Guest Director's Update
Collaborative Initiative Will Tackle Obesity among Youth
By Dr. Robert T. Croyle
Director, NCI Division of Cancer Control and Population Sciences
“We’re fighting a losing battle,” a pediatrician in Watsonville, CA, recently told the Santa Cruz Sentinel. Her blunt statement reflects a startling reality: Nearly 1 in 3 children aged 8 and younger in the city are obese. Another 23 percent are overweight. The majority of the children in Watsonville—which, ironically, is in the heart of one of the most prolific vegetable and fruit growing regions of California—are Hispanic.
Situations like this one are sad and, unfortunately, not uncommon. Nationally, about 1 in 5 Mexican American boys and girls aged 12 to 19 are obese. Among African American girls in the same age group, more than 1 in 4 are obese.
Today, 12 million children and adolescents in the United States are obese and another 11 million are overweight. And studies have demonstrated that these kids have a strong likelihood of maintaining that weight status as adults. That translates into a huge population that is at significantly elevated risk for adverse health outcomes in the short and long terms, including asthma, diabetes, heart disease, and, as a number of studies have now shown, cancer.
Convincing evidence has been found associating excess body fat and colorectal, pancreatic, esophageal, endometrial, postmenopausal breast, kidney, and thyroid cancers, as well as associating excess abdominal fat and colorectal cancer.
This is why NCI has signed on to be part of an ambitious new initiative that we believe can help improve the health of the families and communities in places like Watsonville. It is called the National Collaborative on Childhood Obesity Research (NCCOR), and its other partners in the initiative include four NIH institutes, divisions and offices in the CDC, and the Robert Wood Johnson Foundation.
I don’t use the term “ambitious” lightly. At its core, NCCOR is intended to reverse the significant increases in adolescent and teen obesity over the last 3 decades (see graphic), and to witness results in years, not decades. And NCCOR is not designed to be a one-trick pony. Because, although there will be an emphasis on communities and populations where the obesity crisis is most severe, NCCOR is intended to be a long-term effort to create sustainable, population-wide change.
One of the key tactics the NCCOR initiative will employ is to identify and help implement strategies that studies have shown are effective and that can be replicated across broad populations. Special emphasis will be put on those interventions that can influence multiple aspects of the “energy imbalance” that leads to obesity, simultaneously influencing what and how people eat and their activity levels. Such interventions often don’t just focus on the individual, but—much like the idea of developing new anticancer therapies that target the tumor “microenvironment”—alter local environments, whether that’s at school, in the home, or in the types of programs and services offered by local and state agencies.
One such example is the Trial of Activity for Adolescent Girls (TAAG), a national study funded by the National Heart, Lung, and Blood Institute aimed at improving physical activity. The rationale behind TAAG is strong: Physical activity levels have dropped precipitously among adolescents and teens, particularly teen girls. TAAG is designed to develop and test school- and community-based interventions that get girls more involved in gym class, organized sports, or recreational play, for example.
In addition to identifying and implementing successful strategies for combating obesity, the NCCOR initiative will help develop the capacity for greater obesity-related research and surveillance, and also establish more effective means of translating that research into practice and evaluating our efforts.
Achieving these goals will not be easy. But it’s something we can no longer afford to ignore. This holds true from a public health perspective, but also from an economic one, with direct obesity-related costs annually accounting for more than $100 billion in health care spending.
Sharing this recognition that childhood obesity must be addressed swiftly and comprehensively, the Alliance for a Healthier Generation, a joint initiative of the American Heart Association and the William J. Clinton Foundation, has announced the formation of the Alliance Healthcare Initiative, a collaborative effort with national medical associations, leading insurers, and employers. NCCOR’s research goals complement this new initiative, which focuses on health care coverage for and delivery to children and families for the prevention, assessment, and treatment of childhood obesity.
Clearly, continuing on the current course with regard to the obesity epidemic and the factors that influence it is no longer an option. The costs in terms of physical and economic well being are too high. By taking bold action now, we have the opportunity to improve the health and wellness of millions of Americans.