American Society For Nutrition

Interview with ASN Member, Dr. Steven B. Heymsfield

Interview with ASN Member, Dr. Steven B. Heymsfield

Excellence in Nutrition Research and Practice
Steven B. Heymsfield, MD, has been an ASN member since 1979. Transitioning from Merck & Co. Inc. to serve as the Executive Director of Pennington Biomedical Research Center, Dr. Heymsfield serves on the ASN Sustaining Member Committee.

Dr. Steven Heymsfield is one of the pharmaceutical industry's leading weight-loss researchers.  As the global director for scientific affairs and obesity at Merck & Co., Dr. Heymsfield has paved the way for a number of breakthroughs in clinical nutrition.  Some of his achievements in the field include the development of the Lithogenic Index and the discovery that CT scans could be used to analyze the relationship between obesity and liver disease and between body fat and skeletal muscle mass.  He is the author of nearly 430 peer-reviewed scientific articles, six books, and more than 114 book chapters or reviews on obesity, anorexia, bulimia, malnutrition, pregnancy, body composition and caloric expenditure.  

Dr. Heymsfield, is a past president of ASN's predecessor organization, the American Society of Clinical Nutrition, and was recently appointed by Louisiana Gov. Bobby Jindal to head the LSU System's Pennington Biomedical Research Center (PBRC).  As one of the world's foremost obesity researchers, Dr. Heymsfield possesses a unique insight into the triumphs and challenges faced by both industry and academic scientists working to develop new weight loss treatments.  He recently shared with us some of those insights as well as details of how his long-time involvement with ASN continues to help him encourage collaboration and stay abreast of the latest research in obesity and weight loss.

How did you first become interested in nutrition?

Dr. Heymsfield: Well, I'm a physician trained in internal medicine.  As I reached the end of my training, I gravitated very strongly towards research as opposed to clinical practice.  The first research environment that I had a chance to work in was with Daniel Rudman who ran the clinical research center at Emory University.  Dr. Rudman was a pioneer of metabolism and nutrition research.  In the early 1970s, he was the first to introduce me to clinical nutrition and to mentor me in the field.  The 1970s was a period of signficant growth for clinical nutrition because, among other things, artificial feeding was just being introduced to the world. It was many of the exciting related challenges that really swept me into the field.  

Interviewer: How did your interest in nutrition research lead you to ASN?

Dr. Heymsfield: During the time that I was training, ASN was the premier nutrition society, which of course it still is. At that time, it was the American Society for Clinical Nutrition (ASCN).  As a young physician scientist it was the most prestigious and most exciting society related to the work that I was doing.

Interviewer: What about your membership have you found most helpful to your career as a nutrition researcher?

Dr. Heymsfield: ASN is the home of a very large percentage of the scientists I collaborate with and whose works I follow. For that reason, being a member of the ASN has been invaluable in my career.  It keeps me knowledgeable of what other people are doing.  Such an important part of being a researcher is about knowing people first hand—to be able to pick up the phone or to see them at meetings to share ideas.  

Interviewer: As a leader in obesity drug development, what do you think are the biggest challenges facing industry researchers today?

Dr. Heymsfield: In the context of weight-loss drug development, I think the biggest challenge we face has to do with metabolic pathways or receptors used as targets for drug research.  It's only been about a decade since the field established the main targets for weight control.  And during that relatively short amount of time, it has become clear that the systems that control weight are far more complicated than we could have possibly imagined.  Developing weight-loss medications has revealed that if you hit one target perhaps another one may compensate, preventing greater weight loss than you might expect.  We are still really learning how to modulate them with drugs because of the complexity of weight-loss mechanisms.  

The flip side of this complexity is that there is not one system that regulates body weight and nothing else.  Weight is tied to a number of other processes including heart rate, core temperature, blood pressure, and menstrual cycles in women.  This interconnectedness means that when you hit weight-loss targets with drugs, you do not just see a weight-loss effect.  You may also have some effects that you had not anticipated that are not necessarily positive.  That's been a huge challenge to the field—to find drugs that are both clinically meaningful in terms of efficacy but are also very safe.

Interviewer: Two of the major issues we hear being discussed a lot right now are conflict of interest and publishing concerns, such as the use of ghostwriters. What are your thoughts on these issues and what actions can industry researchers help alleviate these concerns?

Dr. Heymsfield: If we blanket the industry with one brush, you can see that if you go back five years or ten years there was a process of ghostwriting, which meant that professional writers or industry writers often wrote papers using academic investigators' names.  Since that time, there has been a huge transformation. I can only speak for Merck, but I feel that the process has completely turned around to where every author on every paper is responsible for that paper and for the content of that paper.  

One of the problems that industry faces is that they want their drugs to become known in the scientific community.  One of the best ways to do that is to publish these studies.  Unfortunately, clinical investigators in academia often do not have the time or the interest to write those papers.  So the challenge for industry becomes getting high-quality investigators to do that kind of writing for them or with them.  

Another problem for the scientists within the industry, speaking at least for Merck, is that they are extremely skilled, competent scientists who should be authors or lead authors on these papers, and they are not.  The reason for that is if an industry scientist puts their name as first author on a paper, when interviewed by the press or the outside world, they are not given adequate credibility because of conflict of interest.  I think that is a real problem that we have to solve; because when I look around me at my colleagues, I see they are absolutely as competent and as ethical as people in academia.  I think that if there was some transformation in that view, you would see more industry authors coming out as leads in these papers, as they should be.  

Another solution to this conflict is something being pursued at Merck right now-- we bring in academic investigators before a study is designed.  They participate in the design, the execution, the analysis, and the write-up of the study.  In the past, authors from academia were often asked or chosen after a study was done, which doesn't qualify them to be lead authors on these studies.

Interviewer: Speaking of publishing, what sources do you usually turn to for medical nutrition information? And what are your favorite strategies for staying informed about what's going on in the field?

Dr. Heymsfield: One of the most important ways for me to stay informed is to attend Experimental Biology.  That's where I hear what's coming in the future as opposed what has happened in the past.  By the time you read a journal article, it has been a year or two since that work was actually done.  It is also important for me to have a wide network of colleagues throughout the world. This network fosters informal discussions that help me learn about papers or topics that I might not have been aware of because you can't stay on top of every issue all the time.  My colleagues at ASN are such an important part of that network.  Additionally, I subscribe to the key journals.  I get the American Journal of Clinical Nutrition and the Journal of Nutrition.  Those publications send emails with the table of contents that I religiously review when they come in.