Obesity: State of The Science

The State of Obesity Research
Griffin P. Rodgers, M.D.,

M.A.C.P.
Director
National Institute of Diabetes and
Digestive
and Kidney Diseases
National Institutes of Health
Twitter: @NIDDKgov
The National Institutes of

Health (NIH)
The mission of the NIH is to seek
fundamental knowledge about the
nature and behavior of living
systems and the application of that
knowledge to enhance health,
lengthen life, and reduce illness
and disability.
The NIH supports more than
300,000 members of the research
workforce throughout the country
and around the world at
universities, medical centers,
companies, and at the NIH itself.
Obesity Trends* Among U.S.

Adults
Behavioral Risk Factor Surveillance System (BRFSS), 1985
No Data
<10%
10%14%
MI 30 kg/m2 or 30 pounds overweight for 54 woman

Source: CDC Behavioral Risk Factor Surveillance
System.
Obesity Trends* Among U.S. Adults

BRFSS, 1986
No Data
<10%
10%14%

System.

BRFSS, 1987
No Data
<10%
10%14%

System.

BRFSS, 1988
No Data
<10%
10%14%

System.

BRFSS, 1989
No Data
<10%
10%14%

System.

BRFSS, 1990
No Data
<10%
10%14%

System.

BRFSS, 1991
No Data
<10%
10%14%
15%19%

System.

BRFSS, 1992
No Data
<10%
10%14%
15%19%

System.

BRFSS, 1993
No Data
<10%
10%14%
15%19%

System.

BRFSS, 1994
No Data
<10%
10%14%
15%19%

System.

BRFSS, 1995
No Data
<10%
10%14%
15%19%

System.

BRFSS, 1996
No Data
<10%
10%14%
15%19%

System.

BRFSS, 1997
No Data
<10%
10%14%
15%19%
20%24%

System.

BRFSS, 1998
No Data
<10%
10%14%
15%19%
20%24%

System.

BRFSS, 1999
No Data
<10%
10%14%
15%19%
20%24%

System.

BRFSS, 2000
No Data
<10%
10%14%
15%19%
20%24%

System.

BRFSS, 2001
No Data
<10%
10%14%
15%19%
20%24%
25%29%

System.

BRFSS, 2002
No Data
<10%
10%14%
15%19%
20%24%
25%29%

System.

BRFSS, 2003
No Data
<10%
10%14%
15%19%
20%24%
25%29%

System.

BRFSS, 2004
No Data
<10%
10%14%
15%19%
20%24%
25%29%

System.

BRFSS, 2005
No Data
<10%
10%14%
15%19%
20%24%
25%29%
30%

System.

BRFSS, 2006
No Data
<10%
10%14%
15%19%
20%24%
25%29%
30%

System.

BRFSS, 2007
No Data
<10%
10%14%
15%19%
20%24%
25%29%
30%

System.

BRFSS, 2008
No Data
<10%
10%14%
15%19%
20%24%
25%29%
30%

System.

BRFSS, 2009
No Data
<10%
10%14%
15%19%
20%24%
25%29%
30%

System.

BRFSS, 2010
No Data
<10%
10%14%
15%19%
20%24%
25%29%
30%

System.

BRFSS, 2011
No Data
<10%
10%14%
15%19%
20%24%
25%29%
30%

System.

BRFSS, 2014

System.
ldhood Obesity Trends in the United Sta

(Through 2014)
20%
18%
Children/Youth
2-19 years of age
Percent Obese
16%
14%
12%
10%
8%
Obesity-related
diseases once seen
only in adults are
now being seen in
children.
6%
4%
2%
0%
Year
Source: Data from Centers for Disease Control and Prevention
U.S. Obesity Trends* Among Racial/Ethnic

Groups
NHANES, 2011

Source: CDC/NCHS National Health and Nutrition Examination
Survey, 2011-2014.
NIH Obesity Research

Goals
understand the
causes and
consequences of
obesity
develop and evaluate
prevention and
treatment strategies
build the evidence
base to inform
policies
The Public Health Problem of Obesity:

Prevalence and Associated Health Conditions
Stroke
Depression
Lung disease
Pancreatitis
Nonalcoholic fatty liver
disease
Intracranial pressure
Cataracts
Coronary heart
disease
Diabetes
Elevated fat in the blood
High blood pressure
Gynecologic abnormalities
Gall bladder disease

Cancer
breast, uterus, cervix, prostate, kidney
colon, esophagus, pancreas, liver
Skin
Gout
Osteoarthritis
Vein
inflammation
17.0% of 2- to 19-year-old children/adolescents and 36.5% of

adults are obese
: Adapted (prevalence
from image createddata
by Dr. Wei
Shen2011-14,
and Dr. Steven
Heymsfield,
NewBrief,
York Obesity
Center, St. Lukes-Roosevelt
Columbia Universit
from
NCHS
Data
No.Research
219. National
Center forHospital,
Health
Statistics, CDC, 2015.
The NIH Obesity Research Task

Force
The NIH Obesity Research Task
Force includes representatives
from about 20 of the NIHs
Institutes, Centers, and Offices.
The Task Force is co-chaired by the
directors of the National Institute
of Diabetes and Digestive and
Kidney Diseases, National Heart,
Lung, and Blood Institute, and the
Eunice Kennedy Shriver National
Institute of Child Health and
Human Development.
Research and
Potentially
Newsworthy
Issues
Multifaceted NIH Obesity Research:

Basic, Clinical, Translational
Circadian regulation,
sleep
Adipose (fat) tissue
depots
Genetics
Molecular signaling
pathways
(fat, muscle, liver, gut,
brain)
Brain control of energy balance

Reward pathways
Appetite/food intake
Insulin resistance, inflammation

obesity-related diseases
Gut microbiome
(bacteria)
Pregnancy,
intrauterine
environment
Health Disparities
Physical activity,
Sedentary behavior
Interventions for children,

adults:
- Lifestyle
(behavior/environment)
- Medical
- Surgical (bariatric)
: Adapted from image created by Dr. Wei Shen and Dr. Steven Heymsfield, New York Obesity Research Center, St. Lukes-Roosevelt Hospital, Columbia Universit
Multifaceted NIH Obesity Research:

Basic, Clinical, Translational
Circadian regulation,
sleep
Adipose (fat) tissue
depots
Genetics
Molecular signaling
pathways
(fat, muscle, liver, gut,
brain)
Brain control of energy balance

Reward pathways
Appetite/food intake
Insulin resistance, inflammation

obesity-related diseases
Gut microbiome
(bacteria)
Pregnancy,
intrauterine
environment
Health Disparities
Physical activity,
Sedentary behavior
Interventions for children,

adults:
- Lifestyle
(behavior/environment)
- Medical
- Surgical (bariatric)
: Adapted from image created by Dr. Wei Shen and Dr. Steven Heymsfield, New York Obesity Research Center, St. Lukes-Roosevelt Hospital, Columbia Universit
White, Brown, and Beige Adipose

(Fat) Tissue
White adipose tissue (WAT)

Stores energy as fat
Secretes hormones
Associated with some adverse pathways (e.g. inflammation, insulin resistance)
Brown and beige adipose tissue (BAT)

Burns energy stores
Generates heat; other functions?
Brown fat cells:
-- present in infants, found several years ago in

adults
-- share an origin with muscle cells
Beige fat cells:
-- induced within WAT browning by cold,
exercise
-- show some characteristics of brown
adipocytes, but are distinct
Potential target for obesity treatment?
Potential adverse effects of excess BAT?
Recent NIDDK Initiatives:

Adipose Tissue
Roles of Brown and Beige Adipose Tissue in
Humans
To investigate the biological functions of brown and beige
adipose tissue in humans, and to explore their impact on
human health.
Building a Human Adipose

Depot
To develop a human "fat chip" that will
mimic the normal physiology of
functional fat tissue.
Meteorin-like a hormone that

links exercise to fat browning
Immune cells
(Eosinophils)
dapted from Rao et al. Cell 157: 1279 (2014)
Heat Production
Beige Fat Cells
Effects of Exercise
Zierath JR et al. Cell Metabolism22(1), 25-30,
Molecular Transducers of Physical

Activity in Humans
NIH Common Fund launches physical

activity research program
Program aims to identify molecules that contribute to a variety of health benefits
Understanding Differences Between

People
Within similar
environments, individual
variability in weight and
response to treatment is
considerable
Improved understanding of
behavioral variability will
help advance obesity
prevention and treatment
+4
Percentage Weight Loss
Easy access to high-calorie

foods and sedentary
lifestyle contribute to
obesity
+2
0
2
4
6
8
10
12
14
16
18
N=88
(9.9%)
Gained
0-5%
N=174
(19.6%)
N=99
(11.2%)
N=152
(17.1%)
5-6.9%
7-10%
10%
N=374
(42.2%)
2
Year
4-Year Weight Loss Trajectories of 887

Intensive Lifestyle Intervention
Participants Who Had Lost 10%
Initial Weight at Year 1
Data from Look AHEAD clinical trial
Recent Workshop on Behavioral

Variability
Update: Further research can

help us determine how best to
tailor interventions to people,
considering age range,
sociocultural factors, etc.
NIH Body Weight Planner
Understanding the Intake Side

of the Energy Balance Equation
What did I eat yesterday
What, and how much, are we eating?
What should we eat?
When should we eat?
New Methods To Improve Eating Plan

Assessments
Click!
Calorie content
Nutrient
analysis
Fat vs. Carb Restriction: Are All

Calories the Same?
Calorie for Calorie, Dietary Fat
Restriction Results in More Body
Fat Loss than Carbohydrate
Restriction in People with
Hall et al., 2015, Cell Metab 22:1-10
Obesity
but the real world is

more complicated
than a research lab;
it may be more
important to consider
which type of eating
plan youll be most
likely to stick to over
time. More research
Time to
Eat?
Daily Hours of Access

to High Fat/Sugar Diet
Chaix et al. Cell Metab. 20:991-1005, 2014
Gut Bacteria
and Obesity
Gut Microbial Community:

Genetics and Metabolism
Identical (MZ)
Non-identical (DZ)
Lean individuals have higher levels

of highly heritable bacteria called
Christensenallaceae
Mice raised germ-free received a mix of gut

bacteria. When Christensenallaceae was
added to the mix, mice gained less weight.
Adapted from Goodrich et al. Cell 159: 789-
How Early Should We Intervene

To Prevent or Reduce Childhood Obesity?
Lifestyle Interventions in
Overweight/Obese Pregnant
Women
The Lifestyle Interventions

For Expectant Moms (LIFEMoms) consortium is testing
lifestyle interventions for
pregnant women who are
overweight or obese, to improve
weight and metabolic outcomes
in both the women and their
Hyperglycemia and Adverse

Pregnancy Outcomes (HAPO) Study
HAPO
Study of over 23,000 pregnant women with
blood glucose (sugar) levels that were high
(hyperglycemia)but below the threshold for
diagnosis of diabetes
Found that serious complications occur at
these lower levels of maternal hyperglycemia
HAPO Follow-up study (ongoing)

Is elevated blood glucose during pregnancy, at levels less
severe than gestational diabetes, tied to adverse outcomes 8
to 12 years after pregnancy:
increased body fat in children?
development of type 2 diabetes in mothers?
As of the end of FY 2015, the HAPO Follow-up study had

recruited more than 3,100 mother-child pairs from the original
HAPO study. Children are now ages 8 to 12 years.
NIDDK, NICHD
www.niddk.nih.gov/news
NIDDKs Annual Report
Weight-control Information Network

(WIN)
www.niddk.nih.gov/news/forreporters
niddkmedia@niddk.nih.gov
Twitter: @NIDDKgov

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Obesity: State of The Science

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The State of Obesity Research

Griffin P. Rodgers, M.D.,

The National Institutes of

Obesity Trends* Among U.S.

MI 30 kg/m2 or 30 pounds overweight for 54 woman

Obesity Trends* Among U.S. Adults

MI 30 kg/m2 or 30 pounds overweight for 54 woman

Obesity Trends* Among U.S. Adults

MI 30 kg/m2 or 30 pounds overweight for 54 woman

Obesity Trends* Among U.S. Adults

MI 30 kg/m2 or 30 pounds overweight for 54 woman

Obesity Trends* Among U.S. Adults

MI 30 kg/m2 or 30 pounds overweight for 54 woman

Obesity Trends* Among U.S. Adults

MI 30 kg/m2 or 30 pounds overweight for 54 woman

Obesity Trends* Among U.S. Adults

MI 30 kg/m2 or 30 pounds overweight for 54 woman

Obesity Trends* Among U.S. Adults

MI 30 kg/m2 or 30 pounds overweight for 54 woman

Obesity Trends* Among U.S. Adults

MI 30 kg/m2 or 30 pounds overweight for 54 woman

Obesity Trends* Among U.S. Adults

MI 30 kg/m2 or 30 pounds overweight for 54 woman

Obesity Trends* Among U.S. Adults

MI 30 kg/m2 or 30 pounds overweight for 54 woman

Obesity Trends* Among U.S. Adults

MI 30 kg/m2 or 30 pounds overweight for 54 woman

Obesity Trends* Among U.S. Adults

MI 30 kg/m2 or 30 pounds overweight for 54 woman

Obesity Trends* Among U.S. Adults

MI 30 kg/m2 or 30 pounds overweight for 54 woman

Obesity Trends* Among U.S. Adults

MI 30 kg/m2 or 30 pounds overweight for 54 woman

Obesity Trends* Among U.S. Adults

MI 30 kg/m2 or 30 pounds overweight for 54 woman

Obesity Trends* Among U.S. Adults

MI 30 kg/m2 or 30 pounds overweight for 54 woman

Obesity Trends* Among U.S. Adults

MI 30 kg/m2 or 30 pounds overweight for 54 woman

Obesity Trends* Among U.S. Adults

MI 30 kg/m2 or 30 pounds overweight for 54 woman

Obesity Trends* Among U.S. Adults

MI 30 kg/m2 or 30 pounds overweight for 54 woman

Obesity Trends* Among U.S. Adults

MI 30 kg/m2 or 30 pounds overweight for 54 woman

Obesity Trends* Among U.S. Adults

MI 30 kg/m2 or 30 pounds overweight for 54 woman

Obesity Trends* Among U.S. Adults

MI 30 kg/m2 or 30 pounds overweight for 54 woman

Obesity Trends* Among U.S. Adults

MI 30 kg/m2 or 30 pounds overweight for 54 woman

Obesity Trends* Among U.S. Adults

MI 30 kg/m2 or 30 pounds overweight for 54 woman

Obesity Trends* Among U.S. Adults

MI 30 kg/m2 or 30 pounds overweight for 54 woman

Obesity Trends* Among U.S. Adults

MI 30 kg/m2 or 30 pounds overweight for 54 woman

Obesity Trends* Among U.S. Adults

MI 30 kg/m2 or 30 pounds overweight for 54 woman

ldhood Obesity Trends in the United Sta

U.S. Obesity Trends* Among Racial/Ethnic

MI 30 kg/m2 or 30 pounds overweight for 54 woman

NIH Obesity Research