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 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

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 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

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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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

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 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 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

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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 2: Reduce Human Disease

Sleep and obesity

What characteristics of sleep relate to obesity and does improving sleep using medication help with changes linked to obesity and in the end with weight?

Submitted by (@helenahillmanlaroche)

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

Details on the impact of addressing this CQ or CC :

We are getting more information that sleep is linked to obesity. Those of us treating obesity also try to address sleep but often need to try medication in those with chronic insomnia. Whether this will help with weight or perhaps make it worse and whether one medication might be better to choose over another are questions that impact medical practice.

Name of idea submitter and other team members who worked on this idea : Helena Laroche

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