When bariatric surgeon Ashley Vernon, MD, takes on a new patient, she makes a deliberate and long-term commitment to that person. Vernon and the care team at the Center for Metabolic and Bariatric Surgery (CMBS) meet intensively with patients to develop a plan suited to each individual. They meet with patients not only for appointments leading up to surgery, but also for years or even decades afterward to help them address challenges and life changes.
Vernon has met patients who have committed to diet and exercise regimens but still have excess weight and face life-threatening medical issues. As a bariatric surgeon who specializes in minimally invasive surgery, she can offer them surgical options that can change their lives. But Vernon also wants to understand the underlying metabolic changes that caused her patients to remain obese before surgery, even after they had made lifestyle changes. These questions drive Vernon’s research in the lab and her collaborations across the Brigham and beyond.
A Place to Innovate
When Vernon joined the Brigham 15 years ago straight out of training, the concept of minimally invasive bariatric surgery was new. Academic institutions were just beginning to bring on new faculty trained in laparoscopic techniques. Vernon wanted to join an institution that was not only open to the concept but also wanted to support innovative and cutting-edge ideas.
“I came to the Brigham because I wanted to be part of a department that would allow and support innovation,” she said. “The Department of Surgery and its surgeons had a great reputation and a long history of pioneering new procedures. My mentor for my fellowship knew many of the people here, and thought they would be a great group for me to work with.”
Vernon’s interest in the field was piqued while completing her residency at the University of Alabama Hospital in the late 1990s and learning about the pioneers in minimally invasive gastric bariatric surgery. She also learned about new research suggesting that weigh loss surgery was the best treatment for patients with Type 2 diabetes. Emboldened by both concepts, she wanted to find a fellowship that would allow her to learn how to perform weight loss surgery procedures laparoscopically, enabling patients to be discharged to home in only a few days. But only a few formal fellowships and no clear career track existed then. Instead, she picked up the phone and began making calls, looking for a mentor who could teach her.
Her mentor in residency, Keith Georgeson, MD, a pioneer of pediatric laparoscopic surgery, connected her with bariatric surgeon John Hunter, MD, who trained Vernon at Oregon Health and Science University to complete procedures in adults. Hunter, in turn, helped her connect with the Brigham, specifically with David Brooks, MD, Stan Ashley, MD, Francis “Chip” Moore, MD, and Michael Zinner, MD.
“They told me, if you come to the Brigham and work on innovative projects, we will support you. That was very comforting,” said Vernon.
Driven by Questions
Vernon is selective about the research projects she takes on–just as she commits to her patients, she also commits herself to the research questions she pursues for the long term. During a recent interview in her office in the General and Gastrointestinal Surgical Suite, Vernon smiled, pausing for a moment to think about some of the research questions she has pursued in her 15 years as both a surgeon and a researcher at the Brigham.
“I will wait a long time for a good question,” she says.
Those questions have included: What role might the microbiome be playing in obesity and Type 2 diabetes? How effective is bariatric surgery in helping patients sustain weight loss and improve glucose control? Vernon, who has access to unique and robust samples from bariatric surgery patients who have agreed to participate in research, also collaborates with others on projects related to asthma, the interplay of the immune system/natural killer cells with obesity and more. At the Brigham, she’s found a place where she can pursue these questions and collaborations while also helping patients lead healthier lives.
One of the projects in which Vernon has played an active, long-term role measures the effectiveness of bariatric surgery compared to intensive medical and weight management for treating patients with diabetes and obesity. Previous work has suggested that such procedures may have a greater effect on glucose control than weight loss alone, suggesting that surgery may be an effective treatment for diabetes among patients who are also obese. The research team has found that after three years, surgery produced greater weight loss, better blood sugar control, reduced cardiovascular risk and improvements in obesity-related quality of life in obese patients with diabetes.
The study is a collaboration with Joslin Diabetes Center, which has given Vernon the opportunity to work closely with leaders from the Joslin as well as BWH statisticians and others. The study, known as Surgery or Lifestyle with Intensive Medical Management in the Treatment of Type 2 Diabetes (SLIMM-T2D), began in 2010. Since that time, several other institutions have begun collecting clinical evidence on how effective bariatric surgical techniques are for resolving or reversing diabetes and obesity. These institutions have come together to form the ARMMS-T2D (Alliance of Randomized Trials of Medicine vs Metabolic Surgery in Type 2 Diabetes). Last summer, ARMMS-T2D receive a major grant, and the consortium plans to pool their evidence and publish papers powered by their combined data.
“My collaborators on this project, including Dr. Mary Elizabeth Patti from Joslin, have been incredible,” said Vernon. “The opportunity to collaborate is another thing that drew me to the Brigham.”
Vernon welcomes additional collaborations and hopes that her collection of patient samples will help her and her colleagues better understand both the treatment for and the basis of diabetes and obesity.