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Weighing the Options: Criteria for Evaluating Weight-Management Programs
and Treatment of Obesity of NIH has published a comprehensive report on research needs in obesity (NTF, 1994a). The report presents research recommendations in the following areas: genetic and environmental determinants of obesity, the role of obesity in the pathogenesis of chronic diseases, treatment of obesity, prevention of obesity, and communicating research findings to the lay public and health-care providers. The interested reader should refer to these publications, which, taken together, set forth a comprehensive set of needs in obesity research. The research and policy recommendations discussed below are focused more directly on the contents of this report.
CAUSES OF OBESITY AND ASSOCIATED COMORBIDITIES
One of the more perplexing aspects of obesity treatment is why the vast majority of individuals are largely unsuccessful at long-term management of their weight. We believe that it is because the symptoms of obesity are treated rather than its fundamental causes. It is clear that obesity in many individuals involves an interaction between genes and the environment. Until the fundamental causes of this disease with multiple etiologies are understood—its pathophysiology and development at the genetic, molecular, and cellular levels and its interactions with relevant environmental factors—obesity will be extremely difficult to prevent and cure.
An analogy that may prove helpful is that of the evolution of therapy for cystic fibrosis (CF). The treatment of this debilitating disease has traditionally focused on relieving the symptoms (i.e., the pulmonary infections), improving bronchial draining, and improving nutrition. Though conventional treatments have improved incrementally over time, they provide only short-term improvements in the quality and quantity of life, and more than 90 percent of individuals with CF die at an average age of 29 years (Fuchs et al., 1994). Recent genetic and molecular studies on CF have uncovered the structural defects that lead to pathogenesis. For example, it was discovered that the accumulation of secretions that block the airways is a result of the release of extra cellular DNA by leukocytes. In addition, advances in molecular genetics have led to an understanding of the fundamental genetic defect in CF to the extent that gene-replacement therapy is being studied (Zabner et al., 1993). One of the clinical benefits to date of this research into the molecular and genetic underpinnings of CF has been the development of aerosolized recombinant human DNAse, which is now used to make the secretions easier to expectorate (Davis, 1994; Fuchs et al., 1994).
Using the exciting tools of biotechnology to prevent or cure obesity is