This festive period, Three Wise Women from the Faculty of Medicine give us the gift of wisdom.
Dr Chioma Izzi-Engbeaya, Honorary Clinical Senior Lecturer in the Department of Metabolism, Digestion and Reproduction and Consultant Endocrinologist at Imperial College Healthcare NHS Trust, explores how decades of research into obesity and metabolic health are beginning to translate into better care for women and older adults – from fertility and menopause to cancer and liver disease. But as she explains, the work is far from over: true progress means making sure no group is left behind.
We live in exciting times. Decades of scientific and clinical research have deepened our understanding of the factors driving metabolic conditions such as obesity and metabolic dysfunction-associated steatotic liver disease (MASLD, also known as ‘fatty liver disease’).
Alongside this progress, we’ve seen a rapid rise in treatment options for metabolic conditions, with a variety of ever-increasing options on the horizon. However, significant challenges remain. Access to effective treatments is still limited for many people, and there are gaps in the evidence needed to guide how best to manage specific groups of patients.
Spotlight on women and older adults
In recent years, there has been growing attention on women’s health and the health of older adults. This focus is long overdue – both groups have been historically under-represented in many areas of research.
Take polycystic ovary syndrome (PCOS), for example – a condition affecting more than one in ten women in the UK, which involves both reproductive and metabolic problems. While weight loss through lifestyle changes can improve some of the problems associated with PCOS, it is often difficult to maintain.
At Imperial, the BAMBINI trial showed that bariatric surgery – a type of weight-loss surgery that reduces the size of the stomach and/or changes the digestive system – not only supports significant weight loss and improved metabolic health, but can also increase spontaneous ovulation in women with obesity and PCOS. Emerging evidence suggests that some weight loss medications may also improve reproductive function in this group of women.
However, these interventions come with important considerations. Because of potential risks to foetal growth in the first one to two years after bariatric surgery, and possible foetal abnormalities linked to weight loss injections, women undergoing these treatments are advised to use reliable forms of contraception and postpone attempts to conceive.
Weight, cancer and reproductive health
Endometrial cancer, which affects the lining of the womb, is the fourth most common cancer affecting women in the UK – and it’s strongly associated with obesity. Research suggests that bariatric surgery can lower the risk of developing this cancer in women with obesity.
Now, studies are exploring whether weight loss injections medications that act on glucagon-like peptide-1 (GLP-1) receptors could improve treatment responses in early-stage endometrial cancer. If proven effective, these approaches could revolutionise care, offering alternatives that do not require removal of the womb.
This could make a life-changing difference for older women, as well as younger women who wish to preserve fertility during cancer treatment.
Healthy ageing
Life expectancy is increasing in many parts of the world – but so too is obesity, including among people over 65. In England, more than a quarter of people in this age group are living with obesity.
Older adults are often under-represented in clinical research studies, leaving limited data to guide safe and effective obesity management for them. There are concerns that weight loss interventions may worsen sarcopenia (low muscle mass or function), which is more common as people grow older.
Our research has shown that for appropriately selected older adults with obesity, bariatric surgery can be both safe and effective – and it may be linked to a reduced risk of death within 10 years. These findings highlight the importance of evidence-based care tailored to older populations.
Menopause, metabolism and liver health
Globally, more than one in three adults are estimated to have MASLD, a condition closely tied to obesity and type 2 diabetes. In people with MASLD, the leading causes of death are cardiovascular disease and cancer – but increasingly, liver failure is becoming a major concern.
After menopause, women face higher risks of developing MASLD compared to pre-menopausal women, and they may also be at higher risk of progressing to more advanced disease. In the US, MASLD is now the number one cause of liver transplantation in women aged over 55. As approximately half of the world’s population is female – and women spend roughly a third of their lives post-menopause – understanding these risks is critical.
Some of my research focuses on finding ways to improve the health and wellbeing of post-menopausal women with MASLD, and I look forward to sharing new insights as our work progresses.
Next Steps
In recent years, we’ve witnessed remarkable progress in our understanding and management of metabolic conditions. However, it is apparent that there is room for improvement. We must continue to push for inclusivity in research.
By ensuring that women, older adults, and other under-represented groups are included in research, we can address the gaps in our knowledge and move closer to truly personalised, evidence-based strategies to manage these health conditions.