Personal Reflections on Metabesity 2017

30th – 31st October 2017, UK

MonaLisa Chatterji, Ph.D. 

Metabesity Congress was a unique forum which brought together thought leaders from different domains; resulting in the exploration of areas much beyond the defined agenda.  Discussions over the two days touched aspects of society, policy-making, reimbursement, ethics, science, human behaviour, and technology!

Few main themes that emerged:

Mechanisms that potentially have a role in multiple degenerative disorders – Multiple lectures highlighted/discussed mechanisms that have a central role to play in multiple metabolic disorders. Oxford Regius Professor Sir John Bell presented on evolutionarily conserved interactions that occur between immune response and metabolism, such as the link between inflammation and diabetes, obesity and Alzheimer’s disease. He then described mechanistic pathways and potential targets, including learnings from the UK national program in genomics of disease. Dr. Venkitaraman of Cambridge presented on exploiting tumour suppressive gene(s) for early intervention of cancer, and pointed out the accumulating evidence linking obesity-metabolism and cancer pre-disposition. Dr. Tomas Olsson of Karolinska lectured on underlying causes of multiple sclerosis (MS), including a link between lifestyle environmental factors (such as learned obesity early in life) and the MS HLA risk gene. Dr. Teresa Niccoli of UCL showed how glucose metabolism drops in fronto-temporal dementia, and presented data suggesting potential benefits of metformin in a fly model of Alzheimer’s disease. Dr. Jenny Gunton of University of Sydney presented on a yet unclear relationship between obesity and Vitamin D:  overweight people have lower circulating Vitamin D.


Aging as a risk factor for degenerative diseases - this was the most surprising learning for me! There were multiple talks relating to biological aging. Dr. Eric Verdin, CEO of the Buck Institute for Research on Aging, reviewed the trend in extension of human lifespan, and presented animal studies that have shown prolongation of longevity, for example from calorie restriction.  He also presented on the Okinawa Centenarian study - an ongoing population-based study seeking lifestyle secrets of the planet’s oldest people. There was a fascinating talk on “how to die young at a very old age” from Dr. Nir Barzilai, Director of the Institute for Aging Research at Albert Einstein. He presented data showing that metformin affects many pathways involved in aging, and extends lifespan and health span in a variety of animals. He described the TAME (Targeting Aging with MEtformin) study that aims to show that multiple morbidities of aging can be targeted by metformin. There has been discussion with FDA about a new indication for the delay of age-related morbidities. This will provide a paradigm for studying other drugs targeting multiple morbidities of aging. Details of the TAME trial design were shared by Dr. Stephen Kritchevsky of Wake Forest. He discussed possible end points for such a trial, a composite endpoint of impact on multiple age-related morbidities, and summarized preliminary data from trials and observational studies on the effect of metformin on prevention of age-related diseases such as diabetes, CVD, cancer and dementia, and on mortality. An interesting debate was who should pay for such drugs, and how?


Changing Paradigm from treatment to prevention – how to develop, how to do studies, how to deliver the drug, how to define regulatory pathways, and how to reimburse? Professor Philip Home of Newcastle University entitled his talk “Could diabetes and obesity be prevented”? He presented real-life factors that make it really challenging to prevent metabolic disorders associated with human behaviour and society. He also presented studies with anti-diabetic agents that have been tested for prevention of disease/slowing down disease progression.  Dr. Itamar Raz of the Israeli National Council of Diabetes reviewed the results of various anti-diabetic prevention trials. Most interesting was a model he shared for funding a sustainable prevention program that is being followed in Israel. Another fascinating talk was about improving chronic diseases associated with over-nutrition by using leucine to improve effects of approved drugs. Former Lilly, Amylin and Ironwood executive Mr. Joseph Cook, Jr. presented data showing that leucine when combined with approved drugs enhances therapies for NAFLD/NASH, obesity, diabetes, hypertension and dyslipidemia. Data on the obesity market, weight loss options (from all kinds), and challenges with payer’s systems were extremely interesting, as well as novel options for distribution channels to patients.


Impact of technology on healthcare and human health – The meeting also brought together some technology experts who are testing new ways of impacting human health. Stephanie Tilenius, CEO of Vida Health, presented on a digital platform/application that helps individuals manage chronic diseases through coaching and information to meet individual health goals for 20+ conditions.  Ms. Tilenius shared patients’ feedback on how the platform helped reduce medications, reduce expenses and improve quality of life. Interestingly, Vida’s business model is to offer its platform as a healthcare benefit of large employers.  A fascinating talk by Dr. Alex Zhavoronkov, CEO of InSilico Medicine, was on the disruption of drug discovery/development by artificial intelligence. He provided a glimpse of what could be achieved by new technological platforms which are built to analyse human data. He also explored different forms of “data” that could be used in building knowledge. In the future, organizations that control data and derive meaningful information out of it will be dominant, and Dr. Zhavoronkov proposed using blockchain to allow patients to regain more control over their own data. Anthony Chow, CEO of Mann Bioinvest, part of British billionaire Jim Mellon’s family office, presented on their considerations in betting on longevity; of interest were new molecular targets related to aging being investigated by players in the field. Dr. Thomas Wilckens, CEO of InnVentis, presented on efforts to achieve precision personalized medicine by combining molecular and real-world data with machine learning to identify responders and stratify patients, diagnose, manage adverse events, re-position drugs and ultimately gain new insights about drug pathology.


Finally, the discussion around pricing models for new therapies and existing reimbursement policies in different countries, especially related to degenerative diseases, were very educating. Should society as a whole bear the expense of individuals unable to manage healthy lifestyles? Should individuals be incentivized to meet health goals or penalized?  What is the responsibility of the government in metabolic disease prevention and support, and more broadly in building healthy communities?  Figures related to the burden of these diseases, financially as well as in terms of the absolute number of patients, were mind–boggling! An eye-opening presentation from Ms. Lucy Rose, Founder of The Cost of Loneliness Project, looked at social health in an extremely fast changing world, specifically highlighting the huge increase in loneliness as a co-factor, or perhaps even a root cause, of obesity and degenerative diseases.



Few personal reflections and take-aways:

Based on my understanding of “Metabesity,” I went to the meeting expecting to learn more about mechanisms central to metabolic diseases and ways to develop common/related interventions for multiple disorders. However, the congress was much more than that! It provided a holistic view of metabolic diseases – scientifically, as well as their impact on society.

a)       I was reminding that “modern” healthcare (for non-communicable diseases) Is really sick care – it is reactive and treats organ by organ, post a malfunction. It is not personalized and most often does not consider the context of the whole body and is in general not preventive. Well-being of mind and body as a whole, and indeed well-being of societies, are not aspects that are often enough considered.

b)      Scientific thinking is fragmented and siloed, probably a consequence of our current thinking of healthcare.

c)       The entire drug discovery development discipline and the regulatory framework has evolved or co-evolved to support the medical philosophy of “sick care”. Kinexum’s Dr. Brian Harvey, for example, pointed out the benefits that could accrue from sharing knowledge and approaches for seemingly different disorders in different regulatory verticals, e.g. NAFLD/NASH and diabetes.

d)      How much our metabolism would have to adapt as humans, in a relatively short evolutionary time scale, evolved culturally from hunter-gatherers to today’s technology dependent species. As we quickly rose up the food chain, we have re-defined rules of the food chain. We no longer eat to fulfil our requirements, we eat in excess, for pleasure, food content strikingly different from our ancestral environment.

e)      Ways of “healthy living”, though commonly known, still fail to register for many of us in our day-to-day lives. Professor Philip Home pointed out that our food habits get formed very early on in life and are very difficult to change, and we need to change childhood habits if we want to impact obesity - made me wonder whether a lot of traditional practices which are considered “old fashioned” (which have fallen away) may have scientific rationale.

f)        The intricate relationship of individual and society is interesting and intriguing with respect to defining healthcare policies and governance structure, raising deep ethical questions about what should be reimbursed or not? Is obesity due to individuals’ lack of control, to be treated by state funding?  NuSirt Executive Chairman Mr. Joe Cook noted that “in today’s world, teaching how to be a good citizen and what are the duties, as well as rights, of a citizen are no longer a focus” is very true.

g)       Finally, I contrasted and compared thinking and challenges in developed and developing nations…there are large commonalities and also some unique aspects.

The flow of the meeting, from science to policy, ethics and new business models, was clear, elucidating and cross-disciplinary; the panel discussions were very informative; the content was fascinating, and I hope in subsequent years the congress will be attended by larger audiences, with more opportunities for questions and discussions among the delegates.


Some definitions for reference -

Metabolism is the set of life-sustaining chemical transformations within the cells of organisms. The three main purposes of metabolism are the conversion of food/fuel to energy to run cellular processes, the conversion of food/fuel to building blocks for proteinslipidsnucleic acids, and some carbohydrates, and the elimination of nitrogenous wastes

A metabolic disorder occurs when the metabolism process fails and causes the body to have either too much or too little of the essential substances needed to stay healthy.

Metabolic syndrome, sometimes known by other names, is a clustering of at least three of the five following medical conditions (giving a total of 16 possible combinations giving rise to (?) the syndrome): abdominal (central) obesity (cf. TOFI), high blood pressure, high blood sugar, high serum triglycerides, low high-density lipoprotein (HDL) levels.

Metabolic syndrome is associated with the risk of developing cardiovascular disease and type 2 diabetes. Insulin resistance, metabolic syndrome, and prediabetes are closely related to one another and have overlapping aspects.

Metabesity – The entire spectrum of (?)(constellation of ---?) that lead not only to recognized metabolic disorders like diabetes, metabolic disease and obesity, but even cancer, Alzheimer’s and dementia, and cardiovascular disease, among others,  to the extent caused by metabolic dysfunction.  

Aging - Can be defined as a progressive functional decline, or a gradual deterioration of physiological function with age, including a decrease in fecundity (Partridge and Mangel, 1999Lopez-Otin et al., 2013), or the intrinsic, inevitable, and irreversible age-related process of loss of viability and increase in vulnerability (Comfort, 1964). Clearly, human aging is associated with a wide range of physiological changes that not only make us more susceptible to death but limit our normal functions and render us more susceptible to a number of diseases