was able to stop stressing and quickly lost six more pounds. Today, I'm a lot healthier. My A1C is back to normal. My liver enzymes have normalized. I feel significantly better. I move easier and have been able to do more walking. My body mass index has decreased from 46 to 38."
In reflecting on her most recent weight loss journey, Lorena credits Dr. Ahmad with giving her back her health.
"She really cares about me. She checks up on me and has remained very involved. The day of my procedure, she greeted me before and visited me afterwards. I wouldn't want to go to anybody else for my weight loss journey."
About Weight Gain after Roux-en-Y Gastric Bypass
TORe is a non-surgical procedure to help you hit the reset button on weight gain after Roux-en-Y bariatric surgery. It happens. You took a big step to shed that impossible-to-lose weight by having Roux-en-Y bariatric surgery. Yet several years after your procedure, you start to gain weight. This can happen because the opening between the stomach and small intestines that your surgeon created with Roux-en-Y surgery stretches over time. And, no matter what you try, you continue to gain weight. If you have a body mass index (BMI) between 30 and 50, there’s a good chance you are a candidate for a non-invasive revision procedure called transoral outlet reduction (TORe).
About WakeMed Primary Care
WakeMed Physician Practices features board-certified primary care, internal medicine and family medicine physicians conveniently located throughout the Triangle.
Our exceptional and compassionate providers and care teams pride themselves on developing long-term relationships with their patients and their families.