MEET THE MASTER:

Dr. Walter Pories

Each year the American Board of Obesity Medicine is pleased to honor a physician who has made significant contributions to the science, practice and/or advancement of obesity medicine with the Master of the ABOM award. Next month, William H. Dietz, M.D., Ph.D. will receive the 2015 Master award. ObesityWeek attendees are encouraged to come show your support when the award is presented to Dr. Dietz during the TOS Awards session that takes place on Thursday, November 5 from 8:30-10:30 AM. Previous winners of the Master of the ABOM award include Dr. Walter Pories (2014), Dr. Donna Ryan (2014), Dr. George Blackburn (2013), and Dr. George Bray (2013).

In the occasional “Meet the Master” series we invite you to learn more about one of these amazing pioneers. Below, Dr. Walter Pories sheds light on his distinguished career in obesity medicine.

How did you become interested in obesity medicine? I’ve had a lot of interests but obesity was never one of these. When I came to East Carolina University to help start a new medical school as the first chairman of surgery, I was primarily interested in oncology and cardiothoracic surgery. As it became apparent that there were no pediatric surgeons, I took on that responsibility and delighted in the care of children.

My research area was also not in obesity. I had surprising success (or you could just call it plain luck) in studies of the role of trace elements in animal and human nutrition. In fact, I had been recruited with the understanding that there would be ample research funding to follow that direction. Well, that was not to be. In 1978, about a year after I came to ECU, the dean told us that the research funds had been used to build the medical school and that we, as chairs, should collaborate and, “like an institute”, focus on one area. He was barely out the door when the other chairs agreed quickly to study “obesity.” It was certainly an appropriate goal for an area that has the highest prevalence of obesity in the US, but what, possibly, could a surgeon offer?

As we reviewed the literature, we were not encouraged. Over the previous decade, surgeons performed over 30,000 jejuno-ileal bypasses, operations that excluded all but 18 in. of small bowel — procedures that were successful in producing weight loss but which also caused severe nutritional deficits, liver failure, renal stones and severe problems with mineral balance. Many patients died. It was certainly not a path that we would follow.

Accordingly we looked for another solution and were intrigued with the description of Dr. Edward Mason, the founder of the field of bariatric surgery, of a gastric bypass. Because the field was so new, aware that we needed to learn more, we decided to perform a standardized version of the gastric bypass, to provide care in line with a detailed protocol and to follow every patient closely. We managed to maintain a 92% follow up in 837 patients from 1980 – 1996, still the longest follow up of a currently utilized procedure in the world, a series that documented that the operation produced long-term weight loss with a mean of 106 lbs., full and durable remission of type 2 diabetes and a reduction in mortality of 83%. As I said, we were just lucky. Nothing like total ignorance to guide you in the right direction.

Later, as it became apparent that the results in the US and the world were variable, we started the Centers of Excellence program in which 425 institutions had to earn certification of surgeons, nursing staff, and hospitals and document evidence of good outcomes. With that approach, we were able to reduce the mortality of bariatric surgery to 0.3%, identical to the mortality of routine cholecystectomies even though these patients were far sicker. To put that mortality rate into focus, it is helpful to realize that the mortality of a normal delivery in the US is 0.1% and colectomy is 4 – 6%.

How has the field of obesity medicine changed during your career? It’s certainly made it even more interesting and fun. In pursuing that field, I was still able to practice pediatric, thoracic and oncologic surgery and run my department. It also led to a far better understanding of diabetes and many great friendships.

What do you think the future of obesity medicine looks like? Unfortunately, there is no shortage of patients. The current epidemics of obesity and diabetes continue to increase to the point where, now, in the US, one of every four adults has type 2 diabetes.

It is a great challenge and surgery, while remarkably effective, cannot be the only answer. We cannot operate on everyone in the world with these diseases. The exciting part of the current advances in surgery is that we, finally, have a chance to find the answer to better treatment for the world’s most serious, costly, cruel and deadly diseases. Surgery provides new and previously unimagined opportunities to understand the mechanisms behind these illnesses. Just imagine that now, for the first time, we can study a patient with diabetes and then the same patient without it. The outcome data from the surgery have also introduced an important new concept, i.e. that obesity, diabetes, hypertension, hyperlipidemia and even PCOS are not all separate, individual diseases but probably expressions of a “metabolic syndrome” that may be due to one metabolic defect. We now have to find that molecular error.

What advice do you have for someone considering whether to become an ABOM diplomate? It’s not a question of “whether” but of when. The physician who is armed with the most recent knowledge, who belongs to a group that is doing its best to serve, who cares enough to be well informed, will also have the best results and provide optimal care to his or her patients. Becoming a diplomate of a certifying board such as the ABOM is recognized world-wide as the indicator of professional excellence in medicine.

What has been the best part of being involved with the field of obesity medicine? The great satisfaction of providing effective treatment for cruel, disabling diseases that were previously deemed incurable and in which the recommended therapies had little effect. To see patients’ eyes moisten with tears to thank you, to have spouses ask to give you a hug and to see their children replace disdain with real affection and pride is a wonderful reward.

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