We caught up with Victoria M. Gershuni, MD, MTR, MSGM from Penn Medicine's Metabolic and Bariatric Surgery Program, on topics ranging from what inspired her to become a surgeon to how rewarding her work with patients is.
What inspires you in your work at the Penn Medicine Bariatric Program?
My focus is to empower people to take control of their health. Through our collaborative and comprehensive bariatric program at Penn Medicine, we are giving patients the tools they need to become their own advocates and navigate the health system, which translates to our patients being more successful and having better outcomes after surgery. For our bariatric surgery patients, my goal is to provide patients with education and strategies to develop healthier relationships with their bodies and recognize the power of food as medicine as an opportunity to improve their overall health and life.
What have you learned from your bariatric patients and throughout your career?
Every patient's journey is unique and the same approach won't necessarily work for everyone. I help patients identify strategies that are in alignment with their personal goals and will help simplify their life. At the end of the day, bariatric surgery is a phenomenal tool that allows patients to reclaim their health and improve the quality of their life, but it requires consistency and lifestyle change over the long term to maximize the potential benefits.
Why did you decide to become a bariatric surgeon?
I decided to become a surgeon because I appreciate the opportunity to create a tangible difference in someone's health by changing their anatomy. In surgery, we often have a discreet problem that has an associated technical solution. Now that I am a surgeon, I realize that it is so much more than that. I am honored to have my patients' trust to allow me to operate on them. The patient-surgeon relationship is so important to me and is incredibly rewarding. When I see patients after surgery, it's inspiring to have them walk out of the clinic better than when they first came in to meet me.
With bariatric surgery, specifically, being a part of someone's transformation is incredibly empowering. As their surgeon, I am able to give them a tool that they can use to change their lives for the better. I am in awe of my patients and love getting to see them engage with life in such a meaningful way. It's awesome to hear how their quality of life has improved, especially when they're now able to participate in activities that they never did before, like playing on the ground with their kids.
What has been the most exciting or motivating aspect of your current research projects?
My current research program focuses on the nutritional status of patients before surgery. Many people don't realize that even if they get enough calories, they may not be getting adequate nutrition in the form of amino acids (protein), vitamins, and minerals. So you can be both overweight and undernourished. We have also realized the importance of muscle to help people maintain optimal health and recover from illness/ stress of surgery.
I recently received grant funding to develop a novel imaging biomarker that can determine abdominal body composition (muscle and fat) using machine learning analysis of CT scans. This project is in collaboration with Walter Witschey, PhD (Department of Radiology). We are trying to identify patients at increased nutritional risk for surgical complications ahead of time, so that we can develop nutritional interventions to improve their outcomes after surgery. I've been fortunate to have a pilot study funded by the Penn Center for Cancer Care Innovation called "Prehab to Rehab" that is looking at the concept of pre-operative rehabilitation (aka "Prehabilitiation") using physical therapy and nutritional supplements to improve readiness for surgery.
My previous research has been focused on the interaction between what we eat and the gut microbiome (bacteria within our intestinal tract) and how that impacts overall health and metabolism. Eating real food is important to support not only our own health, but the health of the bugs that live in our intestinal tract. There's a whole little world that lives inside each of us that we need to protect and support.
How does your research inform your vision for the bariatric program at Penn Medicine?
Long-term, we envision designing prospective clinical trials looking at different strategies to optimize weight loss and metabolic health improvements, both before and after surgery.
How do robotic surgery techniques benefit bariatric patients?
Minimally invasive techniques, especially the evolution of laparoscopy (using a camera and small instruments) was a huge advancement for bariatric surgery, and significantly decreased the risks and morbidity of bariatric surgery. With smaller incisions, we're able to decrease the recovery time and minimize the wound morbidity, which means patients get out of the hospital sooner and back to their lives more quickly. The robot takes laparoscopy to the next level and is an amazing surgical device that allows you to have 3D vision and even greater dexterity due to wristed instrumentation.
What words of wisdom would you give to friends and/or family struggling with weight loss?
The best thing you can do to support somebody going through a bariatric surgery journey is to learn as much as you can about that surgery and how their lifestyle is going to change. Surgery is only the first step, and the lifestyle and behavior differences need to last a lifetime, so recognizing how we can all support each other is key. Applaud their wins, and don't always make it about their weight. Instead, ask them, "How are you feeling? How's your energy? How are you sleeping? How do your clothes fit?" Shift the focus to the "non-scale" victories for them, because too much attention on weight and the numbers can become overwhelming. Instead focus on the life gained after surgery. Find activities that involve being outdoors, being in community, playing games, and finding the joy in life, because everyone can afford to have more joy.
What is the most rewarding part of your job?
The feeling that I've made a difference for a patient; getting to see someone after surgery and hearing that they are now able to do things that they couldn't do before. It's incredibly rewarding to be able to develop relationships with my patients and positively impact their lives.
Can you share one of your go-to bariatric friendly recipes or snacks?
I tell everyone to prioritize protein; every snack or meal should be built around the idea of protein first. So anything with protein (like chicken, fish, eggs, Greek yogurt, etc.) is always a win in my book. I also encourage people to seek out a couple different snacks and meals that they enjoy and then just eat them on daily to simplify life.
One of my go-to snacks that I eat almost every day, is unsweetened, plain Greek yogurt with ground flax seeds, almonds, and mixed berries. It's delicious and nutritious. You get plenty of protein. You get all of the antioxidants from the berries. The yogurt is a natural source of probiotics, which help your gut microbiota. The flaxseeds and almonds provide fiber, which can be tough to get early on after bariatric surgery, but is especially important to help with digestive health and keep you regular. Support the bacteria in your gut and they'll support you in return – it's a win-win! And it's a great breakfast or snack.
Is there anything else you would like patients to know about you?
My daughter is the best thing that ever happened to me. My whole life has changed with her in very wonderful ways. I want to be an example for my daughter of what it means to love yourself fully. It's so important that everyone knows and hears that they are good inside and they have value. I want everyone to know that each person has their own unique beauty and worth.
I didn't always feel that way about myself, but rather it's something that I worked on and learned with time. I've struggled with weight throughout my life, so for me it's not just about helping others, it's also personal. And so, I feel like that allows me to empathize in a way that hopefully brings value to my patients.