Layla Esposito

Childhood Obesity Prevention and Treatment Research (COPTR): interventions addressing multiple influences in childhood and adolescent obesity.

This paper is the first of five papers in this issue that describes a new research consortium funded by the National Institutes of Health. It describes the design characteristics of the Childhood Obesity Prevention and Treatment Research (COPTR) trials and common measurements across the trials. The COPTR Consortium is conducting interventions to prevent obesity in pre-schoolers and treat overweight or obese 7-13 year olds. Four randomized controlled trials will enroll a total of 1700 children and adolescents (~50% female, 70% minorities), and will test innovative multi-level and multi-component interventions in multiple settings involving primary care physicians, parks and recreational centers, family advocates, and schools. For all the studies, the primary outcome measure is body mass index; secondary outcomes, moderators and mediators of intervention include diet, physical activity, home and neighborhood influences, and psychosocial factors. COPTR is being conducted collaboratively among four participating field centers, a coordinating center, and NIH project offices. Outcomes from COPTR have the potential to enhance our knowledge of interventions to prevent and treat childhood obesity.

Obesity in children with developmental and/or physical disabilities

Children with developmental or physical disabilities, many of whom face serious health-related conditions, also are affected by the current obesity crisis. Although evidence indicates that children with disabilities have a higher prevalence of obesity than do children without disabilities, little is known of the actual magnitude of the problem in this population. To address this concern, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) held a conference on obesity in children with intellectual, developmental, or physical disabilities, bringing together scientists and practitioners in the fields of obesity and disability to foster collaboration, identify barriers to healthy weight status in populations with disabilities, propose avenues to solutions through research and practice, and develop a research agenda to address the problem. This article describes current knowledge about prevalence of obesity in this population, discusses factors influencing obesity risk, and summarizes recommendations for research presented at the conference.

News from the NIH: research to evaluate “natural experiments” related to obesity and diabetes

Obesity is a major contributor to many serious health conditions that increase morbidity and reduce quality of life. For example, obesity is a significant risk factor for diabetes, cardiovascular disease, and certain forms of cancer. The prevalence of obesity in children and adults in the USA has dramatically increased in the past four decades [1, 2]. Although some cities and states are showing reductions in rates of childhood obesity, the prevalence is still far above 1970 levels [3–5]. Diabetes currently affects an estimated 25.8 million people in the USA and another 79 million Americans are estimated to be at greatly increased risk of developing diabetes in the next several years [6]. Further, most adults with diabetes in the USA are not meeting the recommended goals for diabetes care [7]. Overweight, obesity, and/or excessive weight gain during pregnancy are also contributing to rising rates of gestational diabetes mellitus which in turn increases risk of future type 2 diabetes in the mother and child. In addition to the considerable impairments to health and quality of life with these conditions, there are also serious economic consequences. The estimated current annual cost of diabetes alone in the USA is

Systems Science: A Tool for Understanding Obesity

245 billion dollars per year with

A Public Health Approach to Improving the Lives of Adult Learners: Introduction to the Special Issue on Adult Literacy Interventions

176 billion in direct medical costs and the remainder related to reduced productivity [8]. The increasing challenges of obesity and its related health conditions in our society also coincide with a dynamic time for health care in the USA, including changing consumer demands (employers and individuals) and the pressing need to deliver evidence-based care, improve health outcomes for all Americans, and control costs. In communities and in health-care settings, many of the policy and programmatic changes are evidence-informed, but often little is known about population-level effects. Rigorous scientific evaluation of these “natural experiments” can help to more rapidly build an evidence base to inform key stakeholders and policy makers. Evaluation research generally, and rigorous evaluation of natural experiments specifically, is increasingly recognized as an important and appropriate approach to health-related research, particularly in the context of policy and environmental [9, 10] change. The term experiment in natural experiments is something of a misnomer as the implementation of these public health and health-care system policies and programs are not often designed as true experiments. Generally, the term natural experiment refers to an exposure or change that is not directly manipulated by the researcher, but rather the result of policy or program interventions that are varied in their implementation along a number of possible dimensions, such as time, geography, or content. Research that evaluates the real-world implementation of polices and program has some challenges such as the potential for bias, confounding, and threats to casual inference. Despite these limitations, the data from natural experiment research offers unique opportunities to enrich the evidence base and can offer advantages not provided by other research designs, such as improved external validity. This research can provide important data about the impact of a policy or program in real-world settings and populations; see for example the well-known study on the impact of education on health outcomes by Lleras-Muney [11]. Often, these are data that would be very difficult, potentially unethical, and often cost prohibitive to collect in the context of an investigator-initiated randomized experiment [12]. Natural experiment research also allows for the assessment of potential unintended consequences or subgroup differences in response to the program or policy and measurement of implementation fidelity, variability, and process. Since 2010, several institutes and centers (ICs) at the National Institutes of Health have jointly issued funding opportunity announcements intended to support rigorous evaluation of natural experiments related to obesity and/or diabetes outcomes, including the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); National Cancer Institute (NCI); Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD); National Heart, Lung, and Blood Institute (NHLBI); National Institute on Aging (NIA); and the Office of Behavioral and Social Sciences Research (OBSSR). In these funding opportunity announcements, policies are broadly defined to include public policies at local, state, and federal levels of government and organizational level policies, such as those implemented by large organizations, worksites, or school districts. Polices can be formal such as laws and regulations or informal such as guidelines and procedures. Program is defined as a set of activities initiated by governmental or other organizational bodies to enhance obesity prevention and control.

The NIH Science of Behavior Change Program: Transforming the science through a focus on mechanisms of change

The article looks at research on obesity, as of 2014. It notes obesity has become an epidemic worldwide and says that there is not clear agreement on the causes of obesity, which in turn hinders the development of effective prevention strategies. It discusses how the methodology of systems science may be able to be effectively applied in the area of obesity research.

The social neuroscience of human-animal interaction.

Abstract Addressing the literacy needs of adult basic and secondary education learners must form a core part of a broader public health effort to increase educational and health outcomes for these individuals and their families. Adult learners constitute a significant proportion of the overall adult U.S. population and a proportion that impacts, directly and indirectly, on the physical and economic health of millions of families and society writ large. Enhancing the literacy skills of low-literate adults has proven difficult, hampered by the relative dearth of research data on struggling adult learners and effective intervention approaches, the contextual challenges of delivering intensive interventions, limited personal and systemic resources, and competing demands on learners’ time. We propose a systems-level view of adult low literacy as one that holds promise and provides a basic framework for providing coordinated, comprehensive, and integrated services but that requires additional research to support. Informed and coordinated efforts with the prekindergarten to 12th-grade education system and health and labor services sectors is needed if we are to improve the lives of these adults and their families.

Introduction to a thematic series on animal assisted interventions in special populations

The goal of the NIH Science of Behavior Change (SOBC) Common Fund Program is to provide the basis for an experimental medicine approach to behavior change that focuses on identifying and measuring the mechanisms that underlie behavioral patterns we are trying to change. This paper frames the development of the program within a discussion of the substantial disease burden in the U.S. attributable to behavioral factors, and details our strategies for breaking down the disease- and condition-focused silos in the behavior change field to accelerate discovery and translation. These principles serve as the foundation for our vision for a unified science of behavior change at the NIH and in the broader research community.

Childhood obesity research at the NIH: Efforts, gaps, and opportunities

Humans are a fundamentally social species, preferring to live in dyads, families, groups, communities, and cultures (Cacioppo & Ortigue, 2011). As a species, we have a wonderful capacity to develop and engage in social interactions, both with other humans and with members of other species, most obviously companion animals such as dogs and cats. In fact, the latest figures indicate that 68% of U.S. households (American Pet Products Association, 2014; American Veterinary Medicine Association, 2007) and 46% of British households (Pet Food Manufacturers Association, 2014) include at least one companion animal. Pet ownership has also been shown to facilitate “social capital” in that the presence of pets tends to facilitate social contact and a sense of community (Wood, Giles-Corti, & Bulsara, 2005; Wood et al., 2015).

News from the NIH: Diversity, disparities, and disabilities research

ABSTRACT Despite the lack of a strong evidence base, Animal-Assisted Interventions (AAIs) are becoming increasingly popular as a therapeutic tool for special populations with a variety of psychological and physical conditions. This paper introduces a special series of articles which address the proposed theories and processes underpinning potential effects of AAIs. We recommend strategies for improving the evidence base of AAIs giving specific examples in special populations (e.g., children with Autism Spectrum Disorder [ASD]). We consider the challenges in AAI research and suggest directions for future research.