06-05-2025
Is Obesity Today's ‘Cancer'?
The National Institutes of Health (NIH) encompasses 21 institutes in acknowledgement of the seriousness of a host of conditions, including cancer, heart disease, infectious diseases, mental health disorders, diabetes, gastrointestinal diseases, kidney diseases, neurological diseases, and more. However, one disease is missing from the list, and it's the one that connects many of the others: obesity.
everly Tchang, MD
The first institute, the National Cancer Institute, was created in 1937 in recognition of the importance of fighting the second most common cause of mortality. The resulting decades of investment and research have resulted in a new understanding of the root causes of cancer, prevention and screening protocols, diagnostic tools and technologies, and advanced therapeutics that offer the best balance of benefits over risks. Together, these advancements have saved millions of lives. In just one example, overall breast cancer mortality has decreased by 58% from the 1970s to today.
Similarly, the 1948 creation of the National Heart Institute, which grew into today's National Heart, Lung, and Blood Institute (NHLBI), facilitated astounding medical innovations, including angioplasty, bypass surgery, lipid-lowering medications, and anti-hypertensive medications. With measures directed at both optimizing prevention and treatment, the age-standardized death rate from cardiovascular disease, the nation's No. 1 killer, decreased by 67.5% between 1969 and 2013.
So, is it time for a National Institute of Obesity? Historically, the impetus for establishing prior institutes was three-fold: the disease's prevalence, impact, and priority.
The overall prevalence of obesity surpasses that of cancer and cardiovascular disease. In the United States, the lifetime risk of developing cancer is 38.9%, and the prevalence of cardiovascular disease is 9.9% in adults >20 years of age. The prevalence of obesity in adults is 40.3%. When expanded to include adults with overweight, the figure rises to a sobering 73.6%. This means almost 3 out of 4 adults — in your waiting room, shopping mall, park, voting district — potentially have metabolic disease.
Obesity's impact can't be overstated. Medically, obesity has been identified as the root cause or contributor to over 20 diseases encompassing cardiovascular, gastrointestinal, respiratory, neurological, musculoskeletal, and infectious diseases. A recent study led by Johns Hopkins researchers found significant associations between obesity and 16 health conditions, with the risk of these conditions rising with the severity of obesity: hypertension, type 2 diabetes, hyperlipidemia/dyslipidemia, heart failure, atrial fibrillation, atherosclerotic cardiovascular disease, chronic kidney disease, pulmonary embolism, deep vein thrombosis, gout, metabolic dysfunction-associated steatotic liver disease, biliary calculus, obstructive sleep apnea, asthma, gastroesophageal reflux disease, and osteoarthritis.
On a population level, the estimated cost of obesity, including indirect consequences such as disability or reduced work productivity, exceeded $1.4 trillion from 2014 to 2018, according to a 2020 Milken report.
Prioritizing a person's health is not an individual vs public issue, and in fact, the two are intertwined. With over 200 million people in the United States having overweight or obesity, we have the critical mass to demand real change from our public health system. We deserve better research, transparency, and communication about the impact of environmental factors, whether they be nutrition or work-related stress or endocrine-disrupting chemicals; the genetics or biology that drives our environmental responses; and the interplay between them.
Currently, obesity is treated like a stepchild. It is housed under the National Institute of Diabetes and Digestive and Kidney Diseases, which runs the NIH Obesity Research Task Force. Separately, some institutes focus on isolated aspects of obesity as it relates to their primary goal (eg, obesity's impact on cardiovascular health in the NHLBI).
