1.HEALTH, HEALTH SERVICES AND HEALTH CARE CONSEQUENCES

HEALTH

-Obesity is a core primary problem of other diseases and must be recognised as an independent medical condition e.g. heart disease, bone disease etc.

HEALTH SERVICES

-Services are failing (need new multi-disciplinary approaches)

-Data and standards must be put in place to evaluate successful strategies

HEALTH CARE CONSEQUENCES

-Many of the consequences of obesity are not addressed, e.g. physical and psychological, quality of life – stigma, social discrimination and loss of human resources

2.THE ECONOMY

DIRECT AND INDIRECT COSTS OF OBESITY AND THE ECONOMICAL CONSEQUENCES

-Increased health-care costs of co-morbidities

-Lower work productivity

-Loss of human resources

-Loss of competitiveness

OPPORTUNITIES FOR INDUSTRY (PHARMACEUTICAL AND FOOD) TO DEVELOP

-Industrial competitiveness and regulation of (a) treaters and (b) causers

-Development of different treatments and health-care services

-Improved food quality and functionality

-Improved food marketing and surveillance especially for children

-Standardised food portion sizes - from home to the supermarket

3.SOCIAL ASPECTS OF OBESITY

SOCIETAL VALUES

-Polarisation of society - low class obese/higher class

-Conflict industry or production versus needs of people

-Is obesity a moral or health problem?

ENVIRONMENT (OBESIGENIC) AND SOCIAL ENGINEERING

-Physical activity

-Urban planning especially with respect to exercise

PSYCHOSOCIAL ISSUES

-Health and well being

CONSUMERS

-Government policy

-Food perception (including orosensory and orofractory perceptions) and activity

-Societal impact

-Cultural context

-Self esteem

-Personal freedom vs social control

4.SCIENCE

-Research including spin-offs into other related fields and broad, wide ranging impact – behaviour/gene/metabolism/social

-Use a more integrative approach of disciplines (networks of excellence) and countries but considering the specificity’s of countries and regions

5.EDUCATION AND COMMUNICATION

-Excess and waste of food as an ecological burden

-Consistency of dietary advice

-There is a need for a good teaching paradigm

-Physiology (in vivo and in vitro)

-Molecular mechanisms of energy control including genes and gene development and the influence of genetic background and ethnic related issues

-Environmental triggers

-Psychology of obesity

-Gene-drug interactions

-Mechanisms of dietary approaches to weight management

-Interaction of genes on polygenic obesity, genes/environment

-Mechanisms of derived anomalies of plurimetabolic syndrome

-Perinatal programming in relation to obesity at biochemical, cellular and behavioural levels

-Different kinds of obesities

-The impact of nutrients in food on polygenic obesity particularly in early life

-Of individual susceptibility to obesity, its progression and co-morbidities

-Of the attitudes/beliefs of consumers

-Natural history of diseases of weight through functioning surveillance of physical activity, anthropometry and body composition

-Why some treatments for obesity are successful or unsuccessful.

2.PREVENTION

-Evidence based lifestyle and weight management intervention and evaluation

-Needs assessment – motivation/illness perception

-Dietary behaviour integrated and evaluated in education

-Appropriate/effective public health nutrition strategies for primary prevention, including the role of genetic variability in identifying individualised diet/drug therapy

-More effective social marketing and communication strategies

-Improve knowledge on eating frequency, diet composition etc for obesity prevention

-Innovative products/fitness tools

3.TREATMENT

-Effective treatments tailored for susceptible groups

-Formulation

-Diagnostic tools (cause/treatment)

-Predictive abilities

-Systems to measure impact of treatment strategies

-Develop new markers of obesity and new targets for drugs

-Develop realistic strategies to stabilise or prevent obesity

4.SCIENCE

-System to prioritise research

-Identification of a number of molecular targets through to clinical trials

-Databank

-Defined outcomes and processes to measure effectiveness of interventions

-Identification of biomarkers for obesity-related complications

-Scientific basis to communicate and educate = strategies to transform research to action

-Use of common methodology for epidemiological surveys.

-Halt (adults and children) and reverse the trend in childhood obesity

-Early intervention before obesity development

-Provide guidelines for developing countries to contain their obesity problem

-Identify clear environmental triggers

-Impact of rapid change in lifestyle on prevalence of obesity

-Identification and quantification of different risk factors

2. SERVICES

-Better health care delivery with increased social and educational projects

-Acceptance and greater awareness of obesity as a disease by all health care professionals

-Better education of mother and young

-Prevention through social and educational policy

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3. PREVENTION AND TREATMENT STRATEDGIES

-More tailoring to the needs of the individual or defined sub-groups of the population

-A greater choice of drugs on the market

-Integrate emerging knowledge in genomics into primary prevention and treatment of obesity.

-Identifying optimal/appropriate dietary and physical activity strategies for specific susceptible profiles or subgroups

-Provide strong evidence-based guidelines for prevention and treatment of obesity to policy makers – provide options for the difficult choices to be made.

-Personalise strategies for treatment, due to polygenic nature of obesity.

-Select subgroups for action.

4. SCIENCE

-Design and execute a longitudinal EU wide study on the natural history of obesity

-Illustrate acceptability and utility of genotyping knowledge (e.g. risk co-morbidity)

-Prepare the next generation of scientists to stabilise research and promote training

-Integration of disciplines and transfer knowledge of obesity to other fields.

-Promotion of European success to become worldwide model.

1.Europe wide networks for obesity research – investigate optimal size for maximal reactivity

2.Centre for Excellence (single or multi-site) in obesity research and training (formation of professional clinical researchers)

3.Funding and technology resources

-Integrate national and EU research funding to create a co-ordinated network of integrated research, which is multi-disciplinary and has critical mass.

-Discover optimal size for European collaborative projects

-Rapid response funding to be made available (smaller projects)

-Infrastructure in genomics funded and developed

4.Standardised experimental methods for research including clinical trials (large scale studies on prevention including non pharmacological approaches) and good research practise to ensure total objectivity and transparency.

5.It should integrate human and animal studies and also studies at molecular and whole body level – inter-disciplinary training should be introduced.

6.Extensive access to biological resource bank (including tissue material and biological resources).

7.Multi-dimensional researchers with clinical/research background including behavioural, social and economic scientists

8.Implement targeted problem solving approaches versus traditional approaches

9.Flexible feedback system for information (e.g. multilingual)

-policy makers in EU and academia, industry and member states

-medical researchers and clinicians

-experimental medicine and drug discovery process

1.We should have had an impact in alleviating the economic (decrease in health-care costs and increase in new products), social and physiological burden of obesity and related health problems and have begun to address related inequalities in health within and between countries

-Reduce burden on the poor

-Increase productivity

-Reduce the stigma of the disease

4.We should see an impact on many elements of the food chain from primary production to processing

5.Identification of actionable and necessary environmental and ecological changes

6.There should be more input to policies for widening societal trends

8. To identify cohorts in which obesity should be a benefit (biological diversity).

GROUP 1 – GENOMICS AND BIOTECH

1.Knowledge of Causes and Processes

-Convert the mass of information into knowledge

-Genes and gene networks

-Brain mechanisms -including reward, preferences, motivation, adherence

-Co-morbidity – risks – dangers

-Interactions: Gene/Nutrient/Development/Environment

-Importance of dietary components and composition tailored for age, ethnicity etc.

-Normal energy homeostasis

-Relationships between obesity complications (why is it so dangerous to be obese)

-Adipose tissue development, metabolism and endocrine role

-Identification of predictive biomarkers for co-morbidities

-Sensory perception of food and appetite regulation

-Target biological and social process that can be changed.

2.Natural Experiments

-How to have an impact on changing individual lifestyles

-Lean/obesity resistant individuals

-Side effects of neuroleptics

-Obesity and diabetes and smoking cessation

-Improve cross talk with other diseases

-Increased number of long-term (3-5 year) clinical and prevention studies with special reference to cost and participant compliance

-Address the question of ‘Why are dietary intervention trials so difficult’

3. Technology

-Data proliferation – knowledge and statistical methods (development of data mining).

-Establish well managed tissue banks – standardised phenotyping (ethical issues)

-Global standards for experimental methods.

-Develop animal models.

-Large scale work – numbers and time.

-Validation of druggable gene targets and metabolics.

-Identify biological processes to use as ‘tools’ of genomics and biotech methods, NEW DRUGS, FUNCTIONAL FOODS

GROUP 2 – IMPROVING DIET THROUGH HEALTH AND PHYSICAL ACTIVITY

1.Establish a European Obesity Research Institute.

2.Plan a multi-centred randomised control trial incorporating all elements of weight gain/loss/regain/oscillation – involving diet/physical activity, genomics, etc.

3.Have clear objectives for the evaluation and validation of different types of intervention/treatment strategies.

GROUP 3 – EARLY NUTRITION AND PROGRAMMING

- molecular basis, mechanisms

- time windows

- perspectives of prevention

- in animal models and human groups

1.Identify genes for a genetic network (including gene expression and proteomics)

2.Co-morbidities

-Links with obesity

- Identification of biomarkers

3.Interactions

-Gene

-Environment (including nutrition)

-Physiology (including brain, adipose tissue and energy metabolism)

1.Multi-centre multidisciplinary randomised control trial

2.European obesity research insitute

3.Public health nutrition strategies for intervention in obesity

4.Restrained eating/foetal programming

5.Mis-reporting of food intake

6.Physiology of catch-up growth

For a large multi-centre RCT on diet, lifestyle, behavioural & genomic influences on weight change, the following would need to be considered (for example)

-The intervention e.g. fat levels, glycemic index issues, physical activity, behavourial issues etc.

-The study population e.g. age, family history, co-morbidities

-The method e.g. would centralised supervision of food choice be possible – like the CARMEN study

-Which genes would be examined in screening

-Which metabolic end points would be selected

-What are the key determinants of weight control?

-What will be the clinical significance of the intervention?

-What is the minimal physical activity to maintain healthy weight?

-What strategies will be used to gain compliance on the intervention?

-Will there be a genetic and lifestyle component to the intervention?

-What is the impact of dietary responses on molecular physiology

4.Categorise types of obesity (score – 6)

5.Sensory perception (orofractory etc.)(score – 5)

6.New drugs and food (score – 3)

7.Integration (score – 0)

-Identify major gene effects (10 years)

- What are all the genes involved in (i) energy balance; (ii) food choice; (iii) activity (10 years +)

- Generate normal references for all ethnic groups (5 years)

- Identification Capabilities

- Human and animal genetic screening – QTL

-Validation

-Effect of co-morbidity treatment on obesity (10 years)

-Is there an overlap between obesity and commorbidities and genetic networks? (10 years)

-Why are different compartments of adipose tissue important? (10 years)

-Impact of decreasing obesity on complications

-Data on other methods of weight loss (e.g. surgery) - is weight loss healthy? (+10 years)

-Are complications fully reversible? (+ 10 years)

-Can we find genes that predispose to complications? (better than family history? (5 years)

-Can we find blood borne markers that detect and/or predict complications? (+10 years)

-Merge animal and human work. Benefits and logistics of this merger. (5 years)

-Use experimentally-sensitive designs to look at gene/ environment/ development interactions. These must be able to cope with complexity and variability of the interaction. (5 years).

-What are the mechanisms for the epigenetic effects? (10 years)

-Establish functional tests as a measure of human phenotype (5 years)

- What are the key determinants of weight control?

- What will be the clinical significance of the intervention?

- What is the minimal physical activity to maintain healthy weight?

- What strategies will be used to gain compliance on the intervention?

- Will there be a genetic and lifestyle component to the intervention?

- What is the impact of dietary responses on molecular physiology

G – genomics (group 1); D – diet (group 2)

G – genomics (group 1); D – diet (group 2)

G – genomics (group 1); D – diet (group 2)

1.Genomics and proteomics

-High throughput functional genomic techniques

-Combinations of gene expression and imaging studies

-Develop reference profiling for functional genomics

-Tools for animal model phenotyping

-Integrated platform for validation – functional genomics

2.Mathematical modelling – neural network of metabolism

3.Miniaturisation e.g. for biopsies

4.Animal models to study inter-organ interactions

5.Bioinformatics

6.Delivery – tissue/organelle

7.Effective markers of compliance to the intervention strategy

8.Energy balance as an intervention outcome – are there biomarkers?

9.How do we conduct very long term intervention trials (>4 years) and can we use traditional tools?

10.Can we use resource-efficient data collection e.g. barcodes, internet, palm pilots etc.?

11.Better laboratory reference techniques and field techniques for body composition, energy balance and food reward systems.

12.Can we sample blood automatically in ambulatory circumstances to avoid dependence on fasting blood samples?

13.Repeated longitudinal measure of gene expression in muscle/adipose tissue.

14. Strategically linking animal and human models efficiently.

15.Non-invasive technologies to look at fat mass, body composition, foetal growth of organs

16.Metabolic tools, with stable isotopes

-Transfer of nutrients across placenta

-Metabolic differences in children

1. Integration of functional genomics with epidemiological and large-scale clinical trials.

2. Real-time measurement of metabolism in vivo

3. Influence of nutrients on epigenetic effects

4. Learn from redundant pathways and explore non-redundant pathways

5. Lifecycle of fat cells: fate of stem cell development

6. Use of different animal models e.g. gene trapping by random mutagensis

7. How to speed up animal functional tests to validate genes

9.Metabolics – over long time scale/functions

10.Molecular understanding of food preference

11.Statistical and mathematical modelling of many areas in the diet/lifestyle/obesity link

12.Role of other dietary ingredients

13.Examine liver function through imaging techniques

14.High throughput screening of food ingredients for e.g. insulin effects

15.Stero-specific effects of newly synthesised isomers of nutrients – e.g. the new ‘CLAs’

16.Cognitive behavioural therapy for long-term effects

17.Examine the role of nutrient partioning in food consumption habits

18.Sexual activity and food habits

19.How to treat foetal malnutrition syndrome?

20.Childhood obesity: Examine the change in food composition retrospectively using epidemiological studies e.g. quality of fatty acids and dietary calcium

21.New animal models in addition to rat and mouse

22.Obesity in pet animals and relation to childhood obesity

- Food consumption under-reporting

- Periodicity of eating (intradian, ultradian)

1.Novel, easy, cheap ways of phenotyping subjects

2.Tools to assess how the body is composed at different points in time (engineering).

3.Use other epidemiological samples for data e.g. those collected in CHD & cancer studies

4.Understand linkage between nutrition and genomics

5.Understand the interaction of obesity and (i) psychiatric and eating disorders (ii) sociology and (iii) exercise physiology

5 Common biobank

7. Biomarkers

Consumer science, clinical science, clinical nutrition, public health nutrition (including nutritionists, dieticians, epidemiologists), epidemiology, mathematics/statistics, behavourial sciences, social sciences, education, marketing, communication, molecular/whole body biologists, biochemistry, physiology, paediatrics, surgeons, health economists, cell biologists, geneticists, biochemists, molecular biologists, physiologists, neurobiologists, psychologists, behavioural scientists, physicists, food technologists, technologists.

Metabolic aspects: Biochemistry & other life sciences

Questionnaire(s) design: Consumer science, social science, marketing

Analysis: Maths, statistics, epidemiology