Goal 2: Reduce Human Disease

Using Genomics to Predict Response to Weight Loss Interventions

Weight loss in response to interventions (both short term and long term maintenance) varies widely between individuals. What is the optimal use of the current molecular arsenal (genomics, metabolomics, expression arrays, etc.) to accurately predict individuals that will respond favorably to specific weight loss strategies?

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 :

Addressing this CC would enable targeted prevention and treatment strategies based on genotype.

Feasibility and challenges of addressing this CQ or CC :

The rapid development of high throughput genomic sequencing and large scale molecular marker assays has led to a lower cost that makes this approach currently feasible. This coupled with large scale computational efforts to manipulate, store and analyze Big Data make the present the ideal time to embark on a focused precision medicine initiative addressing one of the most important US health problems.

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

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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 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

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62 up votes
30 down votes
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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 2: Reduce Human Disease

Developing approaches to the dissemination of behavioral weight loss programs

The Challenge is to make behavioral weight loss programs readily available to he many overweight and obese patients who need them. Behaivoral weight loss programs are effective in producing weight losses of 7-10% of initial body weight, which has been shown to have major beneficial effects on a number of diseases relevant to NHLBI--including hypertension and sleep apnea. However, at present, these programs are not widely ...more »

Submitted by (@rwing0)

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

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17 up votes
14 down votes
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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

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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3 up votes
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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
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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

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54 net votes
96 up votes
42 down 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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113 up votes
40 down votes
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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.

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