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 Division of Chronic Disease Research Across the Lifecourse (CoRAL) of the DPM, established in 2006, seeks to address these core problems by conducting interdisciplinary research within defined populations. CoRAL takes advantage of DPM’s position at the fulcrum of a medical school, a health plan, and health care delivery systems.
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 Atrius Harvard Vanguard Medical Associates, 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 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 CoRAL underscore that obesity prevention must start at the earliest stages of human development, a concept that drives much of the activity of CoRAL.
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. CoRAL recently completed a pilot intervention to help limit risk of excessive gestational weight gain among pregnant women at Atrius Health.
Health services research on prevention and treatment of obesity, including governmental and health plan policies and programs; clinical therapeutic interventions; decision support for clinicians; and cost-effectiveness of screening and interventions. One example is CoRAL's ongoing work evaluating effects of point of purchase interventions to improve the healthfulness of food purchases. Dr. Block's recent publication found that per item calorie content was lower for restaurants that voluntarily posted information about calories compared with restaurants that did not post such information. In prior work, he reported that an intervention to increase the price of regular soft drinks compared to diet soft drinks and water resulted in 26% decline in sales of regular soda. Another example is CoRAL's work with obstetric providers and patients evaluating EMR-based tools to support gestational weight gain counseling and tracking.
Activities of the Division of Chronic Disease Research Across the Lifecourse (CoRAL) are having an impact on policies and programs locally as well as nationally, and internationally. Examples include the following:
- American Heart Association (AHA) – Dr. Hivert has served Vice-Chair and now Chair of the Physical Activity Committee and is a member of the Leadership Committee of the AHA Lifestyle Council. She was lead author of the AHA’s 2016 Position Statement on Medical Training to Achieve Competency in Lifestyle Counseling as well as an author of the Science Advisory on Sedentary Behavior and Cardiovascular Morbidity and Mortality http://www.ncbi.nlm.nih.gov/pubmed/27528691. Dr. Hivert is also a member of the Lifestyle in Medicine Education Collaborative (LMEd), which aims to offers leadership, guidance and resources to advance the adoption and implementation of lifestyle medicine curricula throughout medical education across US institutions.
- The Obesity Society (TOS) – Dr. Oken was a member of the committee that authored the Society’s position statement on Breastfeeding and Obesity. Dr. Block is chair of the Policy Track for the TOS annual meeting.
- International Federation for Obstetrics and Gynecology (FIGO). Dr. Oken is the North American representative to the Expert Group on Maternal Nutrition convened by FIGO, and coauthor of the group’s guidelines on adolescent, preconception, and maternal nutrition. She has presented invited talks on behalf of this Expert Group at the 2015 FIGO International Meeting in Vancouver, Canada and at the 2016 South Asian Initiative for Diabetes in Pregnancy in Columbo, Sri Lanka.
- US Department of Health and Human Services (HHS). Dr. Block was a Senior Advisor to the Acting Assistant Secretary for Health in the Office of the Assistant Secretary for Health from 2016-2017. Dr. Oken served on the Workshop Planning Committee and as co-chair of one of four working groups for the HHS/USDA evaluation of evidence to include children 0-2 years in the Dietary Guidelines for Americans.