We must confront our national obesity crisis, warns NIH director Francis Collins, or face a decrease in life expectancy.

Question: What are the biggest health risks facing America?

Francis Collins: If you look at health in the United States, you could point to some really significant achievements and you could also point to the role that NIH has played in making those things happen; cardiovascular disease has dropped by more than 60% in mortality over the course of the last 30 to 40 years, much of it from insights derived from groups like the Framingham Study which pointed out what the risk factors were and what we could do about them.  Cancer is dropping in its frequency, finally, after many years of going up.  

But there are clouds on the horizon of public heath, obesity and it’s related disease, diabetes, probably is the one that causes the greatest concern when you see the way in which our population is growing more overweight almost year by year with no sign that we’ve managed to turn this around.  And that could, if not somehow addressed, result in an outcome where our grandchildren will not live as long as we do and we would therefore turn down what has been upward curve in longevity over many decades.  A critical need there through research, research that involves nutrition, research that involves understanding exercise, then understand the built environment and how to motivate health behaviors to try to turn around this obesity epidemic.  

Certainly other areas of concern... Alzheimer’s Disease comes to mind as a condition which as our population is aging and as the Boomers are coming into this phase of potentially higher risk of Alzheimer’s, that we are gong to see very large numbers of people affected by this heartbreaking disease with terrible consequences for themselves and their families and for our medical economics because of the cost of caring for them.  So this has to be a very high priority for our high intensity efforts to come up with new solutions about prevention and treatment.

Question: How much of research should be focused on prevention, as opposed to treatments and cures?

Francis Collins: NIH is intensely interested in prevention.  I think everybody would agree that we haven’t paid enough attention to this approach to maintaining health, that we’ve not had a health care system in terms of medical care—we’ve had a "sick care" system where if you get sick there might be some help for you, but there’s been relatively little invested in terms of helping people stay well.  And maybe as a part of that we’ve had modest efforts, really, to try to invest in research on prevention.  That’s all changing.  Some of that’s coming about because of a better understanding of the environment and things that people should be careful about as far as bad influences on their future health, whether it’s smoking or diet or exercise.  We’re learning a lot about that.  

And some of it is the ability through personalized medicine to begin to identify individual risks for a future illness to get us beyond the one-size fits all approach to prevention, which has been not that effective.  People haven’t necessarily warmed to these recommendations about what you should do about diet, exercise, colonoscopies, mammograms and so on because it all sounds very much generic.  

But if you could provide people with information about their personal risks and allow them therefore to come up with a personalized plan for maintaining health that seems to inspire a lot more interest.  Genomics is moving us in the direction of being able to do that and I think that’s one of the more exciting developments in the prevention arena even though it’s early days yet, to see how that’s going to play out.

Recorded September 13, 2010
Interviewed by David Hirschman