April 28, 2015
Gary H. Gibbons, M.D.
National Heart, Lung, and Blood Institute (NHLBI)
Building 31, Room 5A48
31 Center Drive MSC 2486
Bethesda, MD 20892
Attn: Strategic Visioning Team
Dear Dr. Gibbons,
I am writing on behalf of The Obesity Society (TOS) to provide input to the Strategic Visioning process undertaken by the NHLBI. First, we would like to convey our appreciation of the efforts made by NHBLI in supporting research to reduce the burden of heart, lung, and blood diseases worldwide, which has made enormous impacts. We also appreciate that NHLBI recognizes that obesity plays a central role in heart, lung, and blood health and provides funds for obesity-related research. TOS applauds NHLBI for undertaking strategic visioning and for providing the opportunity to provide input about future research and funding priorities. As a scientific society, we have actively participated in the strategic visioning forum and have also urged our membership to participate. Below, we have highlighted the need for additional research in several areas of obesity. We trust that you will consider this information while determining the strategic goals for NHLBI support.
As you recognize, obesity is a health crisis of epic proportions. About 34% of adults in the US have obesity, up from 31 % in 1999 and about 15% in the years 1960 through 1980. Obesity increases the risk of death from all causes, risk of cardiovascular diseases, and numerous other physical and mental health conditions. Obesity leads to social stigmatization and discrimination, which decreases quality of life dramatically. The chronic diseases that result from obesity annually cost over $150 billion in weight-related medical bills. Reduction of obesity improves cardiovascular and other health outcomes, yet what is currently known about obesity is inadequate to combat the global obesity epidemic. A comprehensive understanding about the mechanics of obesity may help in developing more effective preventive and treatment strategies, which in turn will substantially improve cardiovascular and other health measures. A few areas are outlined below to illustrate how future research could build on our current understanding of this disease.
Years of obesity research have revealed the complex nature of this disease and its multi-factorial etiology. While research has firmly established the role of energy balance in weight gain and weight loss, it is important to discover upstream factors that predispose only certain individuals to energy imbalance. This may be addressed by further focusing on newly identified putative contributors of obesity, including but not limited to the impact of sleep deprivation, ambient temperature, age at first pregnancy, intrauterine and intergenerational factors, neuro-endocrine factors, epigenetics, environmental chemicals and endocrine disruptors, gut microbes, infections and the immune system, and social and behavioral factors associated with obesogenic behaviors. These studies may provide mechanistic insight that may also lead to the development of new pharmacological approaches. It is possible that cause-specific prevention or treatment approaches may yield more effective results than generic approaches that do not necessarily consider upstream modulators of energy imbalance, or inter-individual differences.
Past research focused on using variations of diet and exercise has revealed important information about the health benefits of weight loss. The limitations of such approaches in producing biologically meaningful and sustained weight loss for the majority have also been recognized. Even within a study population, compliance to weight loss regimen, weight loss and its sustainability, and improvement in health outcomes vary considerably. Research is needed to identify the basis for this variation, which may lead to enhanced outcome and applicability of such approaches. A strong support of promising clinical translational research may promote a conducive environment for developing more practical applications.
Population based and epidemiological studies have identified segments of population that are resistant or susceptible to obesity and cardiovascular risks. Continued research is needed to identify additional such populations and their differences. Moreover, the next phase of research could be to understand the basis for this relative resistance or vulnerabilities, and exploit the information to improve obesity and cardiovascular disease risk at a community level.
Overall, years of excellent research supported by NHLBI, other NIH institutes and others have yielded a wealth of information about the complexity of the disease obesity, and its close link with cardiovascular health. As any sound research approach would provide, this research has indicated promising areas to focus, as well as seemingly dead end areas to sidestep. We submit that moving forward, strategies are needed that don't yield only incremental benefits, but instead emphasize 'high risk, high impact' research to some extent.
Given the enormous public health crisis obesity represents, and its close association of cardiovascular health, we urge your continued support of basic, clinical, population, and translational obesity research as you engage in strategic visioning to develop your research priorities for the next decade.
Nikhil Dhurandhar, PhD, FTOS
President, The Obesity Society