February 5, 1998

Mr. Chairman,

My name is Judith S. Stern Sc.D. I am testifying today as Vice President of the American Obesity Association, an organization founded to serve as an advocate for the millions of persons in this country suffering with obesity. In addition, I am Professor of Nutrition and Internal Medicine and Co-Director of the NIH funded Center for Complementary and Alternative Medicine Research in Asthma, Allergy and Immunology the University of California at Davis. A list of my federally supported research projects to appended to this testimony. I have also served as Past President of both the American Society for Clinical Nutrition (ASCN)  and the North American Association for the Study of Obesity (NAASO). I am a member of the National Academy of Sciences Institute of Medicine and chaired its committee setting criteria for evaluating obesity treatment programs (Weighing the Options, NAS Press, 1995). [1]

Mr. Chairman, I come before you today to discuss the greatest neglected public health crisis in this country - obesity. There are many examples of how the country's health care system has failed to respond to the growing epidemic. Today, I want to bring to your attention a serious disparity in the programs of the National Institutes of Health (NIH). Briefly, this disparity involves the scale and costs of the epidemic of obesity in the United States and the resources devoted by NIH to advance the understanding of obesity and develop new treatments. As I will describe, the NIH support for obesity research is significantly out of line with both the devastation caused by the disease of obesity and the scientific opportunities to find new treatments. The American Obesity Association urges the committee to focus its attention on resolving this disparity.

First, let us examine the scale and costs of the epidemic of obesity in the United States. In 1985, the NIH recognized obesity as a disease. The NIH Consensus Development Conference stated, "Current knowledge of human obesity has progress beyond the simple generalizations of the past. Formerly, obesity was considered fully explained by the single adverse behavior of inappropriate eating in the setting of attractive foods. The study of animal models of obesity, biochemical alterations in man and experimental animals, and the complex interactions of psychological and cultural factors that create susceptibility to human obesity indicate that this disease in man is complex and deeply rooted in biologic systems. Thus, it is almost certain that obesity has multiple causes and that there are different types of obesity." [2]

Obesity is the second leading cause of preventable death in the United States, after smoking. [3] According to the latest reports from the Center for Disease Control and Prevention about 58 million American adults are overweight to the point where they are incurring health risks. The percentage  of American adults with obesity has increased 30% in 10 years, from 25% in 1980 to 33% in 1991. Conservative estimates indicate that 14% of children and 12% of adolescents are overweight. 33% of men and 36% of women are overweight. Obesity disproportionately effects minorities; the prevalence is 48.5% of non-Hispanic black women and 47.2% of Mexican American women. The Centers for Disease Control and Prevention report that the prevalence of overweight in the United States has continued to increase. [4]

Last month, former Surgeon General C. Everett Koop supported the estimate that 300,000 U.S. deaths a year are attributable to overweight. [5] In other words, premature deaths due to overweight equal over 4 Oklahoma City bombings a day!

To further put the obesity figures in context, consider that there are  600-700,000 persons affected with HIV/AIDS, 8 million with cancer, 16 million with diabetes, 22 million with heart disease and 58 million with serious health risks from obesity.

Obesity is a long term chronic disease. There are at least eight other diseases that worsen as obesity increases or decreases as obesity is treated. They include heart disease, hypertension, dyslipidemia, adult onset diabetes, stroke, sleep apnea, osteoarthritis and deep vein thrombosis.

The costs of obesity are equally staggering. Nearly 80% of patients with adult onset or non-insulin-dependent diabetes mellitus are obese. Much of the estimated $11.3 billion spent each year to diagnose, treat and manage NIDDM stems from obesity. Nearly $2.4 billion dollars or 30% of the total amount spent on gallbladder disease and gallbladder surgery are related to obesity. Nearly 70% of the diagnosed cases of cardiovascular disease are related to obesity. Obesity accounts for $22.2 billion or 19% of the total costs of heart disease. Obesity more than doubles one’s chances of developing high blood pressure which affects approximately 26% of obese American men and women. The annual cost of obesity-related high blood pressure is close to $1.5 billion dollars. Almost half of breast cancer cases are diagnosed among obese women; an estimated 42% of colon cancer cases are diagnosed among obese individuals. Obesity-related breast cancer and colon cancer account for 2.5% of the total costs of cancer of $1 billion dollars annually. And Mr. Chairman, these are 1986 figures, the latest available. [6]

Obesity is also increasing  worldwide as more Western type diets are introduced into other countries. It is no wonder then that recently the World Health Organization declared obesity to be “the biggest, global chronic health problem in adults. If action is not taken to stem the pandemic, millions will develop related diseases such as diabetes and heart disease.” According to data compiled by the World Health Organization International Obesity Task Force, the economic costs of obesity are 3% to 8% of the total health care expenditures in the United States and Europe - proportions at least as great as those for all cancer and AIDS. [7]

At this point, it would be fair to assume that the National Institutes of  Health, the world's premier biomedical research organization would devote resources to this disease compatible with its prevalence, health consequences and costs. It would be fair to assume that the premier institution in basic molecular biology would be focused on research on the basic genetic, environmental, physiological, metabolic and behavioral causes of the disease. It would be fair to assume that within NIH obesity research is recognized at a level of organization commensurate with its multifactorial aspects and importance to Americans. Fair yes; accurate no. In fact, obesity research at NIH is an orphan. Its funding levels are far below other diseases with fewer affected persons, less adverse health effects, and lower economic costs. The scientific opportunities for advancing research on obesity are as great as in any area of medicine.

Consider the following estimates of NIH FY98 spending by disease.:

Cancer: $2.7 billion

HIV/AIDs: $1.5 billion

Cardiovascular: $1 billion

Stroke: $130 million

Obesity: $92 million

Diseases or conditions directly linked to obesity or ameliorated by weight loss receive far more generous funding than the causative condition, obesity. For example the following amounts are spent for 3 of the 8 conditions caused or affected by obesity:

Diabetes: $322 million

Colorectal cancer: $107 million

Hypertension: $187 million

These three conditions alone receive over 6 times the amount of funding going into the diseases which causes the condition. Is this "basic" research?

Last year, Mr. Istook, a Member of Congress, undertook to examine differences in NIH funding levels on both a per patient and a per death basis. [8] He reported that NIH funds research at an estimated rate per death from:

The comparable figure for obesity would be $306.

Mr. Istook estimates funding levels per patient are:

Again, the comparable figure for each adult obesity patient is a $1.59 -- a figure which would be even lower if children with obesity were included.

Mr. Chairman, this country and the world need a massive campaign to find the causes and develop new, safe and effective treatments for the disease of  obesity. Public interest and public confusion in issues relating to diet and nutrition are at an all time high. The NIH has funded some groundbreaking research in obesity such as the research published in December 1994 that announced the discovery of a new hormone, leptin, made by fat cells. Today, there is an explosion of scientific opportunities for research in the area of obesity. It is regrettable that NIH has not expanded its support in this critical area.

The Department of Health and Human Services needs a complete reevaluation of its response to this crisis. At the very least the NIH must have a budget for basic and clinical obesity research commensurate with its importance and the scientific opportunities. On behalf of the millions of Americans living and dying with the disease of obesity, we urge this Committee to make a five-fold increase in the NIH obesity budget raising it to $460 million in FY99.

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