Setting the Stage:Setting the Stage:Addressing the Public health Addressing the Public health Problem of Overweight and Problem of Overweight and

ObesityObesityVan S. Hubbard, M.D., Van S. Hubbard, M.D.,

Ph.D.Ph.D.

CAPT, USPHSCAPT, USPHS

Director, NIH Division of Director, NIH Division of Nutrition Research Nutrition Research

CoordinationCoordination

Leadership ActivitiesLeadership Activities

• NIH Nutrition Coordinating CommitteeNIH Nutrition Coordinating Committee• Chief, Nutritional Sciences Branch, Chief, Nutritional Sciences Branch,

NIDDKNIDDK• Healthy People 2010 Nutrition and Healthy People 2010 Nutrition and

Overweight Focus AreaOverweight Focus Area• Surgeon General’s Call To ActionSurgeon General’s Call To Action• Steering Committee for DRI’sSteering Committee for DRI’s• Academy of Pediatrics Committee on Academy of Pediatrics Committee on

Nutrition and Obesity Task ForceNutrition and Obesity Task Force• Interactions with HHS, USDA, and Interactions with HHS, USDA, and

DODDOD

The Public Health Approach to Obesity

The Public Health Approach to Obesity

Defining the problem/surveillance• What is the magnitude and distribution of overweight and obesity?

Identifying the causes and protective factors• What are the risk factors for overweight and obesity?

Developing and testing interventions• What can we do to prevent or ameliorate overweight and obesity?

Implementing interventions• How do we implement and evaluate effective strategies?

NIH Obesity Research Task NIH Obesity Research Task ForceForce

• Establishment of the Task Force by Dr. Elias Zerhouni, Establishment of the Task Force by Dr. Elias Zerhouni, Director, NIH, to facilitate progress in obesity research (April Director, NIH, to facilitate progress in obesity research (April 2003)2003)

• Co-chaired by Directors of NHLBI and NIDDK; members Co-chaired by Directors of NHLBI and NIDDK; members include representatives from many additional NIH include representatives from many additional NIH componentscomponents

Given the relevance of obesity-associated morbidities to the missions of most or all NIH Institutes and Centers, along with new scientific opportunities for research, the NIH clearly can and must play a major role in addressing the increasingly severe obesity epidemic and its serious implications for public health.

Charge to the NIH Obesity Charge to the NIH Obesity Research Task ForceResearch Task Force

• Develop an NIH strategic plan for obesity research based Develop an NIH strategic plan for obesity research based on identification of areas of greatest scientific opportunity on identification of areas of greatest scientific opportunity and need. and need.

• Monitor implementation of the strategic plan; report to the Monitor implementation of the strategic plan; report to the NIH Director and Institute and Center (IC) Directors.NIH Director and Institute and Center (IC) Directors.

• Serve as a point of contact for obesity research-related Serve as a point of contact for obesity research-related issues between NIH and external agencies.issues between NIH and external agencies.

NIH Obesity Research Task ForceCo-Chairs

Dr. Barbara Alving, Acting Director, NHLBIDr. Allen Spiegel, Director, NIDDK

MembersNIDDK Dr. Phil Smith

Dr. Sue Yanovski

Dr. Lisa Gansheroff

NHLBI Dr. Darla Danford

Ms. Karen Donato

Dr. Abby Ershow

Dr. Denise Simons-Morton

DNRC Dr. Van Hubbard

FIC Dr. Rachel Nugent

NCCAM Dr. Margaret Chesney

NCI Dr. Rachel Ballard-Barbash

NCMHD Dr. Mireille Kanda

NCRR Dr. David Wilde

NHGRI Dr. Alan Guttmacher

NIA Dr. Judy Salerno

NIAAA Dr. Thomas Gentry

NIAMS Dr. Gayle Lester

NIBIB Dr. William Heetderks

NICHD Dr. Gilman Grave

NIDA Dr. Joe Frascella

NIDCR Dr. Maria Canto

NIEHS Dr. Allen Dearry

NIMH Dr. Richard Nakamura

NINDS Dr. Merrill Mitler

NINR Dr. Claudette Varricchio

OBSSR Dr. Deborah Olster

ODP Ms. Martina Vogel-Taylor

ODS Dr. Mary Frances Picciano

ORWH Dr. Lisa Begg

OSP Dr. Lana Skirboll

Input from Extramural Scientists, Input from Extramural Scientists, Lay Leaders, and the Public to Inform Lay Leaders, and the Public to Inform

the the NIH Obesity Research PlanNIH Obesity Research Plan

Examples:Examples:

• General scientific meetingsGeneral scientific meetings (Keystone Symposium on Obesity, January 2003)(Keystone Symposium on Obesity, January 2003)

• Meetings convened by NIH ICs for research planning adviceMeetings convened by NIH ICs for research planning advice (NHLBI Think Tank on Enhancing Obesity Research, March 2003)(NHLBI Think Tank on Enhancing Obesity Research, March 2003)

• Panels of experts associated with NIH ICsPanels of experts associated with NIH ICs (Institutes’ Advisory Councils; NIDDK Clinical Obesity Research Panel)(Institutes’ Advisory Councils; NIDDK Clinical Obesity Research Panel)

• Specific solicitations of external input for the NIH Obesity Specific solicitations of external input for the NIH Obesity Research Task ForceResearch Task Force

NIH Obesity Research Outcome Goals

Use knowledge of regulation of energy storage and food intake to develop new therapeutic modalities (including drugs, surgery, and other technologies) to complement lifestyle interventions

Use knowledge of mechanisms whereby obesity increases risk for co-morbidities to develop potential therapeutic approaches for ameliorating these conditions independent of weight loss

Evaluate the effectiveness and assure translation of strategies to maintain healthy weight in children and adults through lifestyle behavior (activity, diet) change which can be applied in a community, home, school, or workplace environment

An Intramural Component of An Intramural Component of the the

NIH Obesity Research PlanNIH Obesity Research Plan

• A coordinated intramural obesity research program is A coordinated intramural obesity research program is being developed by the NIH Deputy Director for being developed by the NIH Deputy Director for Intramural Research and a steering committee of Intramural Research and a steering committee of Scientific Directors from nine ICs, chaired by the Director Scientific Directors from nine ICs, chaired by the Director of NIDDK’s Division of Intramural Research.of NIDDK’s Division of Intramural Research.

• Research focus: animal models, bench-to-bedside, Research focus: animal models, bench-to-bedside, clinical research.clinical research.

Building a Framework for Building a Framework for Organizing and Coordinating Organizing and Coordinating Obesity Research ActivitiesObesity Research Activities

• Identification of genetic, behavioral and environmental Identification of genetic, behavioral and environmental factors causing obesityfactors causing obesity

• Understanding pathogenesis of obesity and its comorbiditiesUnderstanding pathogenesis of obesity and its comorbidities

• Prevention and treatment of obesityPrevention and treatment of obesity

• Policy, health services, economics, translation to practicePolicy, health services, economics, translation to practice

• Enabling technologiesEnabling technologies

• Development of multi-disciplinary research teams Development of multi-disciplinary research teams

Obesity in the USObesity in the US

• Nearly two thirds of US adults are Nearly two thirds of US adults are overweight (BMI overweight (BMI 25), and over 30% 25), and over 30% are obese (BMI are obese (BMI 30) 30)

• 300,000 deaths per year due to poor 300,000 deaths per year due to poor diet/inactivity diet/inactivity

• $117 billion/year in economic costs $117 billion/year in economic costs (2000 data)(2000 data)

Obesity* Trends Among U.S. AdultsObesity* Trends Among U.S. Adults BRFSS, 1991, 1995 and 2001BRFSS, 1991, 1995 and 2001

(*BMI 30, or ~ 30 lbs overweight for 5’4” person)

1991 1995

2001

Source: Mokdad A H, et al. JAMA 2003;289:1

No Data <10% 10%-14% 15-19% 20% 25%

GovernmentGovernment

• Healthy People 2010 – Healthy People 2010 – community community actionsactions

• Dietary Guidance – Dietary Guidance – – Dietary Guidelines for AmericansDietary Guidelines for Americans– Food Guide PyramidFood Guide Pyramid

• NHANES – NHANES – community and longitudinal community and longitudinal needsneeds

• ResearchResearch

“Overweight and obesity… have reached epidemic proportions in the United States…Left unabated, overweight and obesity may soon cause as much preventable disease and death as cigarette smoking”

- David Satcher, M.D., Ph.D.

Public Comments Listening session Nat. Nut Summit

PriorityAreas

Healthcare Media WorksitesSchool Families/Comm

Surgeon General’s Call to Action

SchoolsWorksites Media Families/Comm

Healthcare

National Action

Surgeon General’s Call to Action

To address impact of chronic diseaseTo address impact of chronic disease

• Emphasize the role of Emphasize the role of partneringpartnering in in the development of and response to the development of and response to research and public health initiativesresearch and public health initiatives – Communicate among each otherCommunicate among each other– Identification of “Added Value”Identification of “Added Value”

RealitiesRealities

• There is a finite limit of financial and There is a finite limit of financial and human resourceshuman resources

• Consequently, interactions across Consequently, interactions across Agencies and other organizations Agencies and other organizations are imperative in order to enhance are imperative in order to enhance our investmentsour investments

Promotion of Multidisciplinary Promotion of Multidisciplinary ResearchResearch

• Agencies and other funding sourcesAgencies and other funding sources• Scientific CommunityScientific Community• InstitutionsInstitutions• Other sectors (Community Other sectors (Community

Participatory Research) Participatory Research)

Let us all strive Let us all strive to make a to make a differencedifference

Thank you for Thank you for listeninglistening