Parallel Evolution: One Surgeon and One Society

| February 1, 2015

This column is dedicated to sharing the vast knowledge and opinions of the American Society for Metabolic and Bariatric Surgery leadership on relevant topics in the field of bariatric surgery.

This month: The ASMBS Presidency Entrance Interview of Dr. John Morton

John M. Morton, MD, MPH, FACS, FASMBS
Chief of the Section of Bariatric and Minimally Invasive Surgery,
Stanford University, Stanford, California, and President, ASMBS

Bariatric Times. 2015;12(2):8–9


Dr. Rosenthal: Dr. Rosenthal: Dr. Morton, please provide a brief background on your personal and professional life.

Dr. Morton: First, there are two things that some people may not know about me: 1) I was born in Montgomery, Alabama, and 2) I have a Spanish heritage. My mother is from El Salvador, so I grew up speaking Spanish as my first language and English second. During my childhood, we visited El Salvador every summer. Today, I still speak Spanish and find it helpful in communicating with my Spanish-speaking patients, especially when explaining food and lifestyle changes (e.g., talking about foods that are prominent in a Spanish diet like corn tortillas).

I attended Sidney Lanier High School where I was a National Merit Scholar and voted Most Likely to Succeed. After graduating high school, I attended Tulane University in New Orleans, where I received my undergraduate, Masters in Public Health, and Medical Doctor Degrees. I then received a Masters in Health Administration from University of Washington, Seattle, Washington. It was during my time in Washington that I began thinking about surgery, especially how it is connected to the public’s health. Surgery is at the forefront of public health as the treatment for one of the largest public health problems—obesity. Surgeons are the tip of the spear as the first responders to the obesity epidemic. With my background in public health, pursuing bariatric surgery just fit. Also, medicine is part of my family history as my grandfather and great grandfather on my mother’s side were surgeons.

As a surgical resident at Tulane, I was the first surgical resident to receive a Robert Wood Johnson Clinical Scholar Fellowship in the program’s history. After studying in Washington, I moved to Chapel Hill, North Carolina to complete an advanced laparoscopic fellowship at University of North Carolina. When I started there, they were just starting laparoscopic bariatric surgery. I trained with Tim Farrell and together we learned how effective bariatric surgery was.

I had an interest in bariatric surgery because 1) it involved interacting with patients and addressing a public health need, and 2) it presented technical challenges for surgeons. I was most impressed with how bariatric surgery allowed me to witness amazing results; weight loss and comorditiy improvement or complete resolution. The surgeon ethos is to provide definitive care and I think bariatric surgery does that. I will never forget the first patient on which I performed weight loss surgery. It was incredible to see her after the Roux-en-Y gastric bypass procedure. Prior to the operation, she had type 2 diabetes mellitus and other comorbidities. When I saw her during follow up, she was completely off of her diabetes medications. I was stunned and hooked!

While at the University of North Carolina, Stanford University recruited me to start a bariatric program. From there, Stanford went from “zero to hero” in bariatrics, building volume, publications, and credibility in the weight loss surgery world.

Dr. Rosenthal: Back then, did you think that you would become President of the American Society for Metabolic and Bariatric Surgery?

Dr. Morton: Becoming President of the ASMBS was a goal that never entered my mind. I attended my first ASMBS annual meeting in 2002. I loved the organization because it was focused on disease treatment. The society had a pure motive, which got me more excited about bariatrics. I started to become more involved in the ASMBS annual meetings by presenting. During one meeting, Dr. Harvey Sugerman, a bariatric leader, approached me to help with the new at that time ASMBS journal Surgery for Obesity and Related Diseases (SOARD). This was a great honor. Other prominent leaders in ASMBS encouraged me along the way. Dr. Robin Blackstone and I had a shared passion for patient access. Dr. Phil Schauer also expressed that he wanted to see me do well and has also been a great mentor. Dr. Bruce Wolfe went to Stanford University and we became friendly attending basketball games together. He is my greatest role model to whom I owe much.

When I was National Chairman for Access to Care and Data Dissemination for the ASMBS, we always asked, “How can we do better?” I think we are all answering that and I am very proud of the work we have done as a society. We are an example of a society that puts everything on the line for its members and patients. We’ve excelled in quality and improvement. We were doing the team approach before everyone else, which represents the epitome of medicine—safety, efficacy, and collaboration.
To get back to your question, I use the following phrase a lot: “The bariatric surgery evolution is perfectly timed with my evolution as a surgeon.”

Dr. Rosenthal: What do you hope to accomplish during your term as ASMBS President?

Dr. Morton: We are in a unique position because we are all getting to see bariatrics at its creation. We are present during great milestones, such as the American Medical Association declaration of obesity as a disease. We’ve made so much progress and we are still building.

I have five main priorities: 1) mainstream bariatric surgery, 2) increase membership, 3) increase access to care, 4) improve quality and safety, and 5) increase physician referrals. There are many initiatives going on right now aimed at achieving these goals. One event that helps to meet these priorities, especially the hope to increase physician referral is The Obesity Summit, which started in 2014 and will occur again in 2015.

The Obesity Summit is a unique opportunity for thought leaders across multiple disciplines (e.g., endocrinology, cardiology) to interact and discuss the problem of obesity. Last year, 26 medical societies met and developed guidelines that all healthcare providers can use in care and treatment of patients with obesity. We hope these create a model that ensures everybody gets care.
We have done a terrific job in decreasing the mortality rate, but more work needs to be done in decreasing hospital readmissions.

The Decreasing Readmissions through Opportunities Provided program or DROP program aims to mimic Stanford’s success in decreasing 30-day readmissions by providing more evidence-based resources, including best practice toolkits. Modules will include best practice information on important areas in bariatric surgery that may directly impact re-admissions (e.g., surgical site infections, types of antibiotics used, and dietary recommendations). Accredited centers have been invited to participate and we estimate this program will have a lot of success.

One way we are mainstreaming bariatric surgery is through a motivational video that can be viewed on www.asmbs.org. The video is called “It Starts Today: How Obesity Surgery Helps People Reclaim Their Lives”. We encourage everyone to share the video with colleagues and patients. We are also planning to do more public service announcement type projects such as this video, with a focus on reaching patients. (ASMBS website also features a “href=”http://bariatrictimes.com/wp-content/uploads/morton-feb15-2.jpg”>”Patient Learning Center”)

Two other initiatives focus on patients. We are working on a patient portal where patients share their stories, including what procedure they underwent and how it changed their lives physically and mentally. It is similar to the National Football League’s “Together We Make Football” and “Why We Love Football” projects. If my life was changed by just one patient, imagine how these stories will amplify change in patients and potential patients. We are calling this portal, “This Time It Counts!”
We are also working to increase patient engagement. During ObesityWeek 2015, we will be holding what we call “The ObesityWeek Film Awards.” We plan to sponsor a film competition where film students submit movies on obesity awareness and treatment. We will debut the videos and name the winner in Los Angeles during ObesityWeek 2015.

We are working on a few other initiatives too, including more outreach and collaboration with China and Latin America. We are looking at producing a curriculum on the essentials of bariatric surgery. We want our field to be enduring, so we need to make sure that the torch is carried forward by the next generation. There is a public education app in the works as well as massive online courses.

A lot of efforts are also being put forth to recharge the ASMBS Foundation and increase Foundation resources.

Dr. Rosenthal: What areas of research do you foresee being important in 2015? Are you involved in any research currently?

Dr. Morton: Stanford has a very active research team. I help with the Medical Scholars program. The program comprises 25 students over 10 years who study everything from aging to quality improvement. I think that much research has proven that bariatric surgery works. Now, we are seeing more research into answering why it works. We are now studying the many effects of bariatric surgery, exploring the fundamentals of the human condition, which makes this research very exciting.
I think the future will bring three things: 1) a further refinement in our treatments, 2) mechanistic research, and 3) focus on how to build complimentary treatments. As in treatment of cancer and heart disease, we now have multiple therapies (medications and devices) to pick and choose from. I think it is great and it will allow us to be even better. We have a real continuum of care—nutrition counseling, psychological counseling, exercise specialists, medications, and surgery—all working toward a solution to obesity. Ultimately, the medical home for the patient with obesity will be the bariatric surgery center. It is an exciting time to be in obesity treatment and we are looking forward to growing.

Dr. Rosenthal: It sounds like there is a lot going on in the ASMBS. How do you have time to do it all?

Dr. Morton: First, being President of the ASMBS is an enormous honor. It is a career culmination and a dream come true. As with anything that you are passionate about in life, you make the time. I also have a lot of help from the staffs at Stanford and the ASMBS. I thank them for their help and support. It is a team approach and I am truly grateful to all those who have helped and continue to help along the way.

Funding: No funding was provided in the preparation of this manuscript.

Financial disclosures: The author reports no conflicts of interest relevant to the content of this article.

Category: Ask the Leadership, Past Articles

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