Torfay Sharifnia Roman, MD, joined Orlando’s AdventHealth Transplant Institute in October 2014 as a Transplant Hepatologist. She completed her Internal Medicine residency training at Boston University Medical Center in Boston, Massachusetts. She subsequently completed her Gastroenterology fellowship, as well as an advanced fellowship in Transplant Hepatology, at Vanderbilt University Medical Center in Nashville, TN. She is board certified in Internal Medicine, Gastroenterology, and Transplant Hepatology.

Dr. Roman cares for patients requiring treatment for liver related diseases, including those with end stage liver failure/cirrhosis needing liver transplantation. Her clinical specialties include management of patients with viral hepatitis, NASH/fatty liver, autoimmune liver disease, genetic liver diseases, alcohol mediated disease, liver cancer and cirrhosis. She specializes in treating patients who require liver transplantation and manages their long-term post-transplant care.

Additionally, Dr. Roman is the Medical Director for the Fatty Liver Disease program at AdventHealth, Winter Park. She provides sub-specialty, comprehensive care for those with Non-Alcoholic Fatty Liver Disease (NAFLD). She is a member of the American Association of the Study of Liver Diseases (AASLD), American Gastroenterological Association (AGA), and American Society of Transplantation (AST). Her research interests include NAFLD and therapeutics targeting disease progression.

Why did you pursue obesity medicine certification?
I am a Transplant Hepatologist and have a large panel of patients with non-alcoholic fatty liver disease (NAFLD), which affects about 25% of the US population. Approximately 30% of those with NAFLD will develop a more severe form of liver disease, nonalcoholic steatohepatitis (NASH). About 20% of NASH patients will progress to cirrhosis, and subsequently, end stage liver failure with increased risk of death by end stage liver disease and liver cancer (HCC). By 2025, it is expected that more than 25 million Americans will have NASH related liver disease.

Over the last several years, I have personally witnessed this exponential rise in NAFLD and its sequelae of increased morbidity and mortality through daily patient care. Although there are many therapeutics in the research pipeline, there are currently no FDA approved medicines for NASH. Because of this, patients are presenting sicker and younger, often at late stages of disease, where liver transplant is the only option. Many patients with NASH cirrhosis may not qualify for liver transplant in the setting of significant comorbidities, including morbid obesity, significant cardiovascular disease, renal disease, decreased functional status, and others. As a result, many patients have progressive, irreversible chronic disease with little to no meaningful solutions.

Because of this pressing need, we have developed a clinical program specifically dedicated to those with NAFLD/NASH, in hopes of offering early diagnosis and meaningful intervention.

It is well known that obesity plays a central role in NASH and many would agree that NAFLD is the hepatic manifestation of metabolic syndrome. There is robust evidence in the literature that shows that 10% or more TBW leads to histologic regression in NASH and even fibrosis. As such, to offer patients meaningful change in their disease progression, it is essential to engage early in disease and intentionally offer solutions for weight loss. As such, practicing obesity medicine is fundamental to my clinical practice. The natural next step was board certification in Obesity Medicine.

How do you currently incorporate your obesity medicine training into your practice?
Obesity medicine is integral to my NAFLD practice. We start with lifestyle counseling but also educate early about the critical role of weight loss in fatty liver disease reversal. Many patients meet criteria for FDA approved anti-obesity medicines and, as such, we regularly offer these as an option in a patient’s individualized treatment plan. For those that meet criteria, endo-bariatrics and bariatric surgery are effective therapeutic interventions for disease reversal.

Why do you believe obesity medicine certification is valuable?
Getting certified in obesity medicine has given me the essential tools I need to provide comprehensive multi-modality solutions to my patients with NAFLD. Understanding obesity as a multisystem disease helps me collaborate effectively with my colleagues in internal medicine, endocrine, endo-bariatrics, cardiology and bariatric surgery so that we can offer patients complete multidisciplinary care.

What is the biggest challenge you face in your practice?
Living with obesity takes a toll medically, mentally and socially. Patients are often discouraged and have “given up” by the time I meet them for the first time. Once they hear about liver disease, they tend to feel even more helpless in their quest for health. Empowering patients with the tools they need to take back control over their health requires patient education, long term clinical follow up and consistency, and streamlined multi-specialty collaboration. Despite the challenges, it is immensely rewarding to see a patient’s success.

What do you wish other physicians knew about treating obesity?
Obesity effects every organ system and is relevant to every specialty. It is a central driver of much of the pathology we see in our daily practices. Learning more is essential in taking good care of our patients.

Is there anything else you would like to share about your experience with obesity medicine?
Getting certified in obesity medicine has made an important difference in my practice. It has expanded my scope as a physician, and as such, allowed me to offer more comprehensive care to my patients.

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