EASO Congress Speaker Spotlight: Dr. Philip Schauer

Philip R. Schauer, MD, is Chief of Minimally Invasive General Surgery and Director of the Cleveland Clinic Bariatric and Metabolic Institute. He is also Professor of Surgery at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. He is immediate Past President of the American Society for Metabolic and Bariatric Surgery.

After receiving his medical degree from the Baylor College of Medicine in Houston, Dr. Schauer completed his residency in surgery at the University of Texas, where he served as Chief Resident of General Surgery. He then completed a fellowship in laparoscopic surgery at Duke University Medical Centre in Durham, N.C. Prior to joining Cleveland Clinic in 2004, Dr. Schauer served as Director of Endoscopic Surgery, Director of Bariatric Surgery and Director of the Mark Ravitch/Leon Hirsch Centre for Minimally Invasive Surgery at the University of Pittsburgh Medical Centre.

Dr. Schauer’s clinical interests include surgery for severe obesity, minimally invasive surgery (laparoscopic) and gastrointestinal surgery. He has performed more than 4,000 operations for severe obesity. His research interests include the pathophysiology of obesity and related diseases, physiologic effects of laparoscopic surgery on postoperative injury and recovery, and outcomes of laparoscopic management of obesity, gastrointestinal diseases and hernias. He has also participated in the development of new minimally invasive, endoscopic and laparoscopic operations.

New concepts in surgical training and education have been a major focus of his educational interests. He has authored more than 200 scientific papers, editorials, textbook chapters, abstracts and video productions. He has been an invited speaker for more than 100 regional, national and international lectures on the subject of obesity surgery and laparoscopic surgery. He has been on the board of Governors of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) for the last 5 years.

You have been named one of the Best Doctors in America for 5 consecutive years. That’s really impressive!  Please tell us a bit about yourself; where are you from, where did you grow up? Where do you live now and how long have you been with the Cleveland Clinic?

I was born in Phoenix, Arizona but spent my childhood in Fairfax, Virginia until my second year of high school. In the late 1970s, my family moved to Dallas, Texas, where I finished high school. I completed my undergraduate education at Texas A&M University and then went to the Baylor College of Medicine in Houston, Texas. I did my surgical residency training at the University of Texas at San Antonio and later my fellowship in advanced laparoscopic surgery at Duke University,  in Durham, North Carolina. In 1995, I started my career at the University of Pittsburgh and stayed there for 10 years prior to joining Cleveland Clinic.

You have held several high profile clinical  posts, focusing on surgery for severe obesity and minimally invasive surgery. How did your original interest in obesity surgery develop?

After completing my fellowship in advanced laparoscopic surgical training at Duke, I became interested in the use of minimally invasive surgery (MIS) for bariatric patients. I realised the benefits of MIS to those patients – a less invasive operation with reduced morbidity and mortality. At that time, I also noticed how surgical weight-loss operations improve the quality of life of patients suffering from obesity and associated core morbidities, like diabetes.

After discovering that gastric bypass surgery quickly and dramatically improves diabetes, I became interested in developing a randomised clinical trial, now known as STAMPEDE, to directly compare surgery to medical treatment. The study has elucidated many important aspects of metabolic surgery, which has led to a much greater understanding of the pathophysiology of obesity and type 2 diabetes.

Our readers would enjoy learning about your favourite activities, hobbies, and interests outside of your professional work.

I enjoy spending time and traveling with family. I am fond of outdoor activities such as running, swimming, biking, and hiking.

Your reputation for innovation in obesity surgery is world renowned. Can you tell us briefly about the latest concepts in surgery education and  training you are involved in?

I use modern technological advances to conduct telemedicine-based conferences. Thanks to the internet, physicians and scientists around the world can share ideas from their home or office.

Opportunities to develop new procedures and medications to treat obesity have never been greater. I am optimistic about the future and our ability to prevent and treat obesity as well as associated co- morbidities in the years to come. Obesity is a disease that has risen to a high level of importance, and countries around the world need to pay attention.

Spotlight Interview: Ruth Loos, PhD

Ruth, please tell us a bit about yourself; where are you from, where did you grow up? Where do you live now? I see that you have had diverse training and experience – and your pathbreaking work at the MRC in the genetic aetiology of obesity moved the research paradigm forward. How did your original interest in the field develop, and how did you come to focus on epidemiology?

FullSizeRenderI’m from Belgium and grew up in a small town near Antwerp (called Schilde), in the Flemish/Dutch speaking part of Belgium, where my parents had a bakery. I am the youngest of four and have two brothers and one sister.

I did all my higher eduction at the University of Leuven, the oldest and one of the largest Universities in Belgium. Because I was keen on becoming a high school PE teacher, I decided to study “Kinesiology”. However, early in my studies my interest shifted towards more research oriented courses. After completing my BS and MS in Kinesiology, I had the opportunity to become a Research Associate in the department of kinesiology to work on a longitudinal twin study for which I tested the physical fitness, body composition and body shape of “growing” twins between 10 and 18yrs old every 6 months. This twin study piqued my interest in genetics and I learned how to perform heritability analyses. Soon thereafter, I had the opportunity to embark on a PhD focusing on the “fetal origins of adult disease” hypothesis using twins. The twin design allowed me to disentangle the contributions of genetic, maternal and environmental factors contributing to the early origins of disease.

After my PhD, I was awarded a one-year postdoctoral fellowship from the Belgian American Educational Foundation (BAEF), which allowed me to work with Dr. Claude Bouchard at the I very much enjoyed my research there and was able to extend my stay thanks to a fellowship from the American Heart Association.

After 3,5 years, I joined the then recently established MRC Epidemiology Unit, where I had the opportunity to lead the work on the Genetics of Obesity. I was fortunate that the Unit had just invested in the genotyping of 3,000 individuals from the EPIC study, which at that time (in 2005) was still very expensive. This data proved extremely valuable for the discovery of genes for obesity (and many other diseases and traits).

In 2011, I had the opportunity to return to the USA, to become a Professor of Preventive Medicine at the Icahn School of Medicine at Mount Sinai in New York, where I lead a research Program that focusses on the Genetics of Obesity and Related Metabolic Traits.

Our readers would enjoy learning about your favourite activities, hobbies, and interests outside of your professional work:

I love being physically active [that must be my “kinesiology” past]. I am an avid runner; I run one loop in Central Park before work. I also sail in the summer on the Hudson River, I cycle to work (or to anywhere in New York City). I love attending performances of dance, preferable modern dance, and would also attend musicals more often if they weren’t so expensive.

I see that you are  Professor, Department of Preventive Medicine – Director, Genetics of Obesity and Related Metabolic Traits at the Ichan School of Medicine at Mount Sinai. Preventive medicine is perhaps a more common designation in the USA?

I think Preventive Medicine captures the “Epidemiologists”, at least at Mount Sinai; my primary institute and work place in the Charles Bronfman Institute for Personalized Medicine. Our main data resource here is the BioMe Biobank, which is an EMR-linked biobank that currently include data from more than 33,000 individuals from New York. BioMe is extremely data rich and captures the enormous diversity of the City.

Your global reputation in obesity science is longstanding. Can you tell us about your current research interests? 

My current work focusses on rare genetic variants, that may alter protein function, and as such increase risk of obesity. With the GIANT consortium, we have identified already a few of such variants; for example a variant that is carried by 1 in 10,000 people increases body weight by around 8kg.

Another interest, sparked by a gene discovery study in 2011, is the discovery of genes that increase body weight but which nevertheless protect against diseases such as type 2 diabetes and cardiovascular disease.

Even though I have focused my work on genetics for the past 10 years, my interest in obesity is nevertheless very broad.

Dr. Ruth Loos is Director of the Genetics of Obesity and Related Metabolic Traits Program, in The Charles Bronfman Institute of Personalized Medicine of the Icahn School of Medicine at Mount Sinai.

Her primary research interests focuses on the identification of genes and genetic loci contributing to the risk of obesity and related metabolic traits. She has been involved in gene-discovery since 2005, when ‘genome-wide association’ was introduced and has since actively contributed to many consortia that use this approach to identify genetic loci for a large number of metabolic traits. Increasingly, her gene-discovery work also focuses on the identification of low-frequency variants through the implementation exome-chip genotyping and sequencing projects, not only in individuals of white European descent, but also in those of African and Hispanic decent. ​

Besides gene-discovery, Ruth uses epidemiological methods to follow-up on established loci with the aim to elucidate the pathways through which they increase risk of metabolic disease. Furthermore, her work also assesses the public health implications of the established loci by examining their predictive value and their interaction with lifestyle factors such as diet and physical activity.

EASO Patient Council Spotlight: October 2014

Spotlight on Mieke van Spanje

Mieke van SpanjeMieke, please tell us a bit about yourself.

I am now 63 years old and I am morbidly obese.

I was born as a rather large baby but became obese at age 6, after a serious disease.
My first diet was when I was 17. I lost 35 kilos, but gained 40 over the next years. When I stopped smoking another 15 kilos were added.

Is this who I am? Unfortunately my weight is a large part of my personality. So yes, this is who I am.

But I am also: single, a social worker professional, and a pensioner since age 38. I worked as a volunteer in several organisations, such as the Dutch version of OxFam, our local Cultural Centre and of course the Dutch Obesity Society.

I am rather shy and clumsy on social media. However I read the messages.

I have a sister and a nephew and niece; they are my closest relatives.

Where do you live?

I live in Roermond, a small city in the very south of the Netherlands. I live alone in my own house with a garden and nice neighbours.

Can you please share some of your interests with us?

I love opera and science fiction (books more than movies), for example The Vorkosigan Saga.
I cannot imagine a live without opera or other music. My favourites are classical music (though no Bach however!), world music and almost every opera composer from Monteverdi up to Philip Glass. I think the music is more interesting than the stage performance.

I have an absolute dislike of all music used in gyms to accompany exercise. (I often wonder if I
would like to exercise more if it were accompanied by better music!)

I love to travel and go on holidays in cities. I feel more safe and comfortable there than in the
countryside. I find it fascinating to see the way cities, houses, factories, farms or roads are built
and how humans influence the environment. I love to swim but I hate to go to a swimming pool.

Please share with us what your personal experience of obesity been like.

Obesity is a chronic disease. Some people may be (over a period) free from the visible
characteristics, but the disease is still there.

Accepting this is very hard, mostly because the society around us keeps focusing on nonacceptance and on weight loss.

My mother, however much she loved me, gave me the idea that being obese was wrong and ugly. It took me almost 50 years to overcome this and start appreciating myself. These kinds of opinions of obesity marked my life in a very negative way. And I hate to see that this is the case with so many people.

Please tell us how you currently advocate for patients and hope to support people who experience obesity in the future. Do you have advice to share?

Accept yourself and your obesity. That can be a new starting point for your life and the way you
can address the world.

One can only influence other people to accept, respect and appreciate you if you accept, respect and appreciate yourself, just the way you are. I do not want to say that you should stop loosing weight. That is absolutely every one’s personal decision.

On an individual level we should start accepting obesity as a part of our lives, even when it is no
longer visible to the world outside. I want to focus on personal acceptance and Health At Every
Size.

We need rights for the obese, not only as patients but as members of our society.