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May 15, 2012 1PM EST

Q&A with Dr. Francis Collins

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  • Q

    Thanks to Dr. Collins for joining us today. How do you feel about the response to The Weight of the Nation so far?

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    A
    Dr. Francis Collins says:

    There has been a growing amount of interest -- people are surprised to learn how serious the problem of obesity is in our nation, and anxious to learn ways that we could turn this around.

  • Q

    Just wanted to say how much I enjoyed the documentary and how I relate to it and how helpful and informative it was to me in the continuing journey I am on personally.

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    A
    Dr. Francis Collins says:

    I am glad to hear that this program has been helpful already -- that was the goal. Clearly, we all need to take these facts seriously. I am glad to hear you are on your own journey toward better health.

  • Q

    What would you say are the top 3 contributing factors to obesity?

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    A
    Dr. Francis Collins says:

    Wide availability of low nutritive value calories, like sweet drinks and snack foods. Lack of opportunities for physical activity. Too much time in sedentary activities like watching TV or playing inactive video games.

  • Q

    In your research on obesity, what has been the most actionable discovery?

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    A
    Dr. Francis Collins says:

    The Diabetes Prevention Program (http://diabetes.niddk.nih.gov/dm/pubs/preventionprogram) showed that people can achieve a 6 - 7% weight loss with a combination of lifestyle changes including reduced calorie intake and increasing exercise, assisted by trained lifestyle coaches. That led to substantial reduction in developing diabetes in this group of overweight and obese individuals who were at high risk for diabetes.

  • Q

    What can we do to prevent this epidemic from affecting future generations of children?

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    A
    Dr. Francis Collins says:

    We need a combination of strategies -- no single intervention will be sufficient. Families need to be engaged in helping kids develop healthy lifestyles including physical activity (60 minutes a day), reduced screen time, appropriate portion sizes, and decreased intake of sugar-sweetened beverages. Schools can play a big role, and so can communities by providing safe play spaces. For tips for families, see the NIH’s We Can!(r) (Ways to Enhance Children’s Activity & Nutrition) website at http://wecan.nhlbi.nih.gov.

  • Q

    One question I have is, with all I am doing: exercisng, proper eating lifestyle, new attitude and taking all measures with my doctor, can I possibly reverse my diabetes(type II)?

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    A
    Dr. Francis Collins says:

    The recent LOOK AHEAD study by NIH has shown that individuals like you with type 2 diabetes can benefit from lifestyle interventions, resulting in better blood sugar control. So, you are doing the right things!

  • Q

    It seems that it is much cheaper to eat unhealthy foods (like soda and burgers) than it is to eat healthy foods. What advice do you have for people on a tight budget?

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    A
    Dr. Francis Collins says:

    Great question, since processed foods that are high in calories tend to be the cheapest and most accessible. NIH's educational program called We Can!(http://wecan.nhlbi.nih.gov) “Healthier Eating While Saving Money” (http://www.nhlbi.nih.gov/health/public/heart/obesity/wecan/downloads/tip_saving.pdf) and USDA's website "Eat Right When Money's Tight" (http://snap.nal.usda.gov/resource-library/eat-right-when-moneys-tight) can provide tips. Check those out.

  • Q

    Great documentary last night. I'm a fitness instructor and meet so many people every day trying to lose weight. Can you explain to me why once a person has lost weight, they still have to eat fewer calories than someone who has never had a weight problem?

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    A
    Dr. Francis Collins says:

    As was described in the HBO special, there is evidence that the body has a set point, and when an individual loses weight, their metabolism actually slows -- so they don't need as many calories to maintain that new weight. This is something that people losing weight often aren't told. It is important therefore, after successful weight loss to maintain vigilance about healthy eating and physical activity.

  • Q

    The film speaks about controlling calories in order to achieve weight loss and lowering disease. What do you think about Gary Taubes theory that weight gain is a product of high carbhydrates and over insulin production, not calories?

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    A
    Dr. Francis Collins says:

    There are many different theories about which kind of caloric intake is more likely to result in weight gain, and which kind of dietary pattern would be most successful in weight loss. NIH studies suggest that while there may be short term differences in these approaches, the long term results seem not to depend on the details, but on the amount of reduced calories. The best diet is the one that can be sustained over the long term, combined with other healthful lifestyle behaviors.

  • Q

    If, as the film stated, obesity is now rising among all socio-economic and ethnic groups, wouldn't the source HAVE to be the food supply, as that is the only commonality?

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    A
    Dr. Francis Collins says:

    Certainly the average individual is taking in more calories now than 40 years ago, regardless of their socioeconomic status. But the limitation in physical activity is also a factor, and that too has been more of a problem for all groups in the last few decades -- encouraged by more screen time, and less opportunity for walking.

  • Q

    For the overweight who work to get thin, i.e. cut out soda and fast food, switch to carrots for snacks, etc. but are resigned to gaining the weight back as their jobs and family responsibilities mount in the ensuing years, what do you say to them?

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    A
    Dr. Francis Collins says:

    Successful weight management really means a permanent change in lifestyle -- and success in this arena provides that person with a great opportunity to model that behavior for friends and family. Having achieved success, don't give up!

  • Q

    I really want to turn this epidemic for my future children and grandchildren. How long do you think it will take before we see change?

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    A
    Dr. Francis Collins says:

    We got into this problem over about 30 years, so we can't fix it overnight. But we have succeeded in other major changes to improve our health and well being -- not smoking, wearing seat belts, etc. We can do it! But making changes in the right direction will depend on all of us -- our families, our schools, health care systems, communities, industry, and government leaders.

  • Q

    Given that the NIH is starting a new translational center, do you see the NIH pushing any pharm solutions to the problem in the future as part of the mission of this new agency?

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    A
    Dr. Francis Collins says:

    No one should decide to wait to address the obesity problem for the appearance of a magic pill. But NIH is certainly working hard to identify all of the biological factors involved in appetite and weight control, and one of the goals is to identify potential new pharmacological ways to assist individuals with weight management. But in the past, such efforts have often been thwarted by side effects.

  • Q

    This presentation was actual and focused. I so apreciated. Dr. Collins, how important is support in attaining a long term health goal?

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    A
    Dr. Francis Collins says:

    NIH studies suggest that weight loss is more achievable with support from family, friends, and professionals. It helps to have others working with you to achieve a challenging goal, and sometimes being accountable to others can also be a motivator. So anyone initiating a serious weight loss program would be well advised to line up others to encourage and support them.

  • Q

    Dr. Collins, what do you think will be the impact of the new glucose meters that measure % of glycosylated hemoglobin as apposed to simply blood sugar concentration

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    A
    Dr. Francis Collins says:

    It's important to know that measurement of blood sugar gives you an immediate indication of the current status of your body's metabolism. Glycosylated hemoglobin, which is also called A1c, gives you an indication of how good (or bad) your glucose control has been over the past few months. So there would be no reason to assess your glycosylated hemoglobin frequently. Checking your glucose several times a day, however, is often recommended for management of diabetes. Check with your doctor about what's right for you.

  • Q

    Just about every weight struggler interviewed in the documentary had dieted countless times. Yet so far, I see no mention in the documentary of dieting as a contributor to weight gain. Thoughts?

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    A
    Dr. Francis Collins says:

    Many people struggle with losing weight and then regaining it. But there is no convincing evidence that the effort to lose weight actually promotes more weight gain in the long run. So this would not be a good reason to delay starting a weight loss program.

  • Q

    do we need less food (ie caloric intake) as we age?

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    A
    Dr. Francis Collins says:

    Yes, because of reduced caloric expenditure. All the more reason to focus on healthy foods with high nutritive value as we age.

  • Q

    In the Diabetes Prevention Program (DPP), lifestyle changes had bigger impact than metformin. In a country of quick fixes, how do you get message to policy makers that prevention is key, not more drugs? Important especially with budget-wary politicians!

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    A
    Dr. Francis Collins says:

    One of NIH's jobs is to educate the public (including policy makers) about the results of our research studies. (See for example www.nih.gov and the medline plus website at http://www.nlm.nih.gov/medlineplus/.) The DPP (http://diabetes.niddk.nih.gov/dm/pubs/preventionprogram/) is a landmark study that has been widely publicized to health care providers, and has been adapted for community use by partnerships with organizations like the YMCA. To learn more visit the National Diabetes Education Program at www.ndep.nih.gov.

  • Q

    That’s it for our live chat with Dr. Francis Collins. Thanks again for joining us today, Dr. Collins. Is there anything else you’d like to say before we sign off?

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    A
    Dr. Francis Collins says:

    I'm delighted by the interest in the obesity problem that these excellent questions demonstrate. For all who are reading these words, congratulations on taking this situation seriously. Together, we can turn this problem around. But in order to win, we have to lose.

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