Goal 2: Reduce Human Disease

Optimizing weight loss

For patients with obesity and medical comorbidities, what is the optimal approach utilizing multiple therapies (low calorie structured diet, intensive lifestyle, weight loss medications) in combination to optimize weight loss?

Submitted by (@ryandh)

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

Details on the impact of addressing this CQ or CC :

Weight loss has health benefits in diabetes reduction, risk factor improvement, improvement in symptoms of sleep apnea, improvement in NAFLD, improvement in feeling and function (knee pain, urinary stress incontinence, sexual function). In all these circumstances, greater weight loss yields more benefit. Our best lifestyle interventions, delivered by the most skilled behaviorists yield weight loss of, on average 8% and one third of persons undergoing the intervention do not lose even 5%. How can we use multiple approaches together to improve the amount and durability of weight loss achieved in our counseling programs.

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Goal 3: Advance Translational Research

Weight Loss Maintenance

How can we improve and optimize strategies for weight loss maintenance to make them more effective for more individuals?

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

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20 net votes
62 up votes
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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 2: Reduce Human Disease

Obesity and health inequities

What are the most effective weight loss/weight gain prevention strategies for high risk groups?

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 :

Effective obesity interventions for high risk groups would help reduce health disparities.

Feasibility and challenges of addressing this CQ or CC :

This CQ is feasible because there are significant data that shows that health disparities exist and should be addressed.

Currently two thirds of Americans are either overweight or obese and obesity disproportionately affects individuals from disadvantaged backgrounds. To date there have been few, well designed trials that target high risk groups and it is still unclear what are the most effective strategies to prevent obesity and promote weight loss among ethnic minorities and low-income populations. For instance, the prevalence of obesity is highest among Mexican American boys (compared to white and African American boys; Ogden 2014), yet there are few (if any) trials targeting this high risk group.

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

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Goal 2: Reduce Human Disease

How can we improve strategies for weight loss maintenance

There is a need to improve and optimize strategies for weight loss maintenance to make them more effective for more individuals.

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 :

Weight regain is the biggest challenge in obesity treatment. For many obese or overweight adults, losing weight over an initial period of time (usually 6 months) is achievable using a comprehensive lifestyle program, which includes a reduced-calorie diet, increased physical activity, and behavior therapy. Yet, participants in even the most successful weight loss programs regain weight after the first 6-12 months, especially if the intervention is discontinued or becomes less intensive.

Feasibility and challenges of addressing this CQ or CC :

recommendations from a recent working group meeting. We are ready to do more cross-collaborative work between physiologists and behavioral interventionists.

 

This question addresses both discovery science and clinical science goals.

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

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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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44 up votes
20 down votes
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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.

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Goal 2: Reduce Human Disease

Single thing needed to prevent obesity: control the mouth

The cause of obesity is clear and simple: eating > needs, or in > out; that is, energy intake is greater than energy use. For the majority of the public, there is little genetic component to cause obesity or over weight. Rather, personal determination is the single thing that is needed to control body weight. Just control the mouth. Simple and easy, and free. Even for the most favorite food, the amount to eat should be ...more »

Submitted by (@eastcastlegeastcastle007)

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 : eastcastle007

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11 up votes
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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 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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Goal 4: Develop Workforce and Resources

Increased methods training for investigators

It is clear that there are concerns about reproducibility and quality control in science in general and in obesity-related research in particular. Increased opportunities for training in rigorous scientific practices for obesity researchers and biomedical and behavioral researchers in general may be helpful to increase rigor and reproducibility.

Submitted by (@nhlbiforumadministrator)

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

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 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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