World Report

298 www.thelancet.com Vol 382 July 27, 2013

World Report

Research FocusFunding: MRC and Wellcome Trust plan obesity research driveIt’s safe to say that the UK, and the world, is in the grip of an obesity crisis. Global obesity rates have roughly doubled in just 30 years—a single generation. The announcement, therefore, that the Medical Research Council (MRC) and the Wellcome Trust have teamed up to study the causes and consequences of obesity is positive news.

The £24 million investment, £20·9 million of which is core spend for infrastructure, will be led by the Wellcome Trust-MRC Institute of Metabolic Science (IMS) at the University of Cambridge, UK. Just under half the money (£10·8 million) will establish a new MRC Metabolic Diseases Unit at the IMS under the direction of current codirector Steven O’Rahilly. His career highlights include identifying the defi ciency in leptin production, and associated mutations in the MC4R gene, which he says can explain 50 000 cases of obesity in the UK alone.

The other large portion of the money (£10·1 million) from Wellcome will be used to expand and update existing clinical research facilities over two extra fl oors. This will include high-tech bedrooms for study participants where environmental conditions such as temperature, humidity, and lighting (for sleep and circadian research, for example) can be controlled; all the while, overnight blood sampling, full ambulatory metabolic rate, and oxygen production and consumption can be recorded over several days.

The funds will also be used to establish a new “quasi-realistic” Big Brother-style eating behaviour unit where volunteers can bring in and prepare their own food whilst being observed—sometimes without even knowing it. “It is a bit Big Brother but we won’t do it to people without their knowledge”, O’Rahilly explains. “People will need to come in for a few days and

relax; it’s notoriously diffi cult to study eating behaviour without altering it.”

The site of new facilities, the Cambridge Biomedical Campus, also makes sense: close proximity to a neuroimaging centre for functional MRI studies; ability to tap into the 4000 patients of the Genetics of Obesity Study in the region; sharing a campus with a major hub of biotechnology companies for industrial collaboration.

But £24 million is still a drop in the ocean considering, for example, the £332 million that Cancer Research UK spends per year on its research eff ort. Indeed, O’Rahilly points out that there is no national research-funding obesity charity, and admits that even the new funding serves as a consolidation of pre-existing expertise and collaborations, with the Sanger Institute, for example, as much as an expansion. Of four cited programmes, two are new (early nutritional and developmental infl uences on later disease; how hormones produced by the gut aff ect appetite and satiety) and two are renewed (how genetic variation aff ects bodyweight; why obesity leads to adverse metabolic consequences).

Nonetheless, Jason Halford, president of the UK’s Association for the Study of Obesity, says that there is much we do not know yet about the biology of obesity, or the disease pathways underpinning obesity-related disorders such as cardiovascular disease, diabetes, and cancer. “However, the issue remains that this problem is largely an environmental one and one associated with marked society inequities.” He adds that the translation of obesity science is key and it will be the primary care and the public health arena in which this battle will ultimately be won.

It raises the question of whether the problem can really be solved with

science of the “omics” fl avour—don’t we already know that most cases of obesity are caused by eating too much of the wrong kind of food, coupled with a lack of activity?

“That criticism fails to address that we’re dealing with one of the most complex organisms on the planet—the human being”, says John Williams, Head of Clinical Activities at the Wellcome Trust. “We need a more complete knowledge about the human system, in both health and disease, to design interventions.”

But interventions of the pharma-ceutical variety are best left to industry, says Tam Fry, spokesperson for the National Obesity Forum. “£24 million is peanuts to the pharmaceutical industry”, he says. “NHS and public fi nances are in a dubious position. But the pharma companies stand to earn billions if successful.” He supports more investment in research, but as chair of the Child Growth Foundation, thinks better solutions have already been identifi ed in education and support for 8–11 year-old children to maintain a healthy weight—the age that research has already identifi ed as when healthy and unhealthy lifestyle choices can become fi xed.

There’s no doubt that the new investment will help to deliver world-class bioscience—the calibre of research is already too high for it to fail, academically at least. But whether these research outputs will fi lter through to eff ective policies is more opaque because, as O’Rahilly readily admits, obesity is as much a social and political problem as it is scientifi c. “We do need to tackle issues to reduce the obesogenic environment”, he says. “And they require tough political choices on restricting portion sizes and advertising.”

Arran Frood

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