Strategic Goal: Goal 3: Advance Translational Research

Impact research related to obesity interventions in black and and other high-risk populations?

How can we increase high-impact obesity and CVD-related intervention research with black and other high risk populations. Specifically, how can the NHLBI and NIH process ensure the generation of more research on solutions to weight issues that is goal-oriented and population-focused, e.g., sets of studies designed to align with a coherent, population-focused research agenda with prioritized questions based on potential ...more »

Submitted by (@skumanyi)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

The high and above-average prevalence of obesity and severe obesity among black children and adults persists, and obesity prevalence is still increasing in some age and gender subgroups in the black population. Current treatments don’t seem to work as well to reduce weight in blacks compared to whites (at least based on studies in adults), although some show promise for reduction of CVD risk factors even with modest weight loss. Preventive interventions are urgently needed but underdeveloped.

 

The context and process of intervening on weight issues differs by cultural and socioeconomic contexts. Yet, research that specifically focuses on approaches that can be effective in black population subgroups in communities at large is sparse; many studies are small, with methodological limitations. Within the overall research effort to address obesity, more studies, better studies, and coordinated studies on black Americans as a high risk sub-population could move the needle. This could be a general need related to high-risk populations who will never be the mainstream research focus and may have different contexts and needs.

Feasibility and challenges of addressing this CQ or CC :

It is feasible to do this if the challenges can be overcome and appropriate funding mechanisms are provided. The typical funding mechanisms focus on investigators rather than on populations and on disconnected R01s. The likelihood that these will add up to tell a coherent story is low. More mechanisms are needed to support coordinated studies planned to have collective impact for the black (or other) population. Other challenges are to improve methodological quality (including design, measurements, and duration), phase studies so that they can build on each other, and standardize process and outcome assessments to improve the ability to synthesize study results.

Name of idea submitter and other team members who worked on this idea : Shiriki Kumanyika and members/colleagues who are authors of a journal supplement to Obesity Reviews, October 2014

Voting

6 net votes
7 up votes
1 down votes
Active

Strategic Goal: Goal 2: Reduce Human Disease

Strategic effort against obesity

The major challenge we face is that of the epidemic of obesity. It affects more than half the population, particularly Hispanics, blacks and those in the lower income bracket.

It is responsible for premature death, coronary disease, acute myocardial infarction. Atrial fibrillation and cancer.

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Feasibility and challenges of addressing this CQ or CC :

It will require a massive effort, that only the NIH, in conjunction with large grants from private sources. It will require a battle against the major food industry, fast food chains etc. It will require the participation of schools and politicians.

Nevertheless, it is a strategic effort that is needed and should be a priority.

Name of idea submitter and other team members who worked on this idea : Frank Marcus

Voting

3 net votes
5 up votes
2 down votes
Active

Strategic Goal: Goal 3: Advance Translational Research

Public-Private Partnerships to Improve Nutrition & Reduce Obesity

How can we best encourage and support collaborations between academic researchers and industry partners to test strategies for changing nutritional choices and eating behaviors to healthier patterns that can improve obesity rates? Subquestions include issues around adopting healthier food choices in a variety of environments, effects of diet alteration, the methods and effects of enhancing healthier food flavors, understanding ...more »

Submitted by (@nhlbiforumadministrator1)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

The food industry is a powerful force in determining the eating patterns of the US population. Given its influence, collaborative efforts between academia and industry to promote healthier eating patterns could have an enormous impact on obesity rates and cardiovascular health over the long-term.

Feasibility and challenges of addressing this CQ or CC :

Efforts to forge public-private partnerships in nutrition and obesity research are in formative stages and expected to grow substantially over the next decade, It is timely to take advantage of industry interest in such partnerships to answer questions of interest to academic researchers that can benefit from the resources and expertise brought to bear by industry.

Using public-private partnership models, academic researchers could be encouraged to partner with industry on topics of mutual interest; industry partners could ideally provide “in-kind” resources (e.g., food, spice, or beverage supplies, technical assistance such as food preparation techniques). Collaborative partnerships could also be encouraged between academia, industry, and other key constituents such as the stakeholders in the setting of the research (e.g., worksites, schools and universities). Examples of research focusing on nutritional behaviors and obesity that could be conducted using PPP models include the subquestions listed.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

Voting

54 net votes
96 up votes
42 down votes
Active

Strategic Goal: Goal 2: Reduce Human Disease

To build on the information obtained from population based and epidemiological studies

What is the basis for relative resistance or vulnerabilities to obesity or related adverse health effects observed in various segments of population?

Submitted by (@mturner)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Population based and epidemiological studies have identified segments of population that are resistant or susceptible to obesity and cardiovascular risks. Continued research is needed to identify additional such populations and their differences. Moreover, the next phase of research could be to understand the basis for this relative resistance or vulnerabilities, and exploit the information to improve obesity and cardiovascular disease risk at a community level.

Feasibility and challenges of addressing this CQ or CC :

Moving forward, strategies are needed that don’t yield only incremental benefits, but instead emphasize ‘high risk, high impact’ research to some extent. Given the enormous public health crisis obesity represents we urge continued support of basic, clinical, population, and translational obesity research.

Name of idea submitter and other team members who worked on this idea : The Obesity Society

Voting

7 net votes
13 up votes
6 down votes
Active

Strategic Goal: Goal 2: Reduce Human Disease

Can Psychological Science Improve Weight Loss?

Will sensitivity to the psychological aspects of obesity, including lifestyle priorities and motivations, improve the efficacy of long-term effectiveness of weight loss and obesity prevention interventions?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

A primary focus on principles of psychology may result in significantly improved control of the obesity epidemic. Effective interventions could reduce the risk of diabetes, sleep apnea, and hypertension. This research could also affect clinical practice guidelines for weight loss and obesity treatment.

Feasibility and challenges of addressing this CQ or CC :

Psychological science has been successful in developing effective treatments for a number of conditions, including sleep disorders, depressive symptoms, anxiety and phobias. Many of the behavioral principles employed in such interventions (e.g., cognitive restructuring, motivational methods) could be translated for the prevention and treatment of obesity within a reasonable time frame. Additional attention should be directed to the needs of population subgroups in which obesity is most prevalent.

In their Viewpoint article on weight loss intervention research, Pagoto and Appelhans (JAMA, 2013, see attachment) question whether a continued focus on dietary factors in research on weight loss and obesity is warranted. Their commentary raises the importance of attention to the individual psychological characteristics that influence adherence to weight loss interventions rather than dietary composition.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

Voting

51 net votes
104 up votes
53 down votes
Active

Strategic Goal: Goal 3: Advance Translational Research

Greater reliance on stronger observational study designs when true RCTs are not an option

With some notable exceptions, the space in between OATs and pure RCEs is seen, at least in obesity research, as a void. Such a constrained view inappropriately lumps together valid evidence from strong, non-randomized designs with evidence from weak designs that permit little causal inference. There are additional methods occupying that intermediary space of strength of causal inference. If we can encourage the use of ...more »

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Evidence for causation exists along a continuum. The closest we can get to definitive evidence of causation comes from Randomized Controlled Experiments (RCEs) including RCTs. Of course, even these cannot offer absolute certainty because of possible errors in execution and reporting and because of the stochastic nature of statistical reasoning. Yet large, well-done RCEs can, under optimal circumstances, offer inferences about causation with sufficient definitiveness for practical purposes. At the other end of the continuum of certainty (though one might argue about the exact ordering) lie intuition and expert judgment, anecdotes, and studies of ecological correlation – and immediately above those are Ordinary Association Tests (OATs). As Majumdar and Soumerai (2009) point out, “…such a position discounts valid nonrandomized or quasi-experimental study designs, even though health policy randomized controlled trials are rarely feasible.” Such a constrained view inappropriately lumps together valid evidence from strong, non-randomized designs (that is, prospective studies with concurrent controls or the interrupted time series study in which a policy causes a sudden, visible change in trend) with evidence from weak designs that permit little causal inference (that is, the commonly conducted cross-sectional analysis that looks at outcomes only after a policy has been implemented)

Name of idea submitter and other team members who worked on this idea : David B. Allison, Ph.D.; Kevin Fontaine, Ph.D.; Kathryn A. Kaiser, Ph.D.; Andrew W. Brown, Ph.D.; Edward C. Archer, Ph.D.

Voting

1 net vote
2 up votes
1 down votes
Active

Strategic Goal: Goal 3: Advance Translational Research

Natural Experiments and Obesity

How can approaches, such as natural experiments, be used to capture the evolution and impact of policies/environmental change that are related to obesity? There needs to be a mechanism that can quickly support the funding of natural experiment research. For instance, NIDDK and NICHD participate in a rapid response PAR that funds natural experiments in a timely manner. It only takes about 4 months from when the application ...more »

Submitted by (@nhlbiforumadministrator1)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Gaining a better understanding of the impact of natural experiments on obesity would help us better understand how best to translate findings into public health action.

Feasibility and challenges of addressing this CQ or CC :

It is feasible to address the impact of natural experiments and obesity because there are currently naturally experiments taking place and we should capitalize on it.

There are a growing number of policies (e.g., caloric labeling) and environmental changes (e.g., bicycle lanes), being implemented to address obesity. These policy and environmental changes can be seen as natural experiments and should be evaluated. While there are challenges to revaluating real-world implementation of polices/environmental changes, there is the opportunity to increase external validity.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

Voting

32 net votes
62 up votes
30 down votes
Active

Strategic Goal: Goal 3: Advance Translational Research

Develop common-sense standards for obesity research

Obesity research is riddled with methodological problems that are rarely challenged, leading to the perpetuation of misinformation and interventions that do harm. Given the two-thirds of the population who are classified as higher weight and thus subject to these interventions, it is past time to clean up the basic scientific flaws in this research area. For a quick summary of a couple of these issues, see Poodle Science: ...more »

Submitted by (@dbdb00)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

This subject really is both CG and CC. The CQ aspect is to see past the weight bias and stigma we are all subject to in order to see diversity of weight as normal, even as people across the weight spectrum suffer health insults from sources that are rarely investigated within the medical model (cf social determinants of health). The CC aspect is the enormous economic and cultural pressures to maintain the valuing of some bodies over others in order to sell products and create a group of people who have fewer ways to defend themselves from oppression.

Feasibility and challenges of addressing this CQ or CC :

Several key areas could make a big difference and they are quite feasible.

1. Require researchers to have studied weight bias and stigma so they are more aware of their own potential proclivities to frame research questions or results according to the status quo.

2. Require any study that claims a weight loss finding to have, report, and publish followup data on all participants at least 2-5 years post-intervention.

3. Require any study claiming a health issue related to weight to compare not higher and lower weight people, but rather higher weight people who have pursued weight loss and higher weight people who have not, since there is no way for higher weight people to be always-been-thinner.

4. Require weight/health research to control for obvious confounders such as weight cycling, SES, exposure to weight stigma, exposure to weight discrimination, exposure to racism, exposure to stress, lack of access to unbiased medical care, etc.

5. Require that journals allowing statements in the abstract or discussion or conclusions that generalize beyond the data be accountable, and that journals provide an accurate translation of the findings for journalists complete with statements about limitations of findings and possible alternative interpretations.

6. Fund projects which are about listening, especially to people who are rarely asked about their lived experience, in order to generate better research that actually improves quality of life for higher-weight people.

Name of idea submitter and other team members who worked on this idea : Deb Burgard, PhD

Voting

24 net votes
44 up votes
20 down votes
Active

Strategic Goal: Goal 3: Advance Translational Research

Move toward more probative research

As some of us described in a recent publication, in the fields of nutrition and obesity, and perhaps in other fields as well, there is often a great deal of research which uses up resources, investigator time, journal pages, and attention span for questions that do not advance the field. We call for scientists, reviewers, and funding decision makers to collectively ask much more rigorously, "How will this proposed study ...more »

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

A quintessential example of this state of affairs is the large number of studies involving breakfast consumption and obesity. On the order of 100 studies have been done testing the association of breakfast eating vs. breakfast skipping with obesity. This seemed to lead to the belief and widely stated public health message that breakfast should be consumed to prevent obesity or promote weight loss. While the first several such epidemiologic studies were reasonable to conduct, what was needed thereafter were RCTs to test for causal effect. Instead the scientific community provided itself with a large body of observational studies to the point where an association was established far beyond any reasonable doubt (P≈10-42). Only recently have a handful of investigators conducted the RCTs needed to advance knowledge further, i.e. the "probative" studies. These have failed to support the hypothesis that breakfast consumption vs skipping leads to better weight control.

Feasibility and challenges of addressing this CQ or CC :

Similarly, we seem to be faced with a large stream of studies of varying quality testing the hypothesis that modest increases in physical activity in school settings for children will lead to important differences in weight outcomes. Yet, considerable research has already demonstrated to a reasonable degree of certainty that school-based programs with modest increases of physical activity do not have major effects on children's BMIs. This does not mean that physical activity is not important for other outcomes, or that there is not some way of inducing physical activity that would lead to major changes in BMI, but repetitively trying one minor variation on school-based programs after another is not the best use of our resources. These are just examples.

Name of idea submitter and other team members who worked on this idea : David B. Allison, Ph.D.; Kevin Fontaine, Ph.D.; Kathryn A. Kaiser, Ph.D.; Andrew W. Brown, Ph.D.; Edward C. Archer, Ph.D.

Voting

1 net vote
2 up votes
1 down votes
Active

Strategic Goal: Goal 3: Advance Translational Research

Need to Determine the Basis for Difference in Response to Weight Management Approaches

Why does the response to weight loss regimen in terms of weight loss and its sustainability, and improvement in health outcomes vary considerably?

Submitted by (@mturner)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Past research focused on using variations of diet and exercise has revealed important information about the health benefits of weight loss. The limitations of such approaches in producing biologically meaningful and sustained weight loss for the majority have also been recognized. Even within a study population, compliance to weight loss regimen, weight loss and its sustainability, and improvement in health outcomes vary considerably. Research is needed to identify the basis for this variation, which may lead to enhanced outcome and applicability of such approaches.

Feasibility and challenges of addressing this CQ or CC :

Identifying factors that enhance weight management response may lead to translational studies that yield more effective results. A strong support of promising clinical translational research may promote a conducive environment for developing more practical applications.

Name of idea submitter and other team members who worked on this idea : The Obesity Society

Voting

8 net votes
14 up votes
6 down votes
Active

Strategic Goal: Goal 2: Reduce Human Disease

Severe obesity prevention in pediatric and community settings

What novel lifestyle and behavioral modification therapies are needed to prevent or treat youth with severe obesity (>99th percentile for BMI) versus those who are overweight?

 

Can we harness ongoing registries such as POWER (Pediatric Obesity Weight Evaluation Registry) in pediatric primary care (PC) settings to implement novel trials that would link PC and community settings to prevent severe obesity in youth?

Submitted by (@nhlbiforumadministrator1)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

A huge impact on obesity prevention in high risk youth. In addition to physiologic and metabolic changes, severely obese youth are stigmatized and bullied more often than those who are overweight. Self-esteem issues are also common among severely obese youth. Reduction of obesity could improve long term cardiovascular risk factors as well as quality of life and future chronic diseases.

Feasibility and challenges of addressing this CQ or CC :

This CQ is feasible because there a smaller scale RCTs that are short term and have demonstrable efficacy that could be harnessed. Chronic obstructive sleep apnea is also common in severely obese subjects. Thus this initiative could be across HL divisions.

Severe obesity is prevalent in ~6% of US youth (~ 8% in African American and Hispanic youth). But there is limited research on the effects of lifestyle modification approaches on BMI and CV risk reduction in such youth. Of the limited number of tested lifestyle interventions, results (e.g., adiposity and metabolic) have been modest and not sustained long-term. Most severely obese youth may not qualify for bariatric surgery and questions arise on long-term effects of bariatric surgery in young subjects with severe co-morbidities who might qualify for surgery but may lack the emotional maturity, family support, and motivation.

 

Research to better elucidate the underlying physiological, psychological, and environmental factors associated with severe pediatric obesity are needed. Behavioral trials are needed that intervene on multiple areas of influence (e.g., pediatric care, family, and community) and evaluate traditional and non-traditional outcomes—adiposity, cardiometabolic risk factors including vasculature and function, and inflammatory markers and oxidative stress.

 

There could be challenges in changing behaviors but these could be mitigated with novel and intensive approaches.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

Voting

46 net votes
87 up votes
41 down votes
Active

Strategic Goal: Goal 3: Advance Translational Research

Lifestyle Interventions for Weight Control

What is the comparative effectiveness in comparison to usual care of scalable alternatives for delivery of evidence-based, comprehensive, lifestyle interventions for weight control that physicians can prescribe to patients either within the primary care setting or by referral within the community? What kinds of infrastructure changes are needed within the primary care setting to increase the effectiveness of these interventions? ...more »

Submitted by (@nhlbiforumadministrator1)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

Voting

41 net votes
73 up votes
32 down votes
Active