Showing 20 ideas for tag "obesity"

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.

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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67 net votes
97 up votes
30 down votes
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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?

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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73 net votes
113 up votes
40 down votes
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Goal 2: Reduce Human Disease

Behavior change labs: an interdisciplinary team approach

Will integration of behavior science in clinical research improve effectiveness of interventions for HLBS diseases associated with behavioral risk factors?

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

Details on the impact of addressing this CQ or CC

Currently, there is no industry support for T1 (basic to clinical) behavioral research and therefore little incentive for basic and clinical behavioral scientists to work together to develop and test new, innovative strategies for changing HLBS-related behaviors based on basic behavioral science findings on motivation, perception, cognition and social relationships. Bringing together collaborative, interdisciplinary teams of basic behavioral scientists and clinically-oriented behavioral researchers could spur development and testing of innovative new approaches to difficult HLBS-related behavioral problems such as obesity, unhealthy diets, sedentary lifestyles, smoking and non-adherence to preventive and therapeutic HLBS regimens.

Feasibility and challenges of addressing this CQ or CC

New research in the behavioral sciences is elucidating the basic psychological, cognitive, social and behavioral processes underlying behavior and behavior change. Findings in this area could be developed into new strategies targeting problematic HLBS-related behaviors, but a mechanism for developing and testing novel ideas is needed. Networks designed to bring together basic and clinically-oriented behavioral researchers can enable better understanding of the bases of HLBS-related behaviors and accelerate the translation of findings into new approaches.
Adopting and maintaining healthy habits and lifestyles – such as eating healthy diets, engaging in regular physical activity, stopping smoking, and regularly taking prescribed medications – are crucial to heart, lung, blood and sleep (HLBS) health (Akesson et al, 2014; Mozaffarian, 2014). However, for most people, engaging in and maintaining a healthy lifestyle is challenging. Interventions designed to promote behavior change have had limited success, often influencing individuals over the short-term but failing to alter behaviors over longer periods of time, which is necessary to realizing the full benefits of a healthy lifestyle. Underlying the problematic behaviors associated with HLBS-related behavioral risk factors are fundamental psychological, motivational, cognitive and social processes that represent promising targets for the development of new, more effective behavioral interventions. For example, basic behavioral scientists are investigating the role of poor executive function in unhealthy eating behavior and exploring new ways to address the "self-control" failures that lead to impulsive eating.

However, unlike the biomedical arena where the translational pathway from basic science to clinical application is supported by both NIH and industry, there is no industry support and relatively little NIH funding devoted to T1 behavioral research -- i.e., research translating basic behavioral science findings into clinically significant behavioral interventions. As a result, basic behavioral science researchers have little incentive to collaborate with clinical researchers to develop and test novel behavioral treatments. Bringing together collaborative, interdisciplinary teams of basic behavioral scientists and clinically-oriented behavioral researchers could spur development and testing of innovative new approaches to difficult HLBS-related behavioral problems.

A compelling question is how to bring together these disparate researchers over a long enough time frame to enable them to identify, develop and testing new strategies for tackling resistant behavioral problems. One way to address this question is to fund a network of "behavior change labs," each of which brings together teams of basic behavioral scientists who are investigating the bases of behavior and behavior change with clinical researchers interested in designing, optimizing and testing novel ideas for tackling the difficult behavioral problems represented by obesity, unhealthy diets, sedentary lifestyles, smoking and non-adherence to medications used to prevent or treat HLBS diseases and disorders.

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

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83 net votes
129 up votes
46 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?

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

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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 2: Reduce Human Disease

A Systems Approach to Obesity

There is a need to use an integrated systems approach to obesity prevention and treatment. Obesity is a complex phenotype influenced by factors from the molecular to the socio-economic level. To address the causes and prevention of obesity, we need to integrate information at the molecular level with behavioral, social and environmental data. This will require investigators in molecular biology, genetics, epidemiology,... more »

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

Details on the impact of addressing this CQ or CC

Addressing this critical challenge will enable scientists and clinicians to move beyond the identification of singular risk factors for obesity to develop a holistic approach to prevention and treatment of this critical health problem.

Feasibility and challenges of addressing this CQ or CC

The molecular technology, environmental monitoring technology, analytic and bioinformatics infrastructure are sufficiently developed to generate the necessary data and analyze disparate data types within the larger systems biology framework.

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

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97 net votes
138 up votes
41 down votes
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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?

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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46 net votes
87 up votes
41 down votes
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Goal 2: Reduce Human Disease

Impact of intrauterine environment on obesity

How does maternal obesity before or during pregnancy affect the intrauterine environment and increase the risk of overweight/obesity in the offspring?

How does maternal dietary intake during pregnancy impact weight in the offspring?

What types of interventions are most effective for preventing excessive gestational weight gain among high risk groups?

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

Details on the impact of addressing this CQ or CC

Developing effective interventions during pregnancy can help reduce the risk of obesity in the offspring and mother.

Feasibility and challenges of addressing this CQ or CC

Addressing how the intrauterine environment impacts obesity is feasible because there is already existing preliminary data that shows pregnancy can have an impact on obesity in offspring. More work needs to be done to better understand the mechanism and how best to intervene.
There is emerging evidence that the intrauterine environment can have an impact on obesity.

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

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33 net votes
66 up votes
33 down votes
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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?

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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34 net votes
84 up votes
50 down 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 »

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

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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

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?

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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27 net votes
36 up votes
9 down votes
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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?

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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0 net votes
27 up votes
27 down votes
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Goal 2: Reduce Human Disease

To build on the information obtained from population based and epidemiological studies

What is the basis for relative resistance or vulnerabilities to obesity or related adverse health effects observed in various segments of population?

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

Details on the impact of addressing this CQ or CC

Population based and epidemiological studies have identified segments of population that are resistant or susceptible to obesity and cardiovascular risks. Continued research is needed to identify additional such populations and their differences. Moreover, the next phase of research could be to understand the basis for this relative resistance or vulnerabilities, and exploit the information to improve obesity and cardiovascular disease risk at a community level.

Feasibility and challenges of addressing this CQ or CC

Moving forward, strategies are needed that don’t yield only incremental benefits, but instead emphasize ‘high risk, high impact’ research to some extent. Given the enormous public health crisis obesity represents we urge continued support of basic, clinical, population, and translational obesity research.

Name of idea submitter and other team members who worked on this idea The Obesity Society

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7 net votes
13 up votes
6 down votes
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Goal 2: Reduce Human Disease

Additional research needed to identify various contributors of obesity

What are the specific contributors of obesity that lead to chronic positive energy balance and surplus energy storage?

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

Details on the impact of addressing this CQ or CC

Obesity is a health crisis of epic proportions. About 34% of adults in the US have obesity, up from 31 % in 1999 and about 15% in the years 1960 to 1980. The chronic diseases that result from obesity annually cost over $150 billion in weight-related medical bills. Reduction of obesity improves cardiovascular and other health outcomes, yet what is currently known about obesity is inadequate to combat the global obesity epidemic. A comprehensive understanding about the mechanics of obesity may help in developing more effective preventive and treatment strategies, which in turn will substantially improve cardiovascular and other health measures.

Feasibility and challenges of addressing this CQ or CC

Years of obesity research have revealed the complex nature of this disease and its multi-factorial etiology. While research has firmly established the role of energy balance in weight gain and weight loss, it is important to discover upstream factors that predispose only certain individuals to energy imbalance. This may be addressed by further focusing on newly identified putative contributors of obesity, including but not limited to the impact of sleep deprivation, ambient temperature, age at first pregnancy, intrauterine and intergenerational factors, neuro-endocrine factors, epigenetics, environmental chemicals and endocrine disruptors, gut microbes, infections and the immune system, and social and behavioral factors associated with obesogenic behaviors. These studies may provide mechanistic insight that may also lead to the development of new pharmacological approaches. It is possible that cause-specific prevention or treatment approaches may yield more effective results than generic approaches that do not necessarily consider upstream modulators of energy imbalance, or inter-individual differences.

Name of idea submitter and other team members who worked on this idea The Obesity Society

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8 net votes
18 up votes
10 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 »

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

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3 net votes
17 up votes
14 down votes
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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.

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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3 net votes
5 up votes
2 down votes
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