In the last four decades of obesity research, progress has been made in identifying causes and treatments. Research has provided a greater understanding of obesity as a chronic disease caused by a complex interaction of genetic, metabolic, behavioral, psychological and environmental (social and cultural) factors. Despite the advances in research, however, children, adolescents and adults are continuing to become overweight and obese in record high numbers. Due to the complexity of obesity, more research is needed in a variety of areas particularly in prevention to control the spread of this epidemic.

Funding Inequities

• Public research funding for obesity is appallingly low given that it is a major public health crisis.
• The National Institutes of Health (NIH) has a budget of more than $29 billion and is the largest public funder of medical research. In setting the priorities of its budget, the NIH has virtually neglected obesity research, as shown in Figure 1.
  Figure 1
  
  
  
• Obesity-related medical conditions such as diabetes and cardiovascular disease receive far greater funding than the causative condition itself, as shown in Table 1.

Table 1

• Obesity is approaching the level of being the leading cause of preventable death in the U.S. Yet AIDS, another cause of preventable death, receives about 5 times more research funding than obesity, as shown in Table 2.
• Conditions with lower or similar prevalence rates receive considerably more research funding than obesity, as shown in Table 2.

Table 2

Grant Award Inequities

• Disparities in priorities of research are also apparent in the number of grants awarded annually by the NIH.
• More grants have been awarded to obesity research than in past years, however, Table 2 shows that it remains considerably less than for some obesity-related conditions and AIDS.

Funding Criteria

• The NIH uses six criteria for setting research budget priorities. Obesity meets all of them. Listed below are justifications for obesity meeting or exceeding funding criteria. The funding criteria are indicated in italics.

1. Number of people who have a particular disease.

   An estimated 127 million U.S. adults are overweight or obese, compared with 800,000 to 900,000 Americans affected with HIV (about 300,000 with AIDS), 9 million with cancer, 16 million with diabetes, and 26 million with heart disease. Obesity has increased in virtually all ethnic, racial, and socioeconomic populations, both genders, and in all age groups.

2. Number of deaths caused by a disease.

   Poor diet and sedentary lifestyle, contributing factors of obesity, are responsible for between 300,00 and 587,000 deaths per year, making it the second leading cause of preventable death after smoking.

3. Degree of disability produced by a disease.

   Obesity is associated with about 30 diseases or conditions, many of which are incapacitating. Severe obesity often produces musculoskeletal, cardiovascular, peripheral vascular and pulmonary complications that preclude gainful employment.

4. Degree to which a disease cuts short a normal, productive, comfortable life.

   The rate of death and illness from obesity increases in proportion to excess weight. Obesity is a chronic condition that can worsen other medical conditions or disabilities.

5. Economic and social costs of a disease.

   The cost attributable to obesity is approximately $100 billion. A 1998 study estimated the direct medical costs at $51.64 billion. Virtually all cost studies report only a fraction of the total costs of obesity.

6. Need to act rapidly to control the spread of disease.

   Over nearly 10 years (1991 to 2000), the proportion of the population with obesity has increased by 61 percent, according to data from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System. Obesity is also increasing rapidly in children and adolescents, who are affected more today by obesity-related diseases than ever in the past. Described by the World Health Organization as an “escalating epidemic,” the health consequences of obesity appear across the entire globe.

• The National Academy of Science’s Institute of Medicine (IOM), responsible for examining the priority-setting process at the NIH, has proposed adding two more criteria for allocating funds: the burden of disease and the impact of research on the health of the public.
  • First, the burden of obesity extends far beyond the decrease in health-related quality of life, which includes functional disability due to bodily pain. Persons with obesity are also subject to tremendous discrimination and stigma in our society.
  • Second, the American public is eager to deal with their weight problems, and often turn to tabloid announcements of miracle cures, quick fixes and magic bullets. Beyond the studies themselves, the transmission of accurate, evidence-based research information is critical to properly educate the public.

AOA Advocacy Work in Research

• The AOA’s advocacy work includes testifying before Congress to call for a review of research funding inequities. The AOA also called for the commission of an IOM study to:
  • recommend scientific opportunities for research on obesity.
  • recommend an organizational structure for the NIH that optimizes obesity research.
  • identify appropriate budgets to support aggressive research and educational programs on obesity.

• The AOA has also advocated for obesity research in specific areas such as disability, through the Department of Education’s, National Institute on Disability and Rehabilitation Research (NIDRR), and women’s research, through the Department of Health and Human Services’ (DHHS), Women Living Long, Living Well program.
• The NIH, has played a major role in improving the health of the U.S. population. Through its research efforts, the NIH has contributed to the:
  • reduction of mortality from heart disease and stroke.
  • improvement of treatments and detection methods for people with cancer, treatments to reduce paralysis from spinal cord injury, and treatments for depression and schizophrenia.
  • development of vaccines against infectious diseases, and development of dental sealants to prevent cavities.
  • establishment of genetic research that has revolutionized biomedical science.

• The time has come for the NIH to revolutionize obesity research so that it can be counted among the many future NIH medical achievements.

Note: The generally accepted definitions for overweight as a Body Mass Index (BMI) of 25 to 29.9 and obesity as a BMI of 30 or more have been applied to this fact sheet.