Goal 2: Reduce Human Disease

Environmental induction of congenital heart defects and finding means of prevention

Congenital heart defects (CHDs) continue to be the leading cause of death among all infants with birth defects. It is reported that approximately 10% of cardiac congenital anomalies have a genetic basis. An equal percentage, or ~10%, is due to environmental factors. For ~60% the etiology is unknown and considered to have a multifactorial basis, eg, environmental agents having a role against a specific genetic background, ...more »

Submitted by (@kerstilinask)

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

Details on the impact of addressing this CQ or CC :

College drinking is up especially among young women. Women of both high and low income levels drink, may be smoking marijuana, or are exposed to other environmental toxicants. Are there gender effects, as it has been reported that in the US, more male babies undergo severe cardiac surgeries than female. Few grants are presently funded that take a teratological approach to understanding mechanisms underlying induction of congenital heart defects that can occur before a women realizes being pregnant. The embryo may already have been harmed by then and the effects last a lifetime for the child. High dose folate may be preventative of CHDs and this needs to be better defined and the effects of high folate doses on the adult and fetus need to be analyzed. A possible role for gender should be defined.

Feasibility and challenges of addressing this CQ or CC :

A recommended goal is to emphasize the submission of grants specifically addressing the etiology of congenital heart defects due to environmental factors and their prevention, using cell and molecular teratological approaches. Reinstate a study section on Teratology and Toxicology of Birth Defects made up of PIs working in those fields. There used to be four such study sections and were all removed years back. One such section should be reinstated. Current study sections lack such individuals on the panels due to this area receiving little funding. The neural field is way ahead in funding this topic and as a result the heart tends not to be mentioned in available literature that is provided to women of child-bearing age. Yet the risk for heart anomalies is equally as high and important as are effects on neural development. Similarly, both have lifelong consequences for the individual physically and psychologically and in cost to society with repeating hospitalizations and surgeries. Effects on the heart may be so severe that death occurs already in utero and may not always be counted among the epidemiological studies.

Name of idea submitter and other team members who worked on this idea : Kersti K. Linask, PhD

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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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87 up 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)

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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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2 up votes
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Goal 2: Reduce Human Disease

Address bias of doctors treating obese patients

Twice I was allowed to develop severe heart failure symptoms that required hospitalization to treat because my primary care physician assumed that my ONLY problem was that I am fat. Every doctor knows that obesity can lead to the development of diabetes, heart diseases, joint damage and yet too many doctors on the frontlines just say: You're fat go diet. My first experience with this was when I was first diagnosed ...more »

Submitted by (@chriscage)

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I'd like to know how many patients die because their primary care doctors don't take their health complains seriously. If you can somehow get primary care doctors to open their eyes and do their jobs, patients like me might not be on the verge of death because their doctors refuse to listen. I had a history of heart failure, I told my primary care doctor that my first doctor completely missed the symptoms in 1996, including swollen ankles and feet, the inability to walk two blocks without stopping and having coughing fits that forced me out of bed into a wing-back chair. I started having those symptoms again in 2011 and ended up spending two and half weeks in a hospital in November 2012 to treat my problems and to drain 96 pounds of fluid from my body. I couldn't bend my legs to get into a car or a truck.

Feasibility and challenges of addressing this CQ or CC :

Of course it is possible to deal with this issue. The question is whether doctors and medical researchers are ready to be honest about the role neglect by primary care physicians plays in the overall health of their patients.

 

Both of the doctors who risked my life had good reputations. I liked them until they stopped listening to me. I had an echocardiogram in October 2011 my ejection fraction was between 20 and 15. I thought I was going to die. My doctor said: numbers don't mean anything??? One year later, I spent two and a half weeks in the hospital.

 

Why do you think I'm hopping mad. How many other patients are dealing with the same types of problems. I literally had to take Xanax because when my symptoms returned I was afraid that my stupid doctors would kill me by ignoring me again. I reported my fears in detail to United Healthcare, I switched to a more competent medical system. I'm losing weight and spent hours walking around Yosemite National Park last month. That's the difference between doctors who listen and doctors who don't. A patient should not be afraid that their doctor is so stupid that she or he will kill them .... accidentally.

Name of idea submitter and other team members who worked on this idea : Mary Crystal Cage

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5 net votes
21 up votes
16 down votes
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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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51 net votes
104 up votes
53 down votes
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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)

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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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1 up votes
1 down votes
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Goal 1: Promote Human Health

Promoting health through simultaneous prevention of obesity and eating disorders

How to best promote healthy weight while also not stigmatizing obesity and creating risk for eating disorders (i.e., weight concern and body dissatisfaction) in youth. How to tackle both without contributing in unwitting way to development of either.

Submitted by (@tantillo)

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Studies show that diets do not lead to sustained health benefits for the majority of people and several studies indicate that dieting is actually a consistent predictor of future weight gain. Repeated cycles of losing and gaining weight are linked to heart disease, stroke, diabetes and altered immune function. Children and adolescents are especially vulnerable to the impact of dieting. Several long-term research studies show that girls and boys who use unhealthy weight control practices (including dieting) in early teen years are more likely to become overweight five years later, even if they started out at normal weight. These studies also show that early teen boys and girls who use unhealthy weight control practices are at greater risk for binge eating, use of severe weight control practices ( vomiting, diet pills, laxatives and water pills), and eating disorders compared with adolescents not using weight-control behaviors.

 

Since our culture tends to create weight bias and obesity stigmatization, it is not surprising to see our children become increasingly fearful of becoming “fat.” Weight concern can be experienced by underweight, average weight and overweight children and teens. Studies have shown that body dissatisfaction, especially weight concern (for early teen boys and girls), can lead to overweight, binge eating, severe weight control practices, and eating disorders. Weight teasing by family members and peers can also increase the risk for eating disorders.

Feasibility and challenges of addressing this CQ or CC :

Challenges include creating teams of researchers who will collaborate across the two fields. I believe if we could create such teams we could

move both fields ahead with regard to prevention and a focus on health (behaviors that are health promoting), not BMI (a number) or an emphasis on intake.

 

The key to both health problems involves the ecology in which youth are located b/c this ecology influences body image, intake, activity, self regulation and self care.

Name of idea submitter and other team members who worked on this idea : Mary Tantillo PhD PMHCNS-BC FAED

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116 up votes
54 down votes
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Goal 3: Advance Translational Research

Health Behavior Change in Vulnerable Individuals

What knowledge about health behavior change can be leveraged to design innovative and effective strategies for behavior change among the most vulnerable individuals?

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 :

Significant health disparities exist in part because primary and secondary prevention strategies are not optimal for particularly vulnerable populations, who often grapple with multiple co-morbidities and low resources. Improving health promotion efforts by targeting health behaviors could help to close the disparity gap.

Feasibility and challenges of addressing this CQ or CC :

Many health damaging behaviors, such as smoking, are much more prevalent in certain groups than in the population at large. Multi-level efforts to promote health behavior change have not been optimally effective in these vulnerable groups. We need to build on what we know, understand the gaps, and develop new, culturally sensitive behavior change intervention strategies that will be effective for all groups.

Multi-level strategies to change health-damaging behaviors are effective for some behaviors, but tend to be least effective for the most vulnerable populations. For example, the percentage of people who smoke has decreased dramatically in the last 60 years, but significantly less so for racial and ethnic minorities, those with mental health issues, low income groups, and other vulnerable individuals. These differences contribute to health disparities among these groups, and are in part due to the need for multiple risk reduction and for strategies that are culturally informed.

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

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58 net votes
80 up votes
22 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

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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5 up votes
2 down votes
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Goal 1: Promote Human Health

Evaluation of large-scale regulatory efforts in the US and elsewhere

A number of cities(e.g Berkeley), states and countries (e.g Mexico's SSB tax, Chiles SSB and soon marketing controls and food package front of package label) will go into effect. Rigorous evaluations of the efforts will provide some sense of their potential to effect food purchase and dietary pattern and ultimately cardiometaboiic changes. Serious rigorous independent evaluations are needed to learn if these options--pushed ...more »

Submitted by (@popkin)

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 must learn what we can from the natural experiments not only in the US but globally about both the effects of these efforts on food industry behavior as well as household and individual food purchases and dietary patterns and subsequently their effects on obesity and key cardiometabolic outcomes. This requires serious rigorous teams of scholars to utilize a combination of commercial data sets on food purchases, individual diet, body composition measures of obesity and fat composition and biomarkers.

Feasibility and challenges of addressing this CQ or CC :

These efforts are occurring and will be accelerating across many countries in Asia and Latin America. At the same time many cities or states in the US are moving to implement limited sets of key changes. There is a pressing need to learn if these efforts truly will matter and what changes would be needed to enhance their impact, if any. Finding large-scale regulatory ways to reduce improve our diets, prevent/reduce the prevalence of obesity and all the diet and obesity-related NCD's is critical.

Name of idea submitter and other team members who worked on this idea : Barry Popkin

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22 net votes
42 up votes
20 down votes
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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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14 down votes
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