Interview with hVIVO Chief Medical Officer Professor Thomas Forst
Obesity research is a rapidly evolving field, and few areas are advancing faster than incretin-based medicines such as GLP-1 receptor agonists.
In this interview, hVIVO’s Chief Medical Officer, Professor Thomas Forst, talks about what this means for patients, drug developers and the larger cardiometabolic environment. He examines the true causes of obesity-related diseases, the potential and limitations of GLP-1, and how a more nuanced understanding of fat biology is changing the field.
Image credit: hVIVO
Looking at the current obesity situation, where do you think the most unmet needs are?
TF: It turns out that obesity is more than just excess weight. This is a complex and progressive condition with significant medical implications.
Obese people have an increased risk of developing type 2 diabetes, cardiovascular disease, heart failure, sleep apnea, and some malignancies. These complications affect morbidity and mortality, not just numbers on the scale.
As a result, two needs exist: medicines that effectively address the underlying metabolic abnormalities and technologies that reduce the burden of these comorbidities. This field has developed significantly in the last 10 years.
GLP-1 receptor agonists have become essential to this development. What makes it so effective?
TF: GLP-1 was first discovered as a treatment for type 2 diabetes, but its weight loss properties were practically a bonus. Over time, it turns out that these drugs do more than just reduce hunger and weight. They boost overall metabolic health.
Clinical studies have revealed reductions in cardiovascular events, improved outcomes in heart failure, benefits against kidney disease, and positive effects on conditions such as sleep apnea. Importantly, these benefits apply to obese people even without diabetes.
So while public discussion often focuses on weight loss, the real story is that GLP-1 helps address the metabolic abnormalities that make obesity a dangerous condition.
You previously stated that “all fats are not the same.” What does that mean exactly?
TF: Weight and BMI are imprecise measurements. They reveal little about the biological processes that cause the harm.
The main question is where fat is stored and how it acts. Ectopic fat occurs when fat develops in places it shouldn’t be, such as the liver, heart, pancreas, and skeletal muscles. This type of fat increases metabolic activity in the worst ways, causing inflammation, secreting toxic adipokines, and interfering with normal organ function.
Ectopic fat is a much more reliable predictor of cardiometabolic risk than BMI. Measurements such as waist circumference, waist-to-height ratio, and waist-to-hip ratio often reveal more about a patient’s risk profile than just their weight.
When we talk about treating obesity, what we really mean is reducing dysfunctional fat and the inflammatory environment it creates.
Given its complexity, is GLP-1 the perfect solution?
TF: These are effective tools, but they are not a complete solution. It is also not intended to be a complete solution. GLP-1 is part of a larger family of incretin-based drugs, and the field is already investigating dual and triple agonists and oral small molecule compounds that target multiple pathways simultaneously.
These new drugs may offer even greater metabolic benefits, but there is no substitute for the basics. Lifestyle changes are still important. Exercise and diet remain important, especially since weight loss, whether due to drugs or not, can lead to loss of muscle mass. Muscle maintenance is very important for long-term health. Therefore, it is usually a combination of medication and lifestyle rather than either alone.
As this therapeutic area expands, what should drug developers keep in mind?
TF: Science is advancing rapidly, but the basic biology remains the same. Obesity is a metabolic disease with many long-term effects, and the most effective treatments are those that address the full spectrum of these complications, not just weight.
hVIVO has been working in this field for years, supporting sponsors in early-stage research to understand how these drugs work and in designing programs to capture relevant signals. The more we understand about fat biology and metabolic dysregulation, the more precise and effective these treatments may become.
Any final thoughts for clinicians and researchers watching this space?
TF: We are entering a new era in obesity treatment. GLP-1 opened the door, but it’s just the beginning. As more advanced incretin-based medicines become available, it will be possible to treat not only obesity but all the diseases it causes.
Even with these improvements, we must not lose sight of the basics. Medication is most effective when combined with lifestyle changes that promote metabolic health. The combination of science and action produces the best outcomes for patients.
About Professor Thomas Forst
Professor Thomas Andreas Forst is a board-certified physician in internal medicine and endocrinology with over 30 years of experience.
Cardiometabolic research. He began his scientific career at the German Diabetes Institute and subsequently held academic and clinical roles at the Johannes Gutenberg-University Mainz, where he continues to contribute to medical education. Thomas has held senior positions at Eli Lilly, Institute for Clinical Research and Development, and Profile Institute Mainz, and was CMO at the German Clinical Research Service. He has contributed to more than 300 clinical trials in obesity, metabolic disease, diabetes, dyslipidemia, and cardiovascular disease and is an active member of major diabetes associations. He has authored more than 300 peer-reviewed publications and is an associate editor in endocrinology, diabetes, and metabolism.
About hVIVO
hVIVO plc is a science-driven, early stage drug development company founded to meet the increasing complexity of modern clinical research. We operate an integrated early-stage ecosystem that combines specialized clinical sites, advanced virology and immunology laboratories, human challenge expertise, and early drug development consulting. This integrated model allows sponsors to generate rigorous, decision-ready human data early in development, reducing uncertainty and accelerating the progress of Phase I and II trials.
With industry-leading capabilities in respiratory and infectious diseases, and growing expertise in cardiometabolic diseases and other high-growth therapeutic areas, hVIVO supports a diverse global customer base that includes seven of the world’s 10 largest biopharmaceutical companies. The London quarantine facility is the world’s largest dedicated human challenge facility and is complemented by additional early stage clinical capabilities in Germany and a dedicated consulting team providing strategic, regulatory and biometric expertise.
The company’s integrated approach provides a seamless path from preclinical planning to early proof of concept, supported by continuous patient recruitment through FluCamp and a network of outpatient clinical sites for Phase II and III trials. By integrating scientific insight, operational management, and advanced testing capabilities, hVIVO provides sponsors with the clarity, speed, and confidence they need to develop new medicines with confidence.
Sponsored Content Policy: News-Medical.net publishes articles and related content that may be derived from sources with which we have existing commercial relationships, so long as they add value to News-Medical.net’s core editorial philosophy of educating and informing site visitors interested in medical research, science, medical devices, and treatments.
