Development of Multidisciplinary approach to obesity 

Samuel Klein, M.D. Danforth Professor of Medicine
Washington University School of Medicine 

Project Overview: 
Obesity is a chronic and stigmatizing disease that has become a major health problem in most industrialized countries because of its high prevalence, causal relationship with serious medical illnesses, and economic impact. In the United States, approximately 64% of adults (age 20 to74 years) and 15% of children and adolescents (age 6 to 17 yrs) are overweight or obese, and there is no evidence that the rapid rise in the incidence of obesity is slowing down. It is estimated that obesity is responsible for approximately 400,000 deaths per year in the United States, and that the direct (medical expenses) and indirect (value of lost productivity) costs of obesity exceed $100 billion per year. Obesity is expensive for obese persons, health care/life insurance providers, and employers/businesses. 

An increasing amount of medical care costs are consumed by elderly obese men and women. The number of obese elderly persons in the United States is rapidly increasing because of an increase in the elderly population and the percentage of elderly persons who are obese. Obesity has important functional implications in elderly persons because it worsens the age-related decline in physical function, which can lead to frailty and loss of independence and increased health care costs. In fact, obesity may be the single greatest cause of disability in elderly persons and is associated with increased rates of nursing home admissions. 

Today’s obesity crisis represents an adverse gene-environment interaction. The innate genetic drive to eat and store excess energy as fat improved the ability of our ancestors to survive harsh environments and periods of food deprivation. However, the same genes that were initially advantageous, now have harmful consequences on body weight and health. The marked increase in the prevalence of obesity in the last 25 years represents the effect of powerful environmental influences that have caused an increase in energy intake and a decline in physical activity. Energy consumption has increased presumably because more meals are eaten outside the home, serving sizes are larger, there is greater availability of convenience and snack foods, and there is an increase in food variety and palatability. Advances in technology have led to decreased daily physical activity because of energy-conserving devices, sedentary work and social activities, and motorized transportation. 

The biochemical regulation of food intake, the metabolic and cellular mechanisms responsible for the relationship between excess body fat and disease, the environmental influences on body weight, bias and discrimination, and lack of treatment reimbursement underscore the complex nature of the obesity problem. Accordingly, there is a need for interdisciplinary efforts to address obesity issues at different levels. The diverse and distinguished faculty of the many schools within Washington University provides a rich environment for developing a multidisciplinary Center of Excellence in Obesity. This multidisciplinary program would include faculty clinicians, behaviorists, clinical investigators, basic scientists, and health care policy experts from the School of Medicine, School of Social Work, Physical Therapy Program, Psychology Department, Division of Biomedical Sciences, the Plant Biology Program, and the Health Policy Institute. In addition, we hope community leaders will also become involved in this effort. In this proposal we seek funding from the Longer Life Foundation to provide seed money to develop and implement initiatives that will help establish a comprehensive obesity center at Washington University. This initial support will be used to: 1) stimulate interdisciplinary faculty interactions, 2) generate pilot data for future multidisciplinary grant applications, 3) develop and disseminate accurateinformation and education materials on obesity, and 4) develop a proposal to obtain additional funds from other donors to establish a multidisciplinary obesity center at Washington University.

Final Report:
Funding obtained from the LLF was used to provide seed money to develop and implement several initiatives to help establish a comprehensive obesity center at Washington University and increase our national visibility in the obesity field. The use of these funds has been extraordinarily successful in achieving the aims of the proposal. Read the full Final Report.