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Obesity Prevention Program - Research Page
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In a provocative report published in the New England Journal of Medicine in 2005, biodemographer Jay Olshansky ominously predicted that life expectancy would fall in the United States in the 21st century. Reversing 100 years of dramatic gains, the obesity epidemic would take its toll. In 2008, data emerged that female mortality had in fact risen in much of the U.S. Despite its compelling current and future impacts, the pathogenesis of obesity remains poorly understood and the interventions touted as solutions to the problem are rarely studied for efficacy. The Obesity Prevention Program of the DPM, established in 2006, seeks to address these core problems by conducting interdisciplinary research within defined populations. The Program takes advantage of DPM’s position at the fulcrum of a medical school, a health plan, and health care delivery systems.
Core programs
Epidemiologic studies of the development of obesity and its sequelae, including metabolic syndrome, diabetes, and cardiovascular disease. This area invokes the life course approach to chronic disease, and especially targets etiologic factors working at the earliest stages of human development. Project Viva is the archetype of these studies. A cohort study of pregnant women and their children recruited from Harvard Vanguard Medical Associates (HVMA), Project Viva addresses pre- and peri-natal determinants of a range of maternal and child health outcomes. Viva investigators have published widely on early life determinants of childhood obesity
including maternal smoking, excess gestational weight gain, rapid infant weight gain, breastfeeding, and infant sleep duration. These studies have informed the development of family-based interventions to prevent obesity and have influenced the design of the US National Children’s Study and of national health policy. In addition to obesity and cardio-metabolic consequences in mother and child, Project Viva also addresses early origins of asthma/allergy and behavior/cognitive outcomes in the children. The findings of Project Viva and the other observational epidemiologic studies within the Obesity Prevention Program underscore that obesity prevention must start at the earliest stages of human development, a concept that drives much of the activity of the Program.
Interventions to prevent obesity and its consequences, especially among women in the peripartum period and young children. The focus is on innovative behavior change interventions in primary care settings, with an additional interest in community settings such as child care. High Five for Kids provides a paradigm for this area of research. Using precepts of the Chronic Care Model, this cluster randomized trial aims to prevent obesity in preschool-age children. In close collaboration with the practice site, HVMA, investigators have re-engineered the way pediatric practices care for overweight children. Nurse practitioners, supported by their pediatrician and other practice colleagues, deliver the bulk of the intervention using state-of-the-art behavior change techniques with patients and families. High Five for Kids has completed the recruitment of over 500 children and is already producing novel preliminary findings. Results of the trial will be available in 2009. The overall goal of High Five for Kids and the other intervention studies within the Obesity Prevention Program is to develop and field developmentally appropriate interventions, both within and outside the health care system, that are family-based, incorporate judicious use of new technologies, and apply to all segments of the population.
Health services research on prevention and treatment of obesity, including health plan policies and programs; clinical therapeutic interventions; decision support for clinicians; and cost-effectiveness of screening and interventions. Two examples in this area include an ongoing study to estimate the cost-effectiveness of childhood blood pressure screening in the United States by combining published epidemiologic and intervention research in children and young adults with the Coronary Heart Disease Policy Model and a completed study of parental perceptions of overweight management in pediatric primary care. The overall goal of these and other health services research studies within the Obesity Prevention Program is to ensure the highest quality prevention and treatment for obesity and related conditions within the defined populations of health systems.
Impact
Activities of the Obesity Prevention Program are having an impact on policies and programs at the state, national, and international level. Examples include the following:
• Institute of Medicine (IOM) — Dr. Gillman is a member of the Committee to re-examine IOM Pregnancy Weight Guidelines. The Committee, convened by the National Academies, is examining the current state of knowledge regarding maternal weight gain during pregnancy and aims to established national guidelines for pregnancy weight gain.
• American Medical Association/Centers for Disease Control and Prevention/Health Resources and Services Administration — In recognition of the public health importance of childhood obesity, the AMA, HRSA, and the CDC released Expert Committee Recommendations on the Assessment, Prevention, and Treatment of Child and Adolescent Overweight and Obesity in 2007, a revision of guidelines originally issued in 1998. Dr. Taveras was a member of the Expert Committee and an author on the published recommendations for treatment of child and adolescent obesity.
• National Institutes of Health — Dr. Gillman serves as an expert panel member of the National Heart, Lung, and Blood Institute’s Pediatric Cardiovascular Risk Reduction Initiative. Dr. Taveras was an invited speaker at the 2008 Diabetes and Obesity Disparities in Health Care Systems Conference organized by the NIDDK. The conference focused on research related to modifiable elements within health care systems, with the goal of reducing health
disparities.
• Robert Wood Johnson Foundation – Dr. Taveras serves as a member of the executive workgroup for Salud America! The Robert Wood Johnson Foundation Research Network to prevent obesity among Latino Children. The goal of this Network is to fight the epidemic of childhood obesity with plans to unite and increase the number of Latino scientists engaged in research on Latino childhood obesity and seek environmental, behavioral and policy
solutions to the epidemic.
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