NIH Director: For Obesity, There's No Magic Pill, Yet

The National Institutes of Health (NIH) spends more than $800 million on obesity research every year. That is a fraction compared to the total cost of obesity to taxpayers and those affected with obesity.

According to NIH Director Dr. Francis Collins, that fraction is doing a lot to help find systematic solutions to counteract high obesity rates, but there is still much to be done.

For part three of Here & Now‘s series America On The Scale, host Jeremy Hobson speaks with Collins about the latest research and what it says about understanding obesity, its complications and how best to reduce the problem.

Interview Highlights: Dr. Francis Collins

How big of a problem is obesity?

“It's a very serious problem. Certainly, if one looks at the trends over the last 30 years, we've been going very much in the wrong direction and with increasing incidents of obesity, that implies to both children and adults, and we know the health consequences are very significant in terms of increases in diabetes, in terms of joint problems, in terms of cardiovascular disease, even cancer which many people don't realize is increased at risk in obese individuals. So we take this very seriously. We spend something close to $900 million every year on research directly devoted to trying to understand the causes of obesity and how to design appropriate interventions.”

Why are we moving in the wrong direction on obesity?

“It is a complicated story. It is certainly one where there are genetic factors involved. We humans are wired by evolution to go out and find calories wherever we can that allows us to survive during periods of terrible famine. But in a circumstance such as most people in the United States currently have, there are lots of calories around and they're easily accessible and they're cheap and so our genetic drive to acquire those is actually not helping us as nowadays – more than a third of adults are obese and 17 percent of children. So we have to figure out a way to counteract that expectation that calories are always going to help you survive and help you realize that in fact they sometimes you work in the opposite way. So what should we do about that?”

What should we do about it?

“I think it's a complex mix of, first of all, general public realization that this is not just a minor issue. This is a huge threat to individual's health. And parents particularly, I think, have to come to grips with the fact that one of the things you don't want your child to do is to gain too much weight because it's hard once you've had an obese experience as a child to get over that later on. A lot of the wiring gets done at that point. And that means that we both need to engage parents, but also school systems and communities, coming up with ways to provide alternatives to cheap food. So that means also the industry has to be engaged. We at NIH particularly are trying to identify ways to intervene in early childhood with programs that prevent the acquisition of obesity, but also ways to help people that have already slipped into that state with interventions that involve, many of them, actually simple things that we've known about for a long time but haven't necessarily been all that good at applying, simple things like diet and exercise. There's not a magic pill here, at least not yet.”

Is this a problem the U.S. can solve on its own?

“No. It clearly is an international issue. We in the U.S. have a particularly bad case of this problem, but we're not at all alone. There is, by the way, also some difference in susceptibility in terms of individual ethnic background. It seems that certain groups, particularly for instance Pacific Islanders, Hispanics, African-Americans are more susceptible to obesity than, say, Asians. We don't entirely understand why that is and we need to understand that better. But even in countries that one thinks of as low-income and very much struggling with the importance of even finding adequate nutrition, you don't have to look to hard to find pockets where people who have begun to get access to resources are also slipping into obesity challenges. It is an international problem and it needs to be thought of in that way.”

On obesity research currently being conducted

“We do have some pretty interesting new ways to look at this. We after all, humans, think of ourselves as a collection of human cells, but we're actually also coexisting with millions, in fact billions and trillions, of microbes that live on us and in us. And it's very clear now that the particular set of microbes that live in your gastrointestinal tract plays a role in your risk of obesity. If those bacteria are particularly efficient in terms of what they're doing versus what you're doing, that'll have an effect on whether what you've eaten causes you to gain weight or not. Now that could be really interesting because that might mean that you could modify your microbiome by simply eating an appropriate kind of yogurt or some probiotic and shift your risk for diabetes and obesity even without changing your diet. We have a lot to do to prove that's going to work, but it's looking pretty promising and that's a big NIH investment over the last few years.”

How will you measure success on all of the research you're doing into obesity?

“Obviously we want to see the ultimate evidence which is the nation goes on a diet successfully, and you see that overall average BMI for all age groups begin to drop and get back into a range that one would consider healthy. From NIH's perspective, a lot of what we do is earlier in this pipeline for discovery, so we measure it by whether we've been able to mount a clinical trial in a particular group and try an intervention and show that it actually gets results that are sustainable. And we are certainly deeply invested in those trials and that's where a lot of those $900 million are going.”

Guest

• Francis Collins, M.D., director of the National Institutes of Health. He tweets @NIHDirector.

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