Guest Post: My Journey With Obesity Medicine in Clinical Practice, Academia and IndustryThursday, July 28, 2022
Today’s guest post comes from my friend and colleague Abd Tahrani MD, PhD, International Medical Vice President in Global Obesity Drug Development at Novo Nordisk.
My interest in obesity was sparked as a medical student. I remember being fascinated by three diseases: obstructive sleep apnoea, non-alcoholic fatty liver disease (NAFLD) and polycystic ovaries syndrome (PCOS). Clearly, obesity and disturbances in weight regulation (as well as abnormalities in autonomic function but that’s a separate story) play an important role in these diseases. But, at the time, there was no training in obesity in my medical school, which sadly is still uncommon globally today.
My interest in obesity was reignited when I started my specialist training in diabetes and endocrinology. It was clear to me that there was a huge unmet need in the field of obesity. The burden of the disease was huge, access to health care for patients with obesity was challenging, treatment options were limited, stigma, prejudice and myths were quite common in the wider society as well as amongst health care professionals, payers and policy makers, and relatively low interest amongst my fellow trainees to specialise in obesity.
Many of my colleagues felt that I was “mad” to choose obesity. Their negative impressions were driven by the perception that obesity was a “hard” speciality where achieving a successful treatment outcome is challenging and that the “customers” are unlikely to be happy with the results.
For me, the challenge to improve health care delivery, treatment outcomes and patients satisfaction was a major driver. Also, my colleagues often cited the lack of effective pharmacotherapy as a reason to avoid specialising in obesity.
After deciding that obesity medicine was a career for me, I faced the reality that there was no clear training path to become an obesity specialist in the UK. Hence, I had to build my own clinical training program alongside my academic research training. This enthused me to work with the appropriate societies and organisations in the UK to improve obesity training and to establish the first dedicated course to train diabetes and endocrinology trainees in obesity medicine in the UK.
However, obesity medicine can be practiced by a wide range of health care professionals beyond diabetes and endocrinology. Hence, it is important to establish the appropriate education resources across multiple disciplines, especially primary care.
In my years of practicing obesity medicine, I found working with patients in the clinics most enjoyable. It was rewarding to work with patients and their families to improve their health and quality of life and achieve their treatment aims. I found that the negative impressions about obesity as a speciality were unfounded. In addition, working with a large multidisciplinary team allowed for great opportunities for learning and teaching.
Working in the obesity field taught me that patients living with obesity were misunderstood, stigmatised and treated unfairly by the health care system.
Health care professionals know very little about the pathogenesis and management of this disease. Many patients report unsatisfactory interactions with the health care system over years if not decades. Access to treatment is limited. Funders and policy makers generally perceive obesity as a “self-inflicted” condition and do not prioritise obesity care.
Moreover, many funded obesity treatments for obesity are based on inadequate short-term interventions rather than a long-term chronic disease treatment model.
A major unmet need in the field of obesity is the lack of safe and effective pharmacotherapy. Given that better medications for obesity could transform the field of obesity medicine, beyond what I could achieve in academia, in July 2021, I decided to join Novo Nordisk’s global obesity clinical drug development team to play a role in shaping the future pharmacological treatments in obesity, while ensuring that patients’ needs are addressed and to help remove the current barriers to health care delivery.
But there were also personal reasons for deciding to join industry. One of these was that I wanted a role that offered new challenges and wider opportunities for career progression than my academic career at the time.
Changing career tracks come with opportunities and challenges, professionally as well as socially (such as moving with family to a new country). However, the industry is used to support such moves both on the professional and social level and this eased the process significantly.
Also, working with a large team of experts who have deep understanding of obesity and its impact on patients across all the stages of drug development creates a unique environment focussed on training, development and innovation.
As it turns out a lot of my academic, clinical, policy and health economic skills were very handy in my new role in industry. My current role can perhaps best be summarised by being the internal “KoL” supporting and leading the obesity team.
Working with a big company also offers extensive opportunities for training and self-development in a wide range of fields and skills. I have learnt about the value chain and how the different departments from early discovery, to drug development, regulatory, data sciences, policy, marketing, patient access, and medical affairs interact and work together towards a common goal.
I believe that I now better understand the decision-making process in such a big organisation, which is clearly important in my role in order to influence direction and decision making within the company.
One interesting aspect of joining industry was that I had to limit my involvement in social media. Although this may be perceived as losing independence, I still have a lot of choice in what I do in terms of what projects to pursue and what drugs to propose for development.
Working with industry over the last 12 months has definitely given me ample opportunity for self-development, learning and training and offers me the chance to have an impact on the care and treatment of patients living with obesity likely far exceeding the impact I could have had working in academia or private practice.
Of course, I moved to industry at an advanced stage of my career allowing me to start at a rather senior position. However, many colleagues started their industry roles early in their careers and climbed the career ladder step by step. I don’t think there is a right or wrong way.
One of the advantages of working in industry is that “changing tracks” is feasible. I have met many clinicians and scientists who ended up working in marketing, devices, regulatory affairs or machine learning and artificial intelligence for example.
Based on my experience, I would certainly recommend to my clinical and academic colleagues to perhaps consider working with industry, both for the opportunities for self-development and having an impact on patient care. Especially, as we live in an era were moving between industry and academia and clinical work is feasible, the skills gained in one area are invaluable to the other.
Whether working in academia, clinical practice or industry, all these efforts complement each other to ultimately reduce stigma and improve health care delivery to patients living with obesity by improving access to new and safe effective therapeutic options.
Perhaps this post will inspire some of my clinicians and academic colleagues to consider the opportunities in obesity medicine within industry. I do not think there has never been a better time to be involved in obesity medicine for anyone who seeks to make a difference in the lives of people living with this chronic disease.
Abd A Tahrani MD, PhD
About the author: Abd Tahrani is currently the International Medical Vice President in Global Obesity Drug Development at Novo Nordisk. He is also an honorary consultant endocrinologist at the University Hospitals Birmingham NHS Trust (UHB) and an honorary senior Lecturer in metabolic endocrinology and obesity medicine at the University of Birmingham, UK. He has practiced obesity medicine since 2004 and was the lead for the weight management services at UHB and the lead for translational research at the Centre of Endocrinology, Diabetes and Metabolism at Birmingham Health Partners, UK. He has wide experience in obesity medicine, clinical research and health care delivery. He also worked extensively with patient organisations, policy makers, payers, national and international obesity societies, research funding bodies and educational institutes in the field of obesity.