health benefits, by improving diabetes, blood lipids, high blood pressure, Data from the Diabetes Prevention Program demonstrated that lifestyle changes …
Mr Chairman and Members of the Subcommittee:
Thank you for the opportunity to testify before you on behalf of
NAASO, the North American Association for the Study of Obesity NAASO is
the only member-based scientific society dedicated to the study of obesity
Its membership is comprised of the 1,500 leading scientists and clinicians
in the field We are committed to research on the causes, treatment and
prevention of obesity
I am Michael Jensen, MD, NAASO President and a Professor of Medicine
at the Mayo Clinic in Rochester, Minnesota I am here to testify to the
importance of federally funded programs that support obesity research and
prevention The scientific advances we have made in the last ten years
could not have happened without the important support expressed by this
committee for biomedical research We are here today to ask that you expand
your support of obesity treatment and prevention programs and we ask for
your help in seeing that the NIH allocate at least 2 of its research funds
to obesity research in the coming year
Overview
Obesity is a major public health problem in the United States because
of its marked prevalence, association with serious
medical complications,
and economic consequences
The prevalence of obesity in American adults and children has
doubled in the last 20 years, and now approximately 60 of
adults and 15 of children are overweight or obese The
prevalence of obesity is particularly high in many ethnic
minority women
Obesity is the number two preventable cause of death in the
United States, resulting in more than 300,000 lost lives each
year
People who are obese have an increased risk of developing many
serious medical diseases, including type 2 diabetes, high blood
pressure, stroke, heart disease, sleep apnea, arthritis, liver
disease, breast, endometrial and prostate cancer, and pregnancy
complications
Childhood obesity is associated with adult obesity and an
increased risk of having obesity-related diseases such as type 2
diabetes, which is now occurring with increasing frequency in
childhood More than 25 of severely obese adolescents are
diagnosed with insulin resistance
Currently, more than 61
billion/year is spent on obesity-
related health care expenses It is estimated that another 40
billion/year is lost because of obesity-related absenteeism and
decreased work productivity
The health care cost of obesity is exponentially associated with
the prevalence of obesity For instance, between 1988 and 1994,
the number of physician visits attributable to obesity increased
88 With the trend towards increasing prevalence of obesity in
the US, the potential economic impact could be devastating to
our health care system as more and more Americans develop
expensive, lifetime co-morbidities such as diabetes
Obesity has become an epidemic that will continue to have serious
effects on Americas health and economy, if we do not reverse current
trends
Impact of recent research
Research funding supported by this committee has led to marked
advances in our understanding of the molecular, metabolic, behavioral and
environmental factors that contribute to obesity and obesity-related
diseases, and the therapeutic approaches needed to improve health
outcomes
and quality of life
For example:
o The discovery of leptin and other neural and endocrine regulatory
pathways in the brain has revolutionized our understanding of the
factors that regulate food intake Continued research in the area of
appetite regulation will likely lead to improved therapies for
obesity
o We have learned that fat is not simply a storage depot for fuel but an
active, hormone producing tissue Body fat produces signals that can
have widespread effects on the function of other tissues
o We now understand that fat distribution is an important risk factor
for obesity-related disease Excess abdominal fat, and abnormal fat
deposits in muscle, heart, liver, and pancreas are associated with
diabetes, high blood pressure, abnormal blood lipids, heart disease,
and liver disease
o Carefully performed clinical trials have demonstrated that losses of
as little as 5-10 of body weight can have considerable health
benefits, by improving diabetes, blood lipids, high blood pressure,
liver disease, and sleep apnea
o Data from the Diabetes Prevention Program demonstrated that
lifestyle
changes that cause modest 6 loss in weight and increase physical
activity can reduce the risk of developing diabetes by 58 in high-
risk patients
o We now have a better understanding of the factors associated with
food that lead to increased calorie intake eg high-calorie density
foods, increased food variety, large portion sizes, low cost, and
restaurant eating and decreased calorie intake eg low-energy
density foods, low-fat foods, structured meal plans, increased
availability and affordability of fruits and vegetables, and
monitoring food intake regularly These carefully tested
observations provide a scientific basis for dietary manipulations
needed to enhance long-term weight management success
o We have learned that increasing physical activity is critical for
maintaining diet-induced weight loss In fact, several research
studies have been able to determine the amount of physical activity
that is needed to prevent most people from regaining the weight they
have lost
o We have learned that the successful management of obesity requires
long-term therapy,
similar to the approach that is used for other
chronic diseases A series of carefully conducted trials have
demonstrated that long-term behavioral therapy can lead to long-term
weight loss; it is now common for half of patients enrolled in long-
term programs to achieve and maintain a degree of weight loss that
confers significant health benefits
o Other research has demonstrated that comprehensive weight loss
programs for children can lead to both short-term and long-term 10-
year success A key finding from these studies was identifying the
importance of parental involvement in achieving the best long-term
outcomes
o The establishment of NIH-funded Obesity/Nutrition Research Centers
ONRCs and Clinical Nutrition Research Units CNRUs within academic
medical centers has generated a rich environment for collaborative
investigation and training young investigators In addition, these
centers serve to attract new talent to the obesity and nutrition field
and provide an important resource for educating students, trainees,
and physicians in obesity, clinical nutrition, and health
promotion
Research Expenditures
Despite the increase in research dollars over recent years, funding
for obesity research is not commensurate with the scope of this public
health crisis Obesity is the number two preventable cause of death for
Americans, yet the NIH currently plans on allocating only one percent of
its total budget to obesity research Research supported by the NIH has
made a major impact on the health of the US population, by focusing
support to understand the basic biology of human diseases and the
therapeutic approaches to treat and eliminate serious diseases The time
has come for the NIH to provide a major research focus on obesity This
effort must be carefully directed with the overall goal of prevention and
treatment But more resources need to be directed to this most important
health issue NAASO urges this committee to double the amount spent on
obesity research 2 for the number two health problem in America is not
too much to ask
Future Directions
It is important to build on the accomplishments made in the last 10 years
by increasing our research efforts to understand the basic biology and
pathophysiology of obesity, and to translate basic and
clinical research
findings to medical and community practice Future research should be
directed toward: 1 developing more effective prevention strategies; 2
improving obesity treatment; and 3 improving our understanding of the
pathogenesis and pathophysiological effects of excess adiposity
Prevention and treatment efforts in children and adolescents are
particularly important because successful weight management in these age
groups will help prevent obesity in adulthood
The current obesity epidemic can be attributed, in large part, to a
modern environment that implicitly discourages physical activity and
explicitly encourages the consumption of supersized portions of high-fat,
high-sugar foods Therefore, to be successful, prevention efforts will
need to target the modern environment Traditional approaches that have
emphasized education and individual responsibility have not been, and are
unlikely to be, effective Support for developing new and effective
obesity prevention strategies are needed
Additional research efforts are needed to improve treatment for
persons who are already obese These studies should further define the
roles of the types of foods consumed,
structured meal plans, specific
exercise/activity programs, and innovative technological approaches eg,
the Internet in achieving and maintaining long-term weight loss The most
exciting new developments in obesity therapy probably will be derived from
research that improves our understanding of the more basic mechanisms
responsible for regulating energy balance This information may lead to
the development of new and effective pharmacological agents that decrease
energy intake and/or increase energy expenditure Finally, the long-term
effectiveness and safety of new surgical approaches eg, gastric pacing
and laparoscopic techniques and efforts to decrease postoperative
complications need to be studied in randomized controlled trials
The mechanisms responsible for the link between excess adiposity and
many obesity-related diseases are not clear Therefore, additional
research is needed to identify the cellular and physiological factors that
are responsible for organ and tissue damage related to excess total body
fat and specific fat distribution patterns The recent mapping of the
human genome provides exciting new opportunities for understanding the
pathogenesis and
pathophysiology of obesity, which could lead to improved
therapeutic approaches for both obesity and obesity-related medical
complications
Recommendations
In order to stem this epidemic the United States must focus more
resources on both prevention and treatment of overweight and obesity
Prevention
We ask that Programs at the Centers for Disease Control and
Prevention CDC targeting obesity be provided more support The CDC is
currently working with 12 State Health Departments in developing obesity
prevention programs They are working with Kaiser Health Plans to develop
strategies for obesity prevention and treatment with various community-
based organizations developing strategies for physical activity programs
These programs need to be supported and expanded
CDCs Division of Adolescent and School Health DASH is working to
prevent the most serious health risk behaviors among children, adolescents
and young adults Recent studies illustrate that school physical education
programs increase physical activity and potentially reduce obesity or its
complications However, from 1991 to 1999, the number of students attending
daily physical education class declined
from 42 to 29 Children spend
approximately 48 of their waking hours in school or engaged in school-
related sedentary behaviors such as homework Thus, school environments
represent a major opportunity for the implementation of programs to improve
physical activity and nutrition patterns
The CDCs Youth Media Campaign, to begin this summer, is exactly the
type of program that can have an important positive effect in the promotion
of healthy behaviors, especially physical activity, in middle-school-age
children Studies show that mass media can be an effective way to promote
healthy behaviors at a reasonable cost We urge you to fully fund this
program at the requested amount of 125 million in FY 2003
Research support is needed to develop racially and ethnically
sensitive community-based programs that can affect environmental factors
that lead to unhealthy eating and physical activity behaviors Children
and families should especially be targeted, to reduce the risk of childhood
and future adult obesity
Treatment
Most obese persons know what they need to do to lose weight but are
unable to implement the lifestyle changes needed to lose weight permanently
or prevent
weight gain Additional research is needed to identify the
barriers to change and the most effective therapeutic approaches necessary
to sustain long-term alterations in eating and physical activity behaviors
Obese children face a dangerous spiral as excess body fat limits exercise
tolerance and reduces physical activity, ultimately leading to Type 2
diabetes, and other serious chronic diseases and emotional problems
Programs to treat severe childhood obesity are uncommon More studies that
focus on effective therapy for childhood obesity are needed
Pathogenesis and Pathophysiology
Many important basic aspects of obesity are not understood, including
how the total amount and distribution of body fat is regulated, how the
brain communicates with the body to regulate food intake and activity, and
vice versa We also do not know what factors, hormonal and metabolic,
foster the development of obesity at susceptible stages of development If
we comprehend the underlying biology of these issues we may be able to make
the kind of rapid progress in prevention and treatment that has accompanied
similar advances in other aspects of medicine such as hypertension and
excess
cholesterol
The prevalence of obesity is greater in women than in men This is
particularly striking in minority groups such as African-Americans where
37 of women vs 21 of men are obese The reason for the gender
difference in obesity prevalence is not clear, but may have to do with
hormonal effects Both pregnancy and menopause are high-risk times in
womens lives for obesity development While the average woman retains
about 4 lbs following each pregnancy, 20-25 of women experience a major
weight gain of 10 lbs or more due to pregnancy Minority women tend to
retain more excess weight after pregnancy Menopause is also typically
associated with modest weight gain, however some women experience major
weight gain at menopause Fat distribution also shifts at menopause to a
more abdominal pattern, associated with higher risk for heart disease and
diabetes In addition to the general medical complications of obesity such
as heart disease and diabetes, obesity in women increases risk for breast
cancer, infertility and other reproductive problems Research on causes and
treatments of obesity related to gender is needed
Conclusion
Obesity is quickly becoming the leading
health care problem in the
United States It is a complex disease that involves genetic, metabolic,
behavioral, environmental factors The increased prevalence and causal
relationship with serious medical complications have considerable health
and economic consequences for our country Increasing research for
understanding, preventing and treating obesity will decrease the prevalence
of costly obesity related diseases, such as diabetes, high blood pressure,
and coronary heart disease, and ultimately result in considerable financial
savings
NAASO urges the committee to:
1 Allocate 2 of biomedical research to the number two health problem in
America - including increased funding for:
a Research that will increase our understanding of the basic
biology of obesity,
b Translational research to enhance the application of successful
strategies to control body weight,
c Research directly addressing how environmental behavior, and
lifestyle factors can be altered to prevent obesity,
particularly in children
2 Support prevention programs by providing:
a 60 million in support of CDCs request for obesity
programs;
b Full funding for the CDCs Youth Media Campaign at 125 million;
and,
3 Fully fund and increase the number of Obesity/Nutrition Research
Centers and Clinical Nutrition Research Units, which provide think
tanks for collaborative interaction, a training ground for young
investigators, and a resource for health education
Thank you for this opportunity to testify, Mr Chairman I am available
to answer any questions
