Obesity: State of the Science

8/20/2019 Obesity: State of the Science

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Grifn P. Rodgers, M.D.,M.A.C.P.Director

National Institute o Diabetes andDigestive

and Kidney Diseases

National Institutes o ealt!

The State of Obesity Research

witter: @NIDDKgov


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The National Institutes ofHealth (NIH

• '!e (ission o t!e NI is to see)unda(ental )no*ledge about t!enature and be!avior o livingsyste(s and t!e a++lication o t!at)no*ledge to en!ance !ealt!,lengt!en lie, and reduce illnessand disability.

• '!e NI su++orts (ore t!an$$,$$$ (e(bers o t!e researc!

*or)orce t!roug!out t!e countryand around t!e *orld atuniversities, (edical centers,co(+anies, and at t!e NI itsel.


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& &#!ults

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Obesity Tren!s" #$ong %&S& #!ults-R", #$%9

l!hoo! Obesity Tren!s in the %nite! Sta


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l!hoo! Obesity Tren!s in the %nite! Sta(Through /),

$<

#<

9<

&<

2<

%$<

%#<

%9<

%&<

%2<

#$<

2hil!ren34outh#=%1 years o age

4ear

5 e r c e n t

O b e s e

Source: Data from Centers for Disease Control and Prevention

Obesity-relateddiseases once seenonly in adults are

now being seen inchildren.

%&S& Obesity Tren!s" #$ong Racial36thnic


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ource4 CDC7NC National ealt! and Nutrition >?a(inationurvey, #$%%=#$%9.


%&S& Obesity Tren!s #$ong Racial36thnic7rou8s

NAN>, #$%%


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NIH Obesity Research

Goals – understand t!e

causes and

conse@uences oobesity

– develo+ and evaluate+revention and

treat(ent strategies – build t!e evidencebase to inor(+olicies

Th 5 bli H lth 5 bl f Ob it


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The 5ublic Health 5roble$ of Obesity:5revalence an! #ssociate! Health 2on!itions

eininBa((ation

Coronary !eartdisease

ung disease

Gall bladder disease

Gout

Diabetes

steoart!ritis

Nonalco!olic atty liverdisease

ig! blood +ressure

>levated at in t!e blood

Cataracts

)in

Pancreatitis

Cancerbreast, uterus, cervi?, +rostate, )idney

colon, eso+!agus, +ancreas, liver

Gynecologic abnor(alities

tro)eIntracranial +ressure

De+ression

9&)* of /+ to .+year+ol! chil!ren3a!olescents an! 1&-* ofa!ults are obese!revalence data from "#$$-$%& NC'S Data (rief& No. "$). National Center for 'ealthStatistics CDC "#$*.

: ,da!ted from image created by Dr. ei Shen and Dr. Steven 'eymseld& New /or0 Obesity 1esearch Center& St. 2u0e3s-1oosevelt 'os!ital& Columbia 4niversi

The NIH Obesity Research Tas;


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The NIH Obesity Research Tas;


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Research an!5otentially

NewsworthyIssues

ultifacete! NIH Obesity Research:


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#88etite3foo! inta;e

5hysical activity=Se!entary behavior

Insulin resistance= in>a$$ationobesity+relate! !iseases

2irca!ian regulation=slee8

#!i8ose (fat tissue!e8ots

• Health Dis8arities

• Interventions for chil!ren=a!ults:+ ?ifestyle(behavior3environ$ent+ e!ical

+ Surgical (bariatric

Rewar! 8athways

Arain control of energy balance

ultifacete! NIH Obesity Research:Basic, Clinical, Translational

• 7enetics

• olecular signaling8athways(fat= $uscle= liver= gut=brain

5regnancy=intrauterineenviron$ent

7ut $icrobio$e(bacteria


ultifacete! NIH Obesity Research:


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#88etite3foo! inta;e

5hysical activity=Se!entary behavior

Insulin resistance= in>a$$ationobesity+relate! !iseases

2irca!ian regulation=slee8

#!i8ose (fat tissue!e8ots

• Health Dis8arities

• Interventions for chil!ren=a!ults:+ ?ifestyle(behavior3environ$ent+ e!ical

+ Surgical (bariatric

Rewar! 8athways

Arain control of energy balance

ultifacete! NIH Obesity Research:Basic, Clinical, Translational

• 7enetics

• olecular signaling8athways(fat= $uscle= liver= gut=brain

5regnancy=intrauterineenviron$ent

7ut $icrobio$e(bacteria


Bhite Arown an! Aeige #!i8ose


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Bhite= Arown= an! Aeige #!i8ose(


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Recent NIDDK Initiatives:#!i8ose Tissue

Roles of Arown an! Aeige #!i8ose Tissue inHu$ans 'o investigate t!e biological unctions o bro*n and beigeadi+ose tissue in !u(ans, and to e?+lore t!eir i(+act on

!u(an !ealt!.

Auil!ing a Hu$an #!i8oseDe8ot

'o develo+ a !u(an at c!i+ t!at *ill(i(ic t!e nor(al +!ysiology ounctional at tissue.

Ceteorin+li;e E a hor$one that


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eteorin+li;e E a hor$one thatlin;s eFercise to fat browning

a!ted from 1ao et al. Cell $*7: $"7) "#$%8

Immune cells

(Eosinophils)

Heat Production

Beige Fat Cells


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6Gects of 6Fercise

9ierath 1 et al. Cell ;etabolism ""$8& "*-=#&

olecular Trans!ucers of 5hysical


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olecular Trans!ucers of 5hysical#ctivity in Hu$ans

IH Common Fund launches physical

ctivity research program

rogram aims to identify molecules that contribute to a variety of health benet

% ! t !i DiG A t


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%n!erstan!ing DiGerences Aetween5eo8le

>asy access to !ig!=calorieoods and sedentary

liestyle contribute to

obesity

it!in si(ilarenviron(ents, individual

variability in *eig!t and

res+onse to treat(ent is

considerable

I(+roved understanding o

be!avioral variability *ill

!el+ advance obesity

+revention and treat(ent

N=174

(19.6%)

P e r c e n t a g e

G e i g ! t C o s s

% # 9 4ear

Gained

N=374

(42.2%)

N=152

(17.1%)

N=99

(11.2%)

N=88

(9.9%)L#

$

#

9

&

2

%$

%#

%9

%&

%2

L9

0-5%

5-6.9%

7-10%

≥ 10%

9=ear eig!t oss 'raectories o 22;Intensive iestyle Intervention

Partici+ants !o ad ost 6 %$<Initial eig!t at ear %

Data from 2oo0 ,'5,D clinical trial

Recent Bor;sho8 on Aehavioral


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Recent Bor;sho8 on Aehavioralariability

%8!ate:


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NIH Ao!y Beight 5lanner

%n!erstan!ing the Inta;e Si!e


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• Bhat= an! how $uch= are we eating

• Bhat shoul! we eat

• Bhen shoul! we eat

%n!erstan!ing the Inta;e Si!eof the 6nergy Aalance 6Juation

hat did + eat yesterda

New etho!s To I$8rove 6ating 5lan


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New etho!s To I$8rove 6ating 5lan#ssess$ents

2lic;

2alorie contentNutrientanalysis


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Ti$e to6at

Daily Hours of #ccessto High


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7ut Aacteriaan! Obesity

7ut Aacteriaan! Obesity

7ut icrobial 2o$$unity:


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7ut icrobial 2o$$unity:7enetics an! etabolis$

,da!ted from @oodrich et al. Cell $*): 7A)-

Identical (!) N"n-identical (#!)

$ean indiid&al' ae ie* leel'

"+ il, e*itale acte*ia called

Christensenallaceae

ice *ai'ed e*-+*ee *eceied a i/ "+ &t

acte*ia. en Christensenallaceae a'

added t" te i/ ice ained le'' eit.

Identical (!) N"n-identical (#!)

How 6arly Shoul! Be Intervene


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How 6arly Shoul! Be InterveneTo 5revent or Re!uce 2hil!hoo! Obesity

?ifestyle Interventions in


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yOverweight3Obese 5regnantBo$en

'!e ?ifestyle Interventions


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y8 g y5regnancy Outco$es (H#5O Stu!y

H#5O

tudy o over #,$$$ +regnant *o(en *it!blood glucose /sugar0 levels t!at *ere !ig!/!y+erglyce(ia0Obut belo* t!e t!res!old ordiagnosis o diabetes

"ound t!at serious co(+lications occur att!ese lo*er levels o (aternal !y+erglyce(ia

H#5O


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www&ni!!;&nih&gov3news

NIDDKs #nnual Re8ort


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NIDDKs #nnual Re8ort

Beight+control Infor$ation Networ;


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www&ni!!;&nih&gov3news3for+


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Obesity: State of the Science