Donna Ryan, MD, is professor emerita and the interim executive director of the Pennington Biomedical Research Center in Baton Rouge, Louisiana. Ryan’s career has focused on obesity management, and she has been an investigator on several pivotal clinical trials, including the Diabetes Prevention Program, Look AHEAD and DASH. She is associate editor in chief of Obesity and president-elect of the World Obesity Federation.
Ryan spoke with Endocrine Today about her hopes for managing obesity and related diseases and the challenges that come with research.
What area of your field most interests you right now and why?
It’s hard to narrow it down because there are lots of unanswered questions in obesity. The current thing that I am musing about most is variation in weight loss response. Whenever we attempt weight loss, be it with just lifestyle intervention, with medications, with use of a device or even with the different bariatric surgery procedures, we get an enormous variation in individual response to that treatment. While this is true in all of medicine, no treatment produces exactly the same response in every patient, but it is so different in obesity. The amount of weight loss varies to the extreme — a wide variation in response. Some people do extremely well and some don’t lose much at all. Some people even gain weight with our interventions. This is true no matter what treatment we employ. So, I’m interested in what produces that variation. Are there biologic factors or psychologic factors? Are there environmental factors at play? What are those things? I’ve been working with the NIH on the ADOPT (Accumulating Data to Optimally Predict obesity Treatment) Core Measures Project. We’re trying to identify a set of core measures that we would include in our studies that, when analyzed at the end of the study, would help us identify predictors of who is going to respond well and who’s not. It could be genetics; it could be measures of behavior, psychology or environmental factors.
What has been the greatest challenge in your career thus far?
The answer to that is obvious. It’s dealing with disappointment. When you put so much of your energy, effort and ego into writing grant applications — it’s blood, sweat and tears and then they don’t like your ideas and don’t fund them. It’s like being told your baby is ugly! It’s a demoralizing and negative experience. You have to learn to pick yourself up, dust yourself off and try again — just keep going. That’s an important lesson that every academic must learn: That you have to be an adult about it; you have to be resilient. You have to just keep coming back because eventually your ideas will get funded.
What advice would you offer to a student going into the medical field today?
I have a daughter and son who are both physicians and it just kills me that they’re not interested in research. So much of your medical education is devoted to the goal of clinical competence. That’s an extremely worthy goal, but it only takes you so far. It feels good to help the person who is engaging your services as a physician, but there is something about helping people you’ll never see, through the efforts of your research and the things you’re putting out that are going to help people you’ll never see. So, my words of encouragement are that while clinical competence is very important, there is a whole world out there of clinical research, and it can be very rewarding to pursue. I wish more people were as excited about it as I am.
What are some of the most exciting advances that you have been a part of?
The observation that diabetes can be prevented would be number one. It can be prevented by modest weight loss. Diabetes is not a disease that is inevitable and it is something that can even be reversed. We need to work harder to make sure patients who have glucose dysregulation have access to the weight management treatments that can prevent them from going on to develop the sequelae of organ damage that occurs with diabetes. The amount of weight loss needed to prevent diabetes is achievable: only 5% to 10%. That message is so important. I played a small role in this, but it is a game changer if we can translate it into practice.
What do you think will have the greatest influence on the obesity field in the next 10 years?
If I had been asked that question 10 or 15 years ago, I would have said genetics. We’re going to figure out the genes that are causing obesity. Well, that hasn’t exactly panned out. Obesity genetics has turned out to be far more complicated than we ever imagined with multiple risk alleles, each conveying a very small effect size in terms of obesity risk. Furthermore, their gene expression is controlled by a variety of epigenetic mechanisms. I believe the transformation of the field will be identification of medications that can produce and sustain 15% or more weight loss. I believe this will transform the field. Right now, there are companies that have great drug pipelines and active discovery programs exploring mechanisms that drive body-weight regulation. As our knowledge and understanding grows, we’re getting better targets. We are going to have some drugs that are going to help patients produce and sustain weight loss of 15%, on average, and that is going to transform the field.
Disclosure: Ryan reports financial relationships with several pharmaceutical and device companies and weight counseling programs.