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

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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

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Goal 2: Reduce Human Disease

Effect of obesity on recovery of lung function in pediatric survivors of critical illness

What are the determinants of persistent respiratory failure in children? Are obese children at greater risk for prolonged mechanical ventilation than non-obese children? Does BMI affect the time to recovery of lung function in obese children with ARDS? What is the pathogenesis and molecular contributors of obesity on respiratory failure in critical illness?

Submitted by (@greg.martin)

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 : Society of Critical Care Medicine Executive Committee/Council

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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

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Goal 1: Promote Human Health

Prevention of Obesity

What are the behavioral factors that predispose to excessive weight gain and development of obesity? And, which intervention strategies can effectively prevent excessive weight gain and obesity? NHLBI, other NIH institutes and the society at-large have invested heavily in research and clinical practice aimed at treatment of obesity (i.e, weight loss in those who are already overweight). However, much less research ...more »

Submitted by (@rpate0)

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

Details on the impact of addressing this CQ or CC :

Reducing the prevalence of obesity is one of the great public health challenges of the 21st century. Research should be focused, first and foremost, on prevention, not treatment, of this problem. It seems highly likely that improving the behaviors that can prevent obesity would produce a wide range of important public health benefits.

Feasibility and challenges of addressing this CQ or CC :

Two generations ago the prevalence of obesity was much lower than it is today. The prevalence was lower then, not because overweight people were better at losing weight; rather rates were lower because far fewer people became overweight in the first place. It is high time that the scientific community, clinicians, and public health practitioners invested their efforts in prevention first, where there is every reason to believe we could be successful. These efforts should be informed by a robust body of knowledge, and it is recommended that NHLBI lead the effort to expand the body of knowledge on primary prevention of obesity.

Name of idea submitter and other team members who worked on this idea : Russell Pate

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Goal 2: Reduce Human Disease

Design interventions to improve sleep hygiene

Inadequate sleep is associated with risk of obesity. Electronic media devices interfere with our ability to sleep well - they delay sleep, interrupt sleep, and affect sleep quality. However these devices are addictive and ubiquitous. Can we develop interventions to help people obtain adequate sleep?

Submitted by (@anna.adachimejia)

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 : Anna Adachi-Mejia

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Goal 1: Promote Human Health

Basic understanding on the mechanisms of overeating

We have an in depth understanding of the effects nutrients and diet have on the development of chronic disease, yet very little research funding has gone to understanding the basic mechanisms of eating behavior and how to successful change diet. There are currently no study sections at NIH that specialize in nutrition and/or human eating behavior, and therefore proposals in this subject area get farmed out to other study ...more »

Submitted by (@klk370)

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

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Goal 1: Promote Human Health

Individually-Tailored Approaches to Manage Perinatal Weight Gain to Improve Maternal and Infant Health

Managing perinatal weight gain is a major challenge in research and practice. More women enter pregnancy already overweight or obese which increases the risks for morbidity and mortality for both mother and baby. Novel strategies are needed to effectively manage weight gain in this population. This may include infusing engineering principles and dynamical modeling to better understand the complex interactions of biological ...more »

Submitted by (@dsd110)

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

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Goal 3: Advance Translational Research

Increased receptivity to probative programmatic trials

We believe there should be greater openness to large, simple trials that answer clear questions of interest (e.g. does giving children more fruits and vegetables while changing nothing else lead to weight loss?; does eating breakfast regularly lead to weight loss?; etc.). The conduct of such trials may sometimes be expensive but can sometimes be only modestly costly if they are kept simple. However, it is difficult to ...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 :

While we do not mean for a moment that we should drift away from mechanistic science, we believe that there should also be openness to addressing some questions that are simple and perhaps even slightly dull, but can be unequivocally answered with a trial. In this way, beliefs can be converted to facts.

Feasibility and challenges of addressing this CQ or CC :

It is difficult to seek funding for such trials because reviewers want to see more testing of mechanisms, more physiologic outcomes, more testing of hypothesized mediating variables, and more exciting scientific hypothesis tests.

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.

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Goal 4: Develop Workforce and Resources

Research training to support population-focused obesity research in ethnic minority populations

NIH is already facing a challenge in increasing the number and viability of researchers of color. Obesity research in black (or other high risk minority) populations can be used to explore how research training programs that focus on specific issues of importance to populations of color might contribute to the recruitment and success of ethnic minority researchers in the NIH system.

Submitted by (@skumanyi)

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

Details on the impact of addressing this CQ or CC :

To say the least, not all researchers of color study disparities related issues and not all disparities research is done by researchers of color. That is the way it should be. However, I suspect that research focusing on populations of color would attract a greater than average proportion of researchers of color (NIMHD might have data on this but NIMHD funding alone would be grossly insufficient as the only relevant funding stream. It would also be inappropriate and ineffective to silo the entire burden as an NIMHD responsibility).

Feasibility and challenges of addressing this CQ or CC :

The infrastructure for such training might not exist. Isolated minority researchers attached to various centers and programs would not necessarily work; some sort of networking would have to be done based on an infrastructure devoted to population-oriented obesity research and with a critical mass of obesity researchers focusing on the black (or other) population..

Name of idea submitter and other team members who worked on this idea : Shiriki Kumanyika, Melicia Whitt-Glover, Debra Haire-Joshu

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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

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Goal 1: Promote Human Health

dose-response relationship for behavioral treatment of obesity

As a member of the NHLBI panel updating the obesity treatment guidelines, it was clear that there has not been much systematic work on the relationship between the frequency of intervention contacts and the short and long-term effects on weight change and maintenance of weight change. The general finding that more frequent contacts with professional weight loss counselors, and a longer series of contacts, are more effective, ...more »

Submitted by (@victor.j.stevens)

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 sad truth is that many short-term weight loss treatment programs are still being offered by health care organizations. Although experienced weight loss researchers agree that such programs are ineffective and therefore a waste of resources. the definitive research on the does-response relationship between number of intervention contacts, and duration of intervention programs has not been done.

Feasibility and challenges of addressing this CQ or CC :

Such a study could easily be done, but would probably require an RFA mechanism to get past prejudices of some peer reviewers.

Name of idea submitter and other team members who worked on this idea : Victor J. Stevens

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