National Nutrition Summit Position Paper

The North American Association for the Study of Obesity (NAASO) is the leading scientific society dedicated to obesity and includes over 1,200 scientist and clinician members who are involved in obesity research and treatment. Approximately 300,000 deaths each year in the United States can be attributed to obesity. Therefore, excluding smoking, obesity is the country’s leading cause of premature death. It is NAASO’s position that:

Preventing obesity is ultimately the key to managing obesity.
Any solution must involve all sectors of our economy, of our communities and of our health system.
A coordinated, accurate, public information campaign is necessary.
Access to medical treatment must be improved to reduce inappropriate treatment choices.
Greater scientific understanding of obesity and its related morbidities is critical to better prevention and treatment of obesity.
The Surgeon General and the President must publicly recognize obesity as the public health epidemic it is.

Overview of the Problem of Obesity in the United States

Obesity is a major public health problem in the United States because of its high prevalence and causal relationship with many serious medical complications, including diabetes, high blood pressure, high blood cholesterol, heart disease, cancer, gallbladder disease, liver disease, lung diseases, arthritis, sleep disorders, and premature death.
Data from the third National Health and Nutrition Examination Survey (NHANES III) demonstrate that currently 54% of adults (97 million persons) and 25% of children and adolescents in the United States are overweight, defined as a body mass index >25 kg/m2. The prevalence of obesity, defined as a body mass index >30 kg/m2, has doubled in the adult population in the last 15 years.
The prevalence of obesity is rising in all ages, races and genders in the United States but the relative increase is greatest among our children. The increase in early obesity is responsible for an increase in obesity-related diseases in children, such as type 2 diabetes, that were previously considered "adult diseases".
Obesity is more common among certain ethnic minorities, particularly African American, Native American, and Hispanic women.
Obesity has considerable economic effects; numbers of studies have shown the direct health care costs of obesity to exceed tens of billions of dollars. When indirect costs are included, it is estimated that the medical complications associated with obesity cost the United States more than $100 billion/year. Cost per patient per year of diabetes care is estimated at $10,000.

Obesity Prevention

The National Nutrition Summit should develop coherent programs to assist Americans in achieving a healthier balance between caloric intake and energy expenditure.

Public/private partnerships. Public/private partnerships should be developed that involve relevant government agencies, appropriate medical and scientific associations, employer organizations, unions, educational authorities and the media. These groups are positioned to develop community, educational and workplace strategies that focus on long-term improvement in lifestyle behaviors (physical activity and diet). This is a complex process that might be appropriately led by the Departments of Agriculture, Health and Human Services, and Education.

Public information. Educational programs, involving many media outlets television, magazine articles, website, lecture symposia, school programs, and community education, should be developed to teach Americans about the health risks associated with obesity, what can be done to prevent and manage excess weight, and how to evaluate claims made by manufacturers of unproven herbal therapies and supplements. NAASO is already involved in this area and will expand our current programs.

Treatment Issues

Loss of as little as 5%–10% of initial weight alleviates many medical abnormalities associated with obesity, including glucose intolerance, high blood pressure, and abnormal blood lipids. Therefore, modest weight loss, as long as it is maintained, can have important clinical benefits and is a realistic goal. However, even modest weight loss goals are not achievable if appropriate therapies, which include, but are not limited to, physician supervision, diet counseling, physical activity education, behavior modification, and pharmacotherapy, are not affordable. Lack of health care coverage for obesity limits treatment options, makes it difficult to obtain appropriate medical care, and drives people toward inappropriate treatment choices. An evaluation of reimbursement issues related to obesity treatment is needed to consider whether obesity is as deserving of treatment coverage as other chronic diseases.

Research issues

We have made important progress in obesity science, but the greatest challenges are still before us. Research success is absolutely dependent on research support, so we urge a strong commitment to obesity science support by the National Institutes of Health, other government science programs, and by the private sector.

Governmental endorsement

The Surgeon General and the President should provide a strong message to the American public:

Identifying obesity as a growing and dangerous public health problem
Emphasizing the medical risks of obesity and encouraging overweight individuals to seek care with their primary care provider
Recognizing the biological origins of obesity and standing against prejudice toward obese people
Encouraging people to consume a healthier diet (lower calories, lower saturated fat and increased fruits and vegetables) and to increase daily physical activity.

Summary

The North American Association for the Study of Obesity (NAASO) calls on this Summit to begin a process that prevents the continued increase in obesity in both children and adults, enhances treatment options, increases federal funding for research, and encourages our governmental leaders to support the need for healthier lifestyle choices.