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.  

Brought up in the countryside outside Shrewsbury, I was always interested in science and loved doing school projects. I wasn’t seen as particularly clever at school and was even advised that I didn’t need a “career” – just a job until I got married!

The only interesting university course covering “human biology” was medicine. Although I wasn’t sure about becoming a doctor, I applied. My father, a lawyer who had been to Oxford like his own father, wanted me to go there too, but my school was not exactly encouraging. I applied anyway and failed.

Refusing to give up, I moved to another school – Shrewsbury, which was all boys at the time, apart from me – for one term to retake the Oxford entrance exams. This time I was much better prepared, won a place, and began studying medicine in 1980.

It was the first of many moments showing me how important the right guidance and preparation are – and how much more you can learn from failure than success.

Discovering research – and the brain

Still unsure about clinical medicine, I accepted a PhD position offered by my final-year project supervisor and moved to Cambridge. My PhD involved characterising the CCK receptor in the brain in animal models – essentially studying how certain brain signaling systems work.

By the end of my PhD I was still unsure about completing my clinical training so I went to the National Institutes of Mental Health (NIMH) in the USA for a two-year postdoc. Two key things happened there that changed everything.

First, some lab members were psychiatrists who would pop in with blood samples or central spinal fluid samples from patients on the ward. I became fascinated by the patients’ stories and how research could help to understand and treat their conditions. So, I decided to return to the UK to complete my clinical training to become a psychiatrist.

Second, I joined a team studying the GABA-benzodiazepine receptor – the brain’s main inhibitory system – and how it mediates the effects of alcohol and barbiturates in animal models. Several years later, while training as a psychiatrist, I was awarded a Wellcome Trust clinical fellowship (after two attempts!) to study this same receptor in alcoholism, this time in people, using brain imaging (single photon emission tomography).

This fellowship was pivotal: it let me build on my preclinical experience and translate into clinical work – a balance I have maintained ever since.

Finding addiction psychiatry

I trained at the Maudsley & Bethlem Royal hospitals, linked to the Institute of Psychiatry (IOP).  My supervisors were hugely influential. Professor Rob Kerwin, a world-leading psychopharmacologist, drilled into me the importance of having a clear hypothesis –without one, you can’t design the study. It is still a guiding principle and one I instill in my own students and look for when reviewing papers or grants.  My other supervisor, Dr Jane Marshall, a leading psychiatrist in alcoholism, supported my developing interest in addiction. So much so, I switched from training in old-age psychiatry to addiction psychiatry and have never regretted it. I love the mix: neuropharmacology, medicine, and the social and environmental factors that shape addiction.

Serendipity, networking and joining Professor David Nutt’s group

Although the IOP gave me lots of opportunities, there was limited research into the neuropharmacology of addiction. At a conference poster session, I discussed my early data from my imaging work with Dr Andrea Malizia, who worked with Professor David Nutt. I knew David from medical school, and we overlapped at NIMH – but I didn’t realise he had just secured an MRC programme grant to study neurobiology in addiction with PET imaging. He was looking for researchers, and I joined him soon afterwards. We’ve worked together ever since.

This experience taught me the enormous value of attending conferences and talking to people – you never know where a conversation will lead. I’ve always encouraged and supported my students and postdocs to go for exactly that reason.

Years of imaging, moving cities and balancing family life

I began working on the PET programme at Hammersmith in 1997 and have done my imaging here ever since – almost 30 years! I joined David’s group at University of Bristol as a Clinical Senior Lecturer in 2000, while also the Consultant of the alcohol service, but continued travelling back to London for imaging studies.

I loved living near the countryside again after so long in London. In 2009, I became Professor of Addiction Biology at Imperial and joined CNWL NHS Foundation Trust for clinical work. I still live in Bristol, so the commute – and often living away from my family – has been very challenging. But the opportunities and flexibility to work from home (even pre-Teams and Zoom!) have made it worthwhile.

None of this would have been possible without my husband – or “domestic CEO” as he calls himself on LinkedIn – and my daughter, who put up with my absences.  I have always tried to be there for important moments like school plays, and they often travelled with me to conferences. We adopted our daughter when I was in my 40s, which, with a more established career, made taking time out less daunting.

My daughter is a keen equestrian competing on the British Eventing circuit, so most weekends I’m in a field or driving a horse lorry to a competition. I have even joined an ethics committee from the horse lorry! When I recently asked if she felt she’d missed out because of my work, she said no – she got to travel, I was always there for her riding, and she quite likes that her friends are “a bit impressed” by what I do.

Advancing the science of addiction

Over the last 30 years, our team’s neuroimaging studies (PET and fMRI) have helped characterise the neurobiology of addiction, particularly alcohol and opioid dependence.

Working with Dr Louise Paterson, and using strong preclinical evidence, our team has shown that compounds such as NK1 or DRD3 antagonists may help prevent relapse by attenuating dysregulated brain responses in reward system or to triggers like drug cues or emotional stress.

More recently, we’ve run proof-of-concept clinical trials, including a study testing whether baclofen helps people detox from methadone in opioid dependence. Conducting trials in addiction services, many of which are now outside the NHS, has been challenging but has created valuable learning for future community-based research.

Crucially, we have always worked closely with people with lived experience. It’s encouraging that their input and involvement is increasingly recognised as essential by funders and institutions.

Teaching, leadership and an unexpected move into policy

Teaching undergraduates and postgraduates has been one of the most rewarding parts of my career. I’ve always tried to create opportunities for others, whether locally or through national career development panels. Seeing people grow and succeed is a real joy for me.

I’ve also held several leadership roles, including recently being Head of Psychiatry at Imperial. I never set out to be a “leader”, but I realised early on that if you want to change things, you need to be in the driving seat. Sitting on national and international committees taught me a great deal about effective leadership.

More unexpectedly, I was appointed Chair of the Addiction Healthcare Goals at the Office for Life Sciences (OLS). The Goals programmes aim to improve research infrastructure across major health areas so to innovations can reach the clinic faster. I had never done Government or policy work before, so it has been a steep learning curve – but immensely rewarding. I work with a great team at OLS, and we’ve delivered, for example, major funding calls and career development fellowships.

Looking back – and forward

Throughout my career, I have been fortunate to work with many wonderful colleagues and to travel to extraordinary places. Being part of a supportive team has always mattered to me – it makes the highs and lows easier.

My hope is that the evidence we’ve generated will help transform how we treat addiction. That transformation is long overdue.

Asthma is the most common long-term condition affecting children of all ages worldwide. In the UK, around 10% of children live with asthma – meaning at least two or three children in every classroom. Among these, those under the age of five face the greatest challenges: they experience the most acute attacks, have the highest number of hospital admissions, and account for 75% of all emergency department visits for childhood asthma. Despite this significant burden, the rate of attacks and hospitalisations have remained unchanged for over 20 years.

This time of year brings the issue into sharp focus. Most admissions occur during the autumn and winter months. Parents and families live in a constant state of vigilance, never knowing whether the next runny nose will simply be a cold or will escalate into yet another visit to hospital with wheezing and breathlessness.

Why research in under-5s matters

Finding better treatments to prevent repeated asthma attacks in young children is what drives my work. Toddlers, unlike older children and adults, cannot reliably perform lung function tests, and deciphering the mechanisms behind their illness is far from easy. As a result, many researchers avoid this age group altogether. But if we all turn away, nothing will change – and the long-term harms these children will face will persist.

We know that frequent or severe asthma attacks in early childhood lead to a measurable loss of lung function within the first five to six years of life. This early deficit never fully recovers, putting individuals at significantly higher risk of developing chronic obstructive pulmonary disease (COPD) and increasing their likelihood of cardiac and metabolic diseases, such as diabetes in adulthood. In some cases, it can even contribute to premature mortality. Difficultly is not an excuse for inaction. Our efforts will bear fruit – and supporting early career researchers to recognise the scale and urgency of the problem is crucial if we are to make progress.

The wider impact of early adversity

The long-term consequences of poor health in early childhood extend far beyond lung diseases. Adverse childhood events – trauma, stress and adversity during childhood or adolescence – have profound and lasting effects on an adult’s life. They increase the risk of cardiovascular disease, cancer and mental health disorders. Socioeconomic deprivation adds an additional layer of stress, and the heaviest burden consistently falls on children from the lowest-income backgrounds.

Advocating for children through PaeCH

My second passion lies in advocating for children’s lifelong health through the Centre for Paediatrics and Child Health (PaeCH) at Imperial. Without a formal Department of Paediatrics, there is a risk that child health research could lose visibility or recognition. Yet this absence has pushed us to be bold, innovative, and determined in ensuring children’s health remains a priority.

Having formed a Faculty Centre five years ago, we’ve brought together excellent paediatric researchers and created a like-minded community, committed to ensuring the health needs of children remain a priority. Critical and seamless integration with our NHS partners, and a focus on nurturing our early career researchers, has helped to cultivate an inclusive, positive, and highly visible research culture. The inclusion of this “wise woman’s” reflections in this blog is, perhaps, a testament to our persistence – and our commitment to ensuring the children’s voice remains loud and clear.

If we are to improve lifelong health, we must get things right from the very beginning.