Think Tank on Enhancing Obesity Research at the National Heart ...

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• Langue: English

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T H I N K T A N K O N Enhancing Obesity Research at the  National Heart, Lung, andBlood Institute

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Heart, Lung, and Blood Institute

E X E C U T I V E

S U M M A R Y

T H I N K T A N K O N Enhancing Obesity Research at the  National Heart, Lung, andBlood Institute

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Heart, Lung, and Blood Institute

Administrative Use Only January 2004

E X E C U T I V E

S U M M A R Y

F O R E W O R D

As a Nation, we are confronted with an unprecedented obesity epidemic—the solution to which will be as complex in its nature as the epidemic itself. An obesity epidemic, as well as the dramatic parallel increase in associated comorbidities such as heart disease, diabetes, and asthma can be considered nothing less than an expanding public health crisis. So troubling is this crisis to the health and well-being of the American public that the Secretary of the U.S. Department of Health and Human Services (DHHS) considers it a health care priority. We at the National Institutes of Health (NIH) share this significant concern and have joined together to emphasize the importance of employing solid science to support the development of new interventions and treatments. In fact, the NIH has undertaken a series of specific activities to see how the Institutes can address important issues relevant to the obesity epidemic.

The obesity epidemic together with the relationship of obesity to the growing population burden of chronic disease presents unprecedented research opportunities and challenges. But we also are mandated to develop timely and effective solutions. Herein lies the challenge. Decades of obesity-related research funded by the National Heart, Lung, and Blood Institute (NHLBI) and throughout NIH have yielded many important discoveries about both etiological pathways and preventive or therapeutic interventions. Yet, there is a sense that the problem is outpacing these research efforts.

In the spring of 2003, Dr. Claude Lenfant, Director, NHLBI, convened a Think Tank that included many renowned experts in obesity research and asked participants for their best thinking about what targeted research recommendations would be most effective in confronting this public health challenge. The results of their deliberations are provided in this report.

Think Tank on Enhancing Obesity Research at the National Heart, Lung and Blood Institute: Executive Summary

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Barbara Alving, M.D. Acting Director National Heart, Lung, and Blood Institute Cochair NIH Obesity Research Task Force National Institutes of Health

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T A B L E O F C O N T E N T S

B A C K G R O U N D . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Obesity—The Unchecked Epidemic . . . . . . . . . . . . . . . . . . . . . . .1 Obesity and Its Relevance to Heart, Lung, and Blood Diseases and Sleep Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Cardiovascular Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Hypertension and Hemodynamic Disturbances . . . . . . . . . . . .4 Metabolic Syndrome and Its Constellation of Risk Factors . . .4 Heart Mass and Heart Failure . . . . . . . . . . . . . . . . . . . . . . . . .5 Thrombogenesis and Procoagulant Risk . . . . . . . . . . . . . . . . .6 Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Sleep Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 R E S E A R C H R E C O M M E N D AT I O N S . . . . . . . . . . . . . 8 Basic Biological Issues Related to the Etiology and Metabolic Consequences Of Obesity . . . . . . . . . . . . . . . . . . . . . .8 Genetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Adipose Tissue Biology and Behavioral Determinants of Food Intake, Fuel Regulation, and Fuel Partitioning . . . . .10 Critical Periods in Obesity Development . . . . . . . . . . . . . . . .12 Diet and Physical Activity . . . . . . . . . . . . . . . . . . . . . . . . . . .14 Developing Effective, Practical Prevention and Treatment Interventions Based on Better Understanding of Environmental and Societal Influences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16 Environmental and Societal Determinants of Food Intake and Physical Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16 The Family Environment . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 Prevention, Treatment, and Applications to Clinical Practice and Community Settings . . . . . . . . . . . . . . . . . . . . . . . . . .20 Research Training and Mechanisms . . . . . . . . . . . . . . . . . . . .23 Some Consumer and Professional Society Perspectives . . . . . .24 C O N C L U S I O N . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Setting a Research Agenda To Help Americans Achieve and Maintain a Healthy Weight . . . . . . . . . . . . . . . . . .25 P A R T I C I PA N T S . . . . . . . . . . . . . . . . . . . . . . . . . 28

Think Tank on Enhancing Obesity Research at the National Heart, Lung and Blood Institute: Executive Summary

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B A C K G R O U N D

Obesity— The Unchecked Epidemic

Overweight and obesity affect all segments of our popula- tion, and their prevalence continues to increase at an alarming rate—today, two out of three Americans are considered overweight or obese. The epidemic of obesity —together with the relationship of obesity to the popula- tion’s burden of heart, lung, blood, and other diseases— presents unprecedented research opportunities and chal- lenges. Enhanced research to accelerate knowledge is the key to unraveling the etiologies and providing interven- tions that will counteract this growing public health crisis.

In March 2003, the National Heart, Lung, and Blood Institute (NHLBI) convened a 2-dTahiyn   k Tank on Enhancing Obesity Research at the N,H   LwBhIich brought together a diverse group of stakeholders from the academic, consumer, and professional communities, including:

Basic biological and behavioral obesity researchers who view the current epidemic as a challenge for understanding the etiology and pathological processes of this all-too-common condition,
Basic researchers who study cardiovascular, pulmonary, and blood diseases and sleep disorders and for whom the increase in obesity provides a well-defined focal point for the study of pathogenesis,
Clinical researchers—interventionists who have wit- nessed the tremendous increase in the demand for their services as the number of obese people increases and whose efforts have been plagued by the difficulty of achieving long-term success,
Clinical researchers—observational epidemiologists who examine relationships between factors associated

Think Tank on Enhancing Obesity Research at the National Heart, Lung and Blood Institute: Executive Summary

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Obesity and Its Relevance to Heart, Lung, and Blood Diseases and Sleep Disorders

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Cardiovascular Disease

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F I G U R E 1 Obesity and Cardiovascular Risk

Ectopic Fat in Heart,  Dyslipidemia  Left Ventricular Muscle, Pancreas,  Hypertrophy Liver, etc.  Heart Failure

Endothelial Dysfunction Obesity Procoagulant  Prothrombotic States Obstructiv A e p   n Sl e e a ep Hypertension

Insulin Resistance Glucose Intolerance Type 2 Diabetes

Inflammatory Response

Adapted from Sharma, 2002. Source: Reprinted with permission from Nature Publishing Group © (Sharma, AM. Adipose tissue: a mediator of cardiovascularIrinstke.r   national Journal of Obesity and Related Metabolic Disord2e0rs02;26:S6, figure 3).

forms are atherosclerosis, hypertension, chronic obstruc- tive pulmonary disease, and blood-clotting disorders. The most serious atherosclerotic diseases are coronary heart disease (CHD), as manifested by heart attack and angina pectoris, and cerebrovascular disease, as manifested by stroke. Mortality rates from CHD are higher for obese than for nonobese adults. Recently, considerable attention has been devoted to adipose tissue pathophysiology associated with CVD. In obese persons, the amount of lipid stored in the adipose organ is substantially increased. So is the rate of free fatty acid release, even under basal conditions, at least in part as a result of the diminished inhibitory effects of insulin on lipolysis. Whether the higher free fatty acid flux in the peripheral circulation and the increased availability of free fatty acids to organs and tissues play a role in the increased CVD risk

Think Tank on Enhancing Obesity Research at the National Heart, Lung and Blood Institute: Executive Summary

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