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

1. Setting the Stage:Addressing the Public health Problem of Overweight and Obesity Van S. Hubbard, M.D., Ph.D. CAPT, USPHS Director, NIH Division of Nutrition Research Coordination

2. Leadership Activities • NIH Nutrition Coordinating Committee • Chief, Nutritional Sciences Branch, NIDDK • Healthy People 2010 Nutrition and Overweight Focus Area • Surgeon General’s Call To Action • Steering Committee for DRI’s • Academy of Pediatrics Committee on Nutrition and Obesity Task Force • Interactions with HHS, USDA, and DOD

3. 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?

4. 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. NIH Obesity Research Task Force Establishment of the Task Force by Dr. Elias Zerhouni, Director, NIH, to facilitate progress in obesity research (April 2003) Co-chaired by Directors of NHLBI and NIDDK; members include representatives from many additional NIH components

5. Charge to the NIH Obesity Research Task Force Develop an NIH strategic plan for obesity research based on identification of areas of greatest scientific opportunity and need. Monitor implementation of the strategic plan; report to the NIH Director and Institute and Center (IC) Directors. Serve as a point of contact for obesity research-related issues between NIH and external agencies.

6. NIH Obesity Research Task Force NIDDK 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 Co-Chairs Dr. Barbara Alving, Acting Director, NHLBI Dr. Allen Spiegel, Director, NIDDK Members

7. Input from Extramural Scientists, Lay Leaders, and the Public to Inform the NIH Obesity Research Plan Examples: General scientific meetings (Keystone Symposium on Obesity, January 2003) Meetings convened by NIH ICs for research planning advice (NHLBI Think Tank on Enhancing Obesity Research, March 2003) Panels of experts associated with NIH ICs (Institutes’ Advisory Councils; NIDDK Clinical Obesity Research Panel) Specific solicitations of external input for the NIH Obesity Research Task Force

8. 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 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 NIH Obesity Research Outcome Goals

9. An Intramural Component of the NIH Obesity Research Plan A coordinated intramural obesity research program is being developed by the NIH Deputy Director for Intramural Research and a steering committee of Scientific Directors from nine ICs, chaired by the Director of NIDDK’s Division of Intramural Research. Research focus: animal models, bench-to-bedside, clinical research.

10. Building a Framework for Organizing and Coordinating Obesity Research Activities Identification of genetic, behavioral and environmental factors causing obesity Understanding pathogenesis of obesity and its comorbidities Prevention and treatment of obesity Policy, health services, economics, translation to practice Enabling technologies Development of multi-disciplinary research teams

11. Nearly two thirds of US adults are overweight (BMI  25), and over 30% are obese (BMI  30) 300,000 deaths per year due to poor diet/inactivity $117 billion/year in economic costs (2000 data) Obesity in the US

12. 1991 1995 2001 No Data <10% 10%-14% 15-19% 20% 25% Source: Mokdad A H, et al. JAMA 2003;289:1 Obesity* Trends Among U.S. AdultsBRFSS, 1991, 1995 and 2001 (*BMI 30, or ~ 30 lbs overweight for 5’4” person)

13. Government • Healthy People 2010 – community actions • Dietary Guidance – • Dietary Guidelines for Americans • Food Guide Pyramid • NHANES – community and longitudinal needs • Research

14. “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.

15. PublicComments Listening session Nat. Nut Summit Priority Areas School Healthcare Media Worksites Families/Comm Surgeon General’s Call to Action Surgeon General’s Call to Action Healthcare Schools Families/Comm Media Worksites National Action

16. To address impact of chronic disease • Emphasize the role of partnering in the development of and response to research and public health initiatives • Communicate among each other • Identification of “Added Value”

17. Realities • There is a finite limit of financial and human resources • Consequently, interactions across Agencies and other organizations are imperative in order to enhance our investments

18. Promotion of Multidisciplinary Research • Agencies and other funding sources • Scientific Community • Institutions • Other sectors (Community Participatory Research)

19. Let us all strive to make a difference

20. Thank you for listening