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Big Deal: Dr. Philip Schauer is putting Pennington on the global map

Dr. Philip R. Schauer is kind of a big deal. It says exactly that on a nameplate behind his desk at Pennington Biomedical Research Center, which recruited Schauer from the Cleveland Clinic to develop a world-class bariatric surgery program in partnership with Our Lady of the Lake Regional Medical Center.

The nameplate offers a pretty good snapshot of the pioneering surgeon. The director of Pennington’s new Bariatric and Metabolic Institute is a big deal but does not act like one.

You can’t get through Dr. Schauer’s credentials in one breath. He has completed more than 8,000 surgeries for obesity and diabetes. He is the author of 350 scientific papers, 60 textbook chapters and three textbooks on obesity and bariatric, metabolic and gastrointestinal surgery.

Schauer is equal parts towering figure in medicine and down-to-earth regular guy. | Tim Mueller photo
Schauer is equal parts towering figure in medicine and down-to-earth regular guy. | Tim Mueller photo

His research has appeared in the New England Journal of Medicine. His more than 3,500 research citations and awards include recognition from the Wall Street Journal and the Cleveland Clinic, which presented him with the 2015 Sones Award, its highest honor for scientific innovation. Dr. Schauer holds four patents for medical devices. He has trained more than 100 surgical residents.

He revolutionized bariatric surgery at the University of Pittsburgh in developing a laparoscopic approach to it. The use of small incisions and tiny surgical instruments sped recovery time and reduced the risk of complications in obese patients with co-morbidities like heart disease and diabetes.

Schauer and his colleagues at Pittsburgh helped delineate the far-reaching health benefits of gastric-bypass surgery. Their research showed total resolution of type 2 diabetes in 83% of surgery patients in a study published in 2003 in the journal Annals of Surgery.

Subsequent studies prompted the American Diabetes Association to endorse gastric-bypass surgery for treating diabetes in the morbidly obese.

And yet, as the nameplate in his office seems to hint, he does not seem to have let all this go to his head.

Schauer is equal parts towering figure in medicine and down-to-earth regular guy. A November 2020 video on his Twitter account helps make the point. The video on @PSchauerMD shows him with his sleeve rolled up to get the coronavirus vaccine. A masked Schauer shakes his finger at the camera and proclaims, “COVID, you aren’t coming here.” He breaks briefly into the immortal taunt, Na-na-na-na, na-na-na-na, Hey, hey, good-bye.” The video gets shaky as someone off screen starts to laugh.

He uses plain language to explain complex surgical techniques. He points out that a sleeve gastrectomy, for instance, leaves a curved vertical section of stomach that looks like a banana. He is not shy about admitting what researchers and clinicians do not yet know, including exactly why bariatric surgery is effective in treating weight loss and type 2 diabetes.

FOUNDATION FACT: The Baton Rouge Area Foundation has granted millions to Pennington Biomedical, all the way back to financial support that let Pennington recruit Dr. George Bray to be the first leader of the scientific endeavor.

“We know it works, but the reasons why are not clear,” he says.

Years ago, as president of the American Society for Bariatric Surgery, he proposed adding the word “metabolic” to the organization’s name in view of scientific findings on the health benefits of removing or reducing hormones produced by tissue in the gut.

At Cleveland Clinic, Schauer’s patients traveled from as far away as Saudi Arabia and Kuwait to see him. He envisions something similar in Baton Rouge, where the Lake is recruiting additional medical experts and acquiring specialized operating tables and other equipment in anticipation of bariatric-surgery patients who weigh as much as 1,000 pounds.

Schauer hopes to have the equipment and medical personnel in place by mid-2021 to begin treating such patients here in Baton Rouge, which will become one of a handful of places in the world capable of such operations. He envisions Baton Rouge as a global destination for such procedures.

“This will be the go-to place for surgery for people like this,” Schauer says.

In time, he hopes the program can complete 1,000 bariatric surgeries each year. The pandemic delayed but did not derail the program. Schauer began seeing patients in January 2020 before the program, but Pennington’s on-campus operations went on hiatus for most of the spring. He began seeing patients again in June.

The clinical partnership with Louisiana’s largest hospital is a sea change for the research institute. After decades as a research powerhouse, Pennington is moving into health care delivery. Schauer sees patients at the sprawling Perkins Road complex in a space designated for the Bariatric and Metabolic Institute, or BMI.

The institute this spring will move to a much larger site at Pennington that will house clinical and research offices. Surgeries will take place at the Lake, but pre-surgery consultations with patients and other clinical steps will happen at Pennington.

There is no overstating how big a shift this is. Going forward, new findings at Pennington—whose 200 scientists account for a major portion of global expertise in diabetes and metabolic function—will be used to enhance patient care at the new clinical program, including through the potential development of new surgical techniques.

Dr. Schauer, right, with a colleague
Dr. Schauer, right, with a colleague

The blend of basic science and clinical innovation is called translational research, and Schauer is a veteran of the approach. He is also a longtime collaborator with John Kirwan, Ph.D, a former Cleveland Clinic colleague and diabetes researcher who is spearheading the change as Pennington’s president since 2018.

It’s no accident the pair reunited in Baton Rouge.

“What John Kirwan was doing at Pennington in adding treatment there was something new, and it caught my eye,” Schauer said. “Pennington has created a lot of new knowledge. This is a chance to apply it to direct benefit to people.”

He cites another compelling reason to develop the center in Baton Rouge. Louisiana is No. 1 among states for extreme obesity. His surgery patients here may be interested in taking part in clinical trials at Pennington that expand understanding of obesity and diabetes and further improve treatment options.

“This is where this place should be,” he said.

He can’t say exactly what drew him to focus on weight-loss surgery. He grew up in northern Virginia in a family of six children before heading west to college at Texas A&M. He discovered he had an aptitude for surgery at Baylor College of Medicine and the University of Texas Health Science Center in San Antonio. He did a fellowship in minimally invasive laparoscopic surgery at Duke.

He and his wife, Patsy, a Texas native, have four grown children. Mementoes and photos line the shelves of his office at Pennington.

He wonders if his father’s work as an architect and his own years as a high school and college wrestler shaped his interest in surgery.

There are parallels between architecture and surgery, he notes.

“My father took things apart and put them back together,” Dr. Schauer says. “He built things. As a surgeon, you use your skills to manipulate a patient’s anatomy to solve a medical problem. There are similarities.”

He credits wrestling in part for his interest in metabolic function and obesity. He recalls weighing himself every day for months, cutting back on food and working to lose water weight fast to make his weight class or face disqualification from competition. The process built focus and determination and earned him a college wrestling title. He was Texas college champion in the 150-pound class as a sophomore at Texas A&M.

He developed empathy with his patients through a mid-life battle with extra weight. His weight started creeping up in his 30s and 40s. His 5-foot-9-inch frame carried 200 pounds by his 50s. His blood sugar inched up and his BMI moved toward 30—the point at which someone is officially obese.

His personal physician and colleague at Cleveland Clinic offered a frank message.

“He told me I needed to lose weight,” Schauer said. “I thought, ‘I need to do what I’m telling my patients to do.’ It was an epiphany.”

It took a couple years of diet and exercise to get to 165 pounds and a BMI of 24. He continues to run or bike several times each week on the levee between downtown and L’Auberge Casino, on the Pennington campus or at neighboring Perkins Road Park.

He’s also hung onto a better understanding of what his patients face. “I tell my patients that I understand how hard it is.”

Science is an important additional element of that understanding. People do not fully control their weight, he says. Research shows a series of complex factors that include genetics and family history. But obese people are widely dismissed as lazy or otherwise blamed for their size.

The pandemic may help to change that view and convince more people of the health threats of obesity, including the higher risk posed by diabetes.

Data on the impact of COVID-19 show that risk. Patients 50 or younger with obesity were 36% more likely to die of COVID-19 than those with normal-range weight, according to a November study published by the American Heart Association journal Circulation.

Another study found that COVID-19 patients of all ages with severe obesity—determined by a BMI of 40 or higher—were 74% more likely to land in intensive care and 48% more likely to die of the virus.

“One thing COVID has done is convince more people that obesity is a disease and needs to be treated as such,” he said. “It’s not a character trait. It makes people more susceptible to severe COVID and death. That has been made very clear.”