Duration: 10/01/2005 to 09/30/2006

Administrative Advisor(s):

NIFA Reps:

Non-Technical Summary

Statement of Issues and Justification

Overweight and obesity have reached epidemic proportions in the United States. The proportion of adults who are overweight increased substantially between 1980 and 2002 (CDC, 2005). By 2002, 65% of U.S. adults (20-74 yrs of age) were overweight and 31% were obese. Likewise, obesity has become the most prevalent nutritional disease of children and adolescents (Dietz, 1998, CDC, 2005). Children from low SES and racial/ethnic minority groups tend to have higher rates of obesity in comparison to other groups (Nesbitt et al., 2004; Thompson et al., 2003). Among adults, obesity rates are about 28% for men regardless of racial/ethnic group membership. Adult women have higher rates of obesity than males. Obesity rates are higher among Hispanic women (39%) than White women (31%) and even higher (50%) among African-American women (CDC, 2005). It is well known that chronic disease risks increase with increasing body weight (Mokdad et al., 2001). It is also clear that overweight and obese children are likely to remain overweight and obese adults and to develop chronic diseases at younger ages (Ebbing et al., 2002).

Obesity was first declared a major public concern in 1952 (Nestle and Jacobson, 2000). Since then billions of dollars have been spent to prevent and intervene with no discernable effect. It is obvious that we need new approaches. The complexity and multifaceted nature of obesity development and its intractability strongly argue for multi-disciplinary approaches. Clearly, obesity has genetic roots. However, the argument that genetic predisposition to obesity makes obesity inevitable (Speakman, 2004) is no more productive in terms of prevention/intervention than the traditional "eat less, exercise more" solution (Fairburn and Cooper, 1996; Wardle, 1996, Nestle and Jacobson, 2000). Safe, effective and affordable pharmacologic and genetic interventions are, at best, years away from discovery. Stakeholders, individuals, the scientific community, educators and health care providers, cannot and should not wait for drug or genetic "cures" for obesity. Unfortunately, long-term, multi-million dollar campaigns to change behavioral and environmental risks for obesity development have not been able to document success in slowing the rise in obesity prevalence (Nestle and Jacobson, 2000).

While children learn eating behaviors from adults and peers (Jansen et al., 2003), there are relatively few studies examining the role of the family, schools and communities in shaping and supporting behaviors leading to weight gain, loss, or maintenance (IOM, 2000;). Social factors, such as socioeconomic status, social support, employment status, age, ethnic origin and religious beliefs have been identified as ones that influence behaviors. However, standardized, empirical methods for measuring these factors are not fully developed and the effects social factors have on obesity are not well understood. In addition, when positive impacts have been seen with projects targeting obesity risk factors, little is known about which intervention components had the greatest impact.

Most importantly, possible links between behavioral and biological aspects of obesity are not known. Anderson (2001) defined biobehavioral research as "the study of the interactions of biological factors with behavioral or social variables and how they affect each other (i.e., the study of bi-directional multilevel relationships)." Biobehavioral research is in its infancy but it is clear that to be successful, multidisciplinary approaches must be created using a variety of methods including qualitative, quantitative, clinical and laboratory techniques. Successful transdisciplinary research projects addressing biobehavioral aspects of obesity must be theory-driven and must focus on individual behavior within social and biological contexts.

The Multistate Research approach is ideal for fostering this type of transdisciplinary work. Bringing researchers with a wide range of expertise together will provide a platform for developing innovative, multidimensional methods for obesity assessment, prevention and intervention. Multistate research will allow for increased resource capacity, including larger sample sizes from more diverse populations, more varied social settings and a wide range of environments. This will provide more confidence in the reliability and validity of results and, in turn, a stronger foundation for devising and testing interventions. The short-term outcomes will include development of valid methods that can become the standards of measurement, promotion of individual behavior changes that lead to improved health indices, changes in perceptions of health, and acceptance for social/environmental changes that support intervention efforts. The long-term outcome of this multistate project will be a reduction in the prevalence of obesity.

On October 27, 2004, a group of over 40 researchers met to develop a proposal for obesity prevention and intervention. The meeting followed USDA's National Obesity Summit which outlined the multifaceted nature of the obesity epidemic. The researchers, appearing in this Appendix E and in Appendix E for NCDC 203, decided that a transdisciplinary approach including a broad range of disciplinary areas is essential to the solution of the obesity problem. We believe that we must work under the umbrella of a single Multistate project to ensure clear communication and interdisciplinary work.

Related, Current and Previous Work

A CRIS search for active projects in human obesity research resulted in a list of approximately 40 studies. Of these, the main objectives of 12 studies had limited relationship to assessment, prevention or intervention in human obesity (e.g. examining bone loss during body weight reduction; examining swine metabolism for optimizing economic value). The objectives of six projects included single nutrient effects on obesity, surgical procedure comparison, and analysis of secondary data sets. The objectives of seven of the studies were to examine obesity at the molecular, genetic or metabolic level. The remaining studies stated objectives related to food choice behavior, intervention efficacy and diverse populations (e.g. Native Americans and Korean Americans). The behavioral studies are focused mainly on underserved or rural populations. Many of the researchers with obesity-related projects within CRIS have expressed interest in participating in the current proposed study. There were no Multistate Projects related specifically to obesity.

There is no question that more research of biological and behavioral linkages to obesity is essential to address the growing obesity problem. The 2005 Dietary Guidelines Committee (2004) recommended 17 areas directly related to obesity that require research. These areas range from identifying "mechanisms to motivate individual change of eating behaviors and habits" to defining the term "nutrient density." Ten additional recommendations including the need for clinical trials, identifying macronutrient impacts on metabolism, and examining food composition reflect the strong emphasis this publication places on all aspects of obesity research. Likewise the 2004 Strategic Plan for NIH Obesity Research (NIH, 2004) lists six broad areas for research including, "Behavioral and environmental approaches to modifying lifestyle to prevent or treat obesity; Research on special populations at high risk for obesity, including children, ethnic minorities, women and older adults"; and "Translating basic science results into clinical research and then into community intervention studies." In 2004, several USDA agencies jointly sponsored a National Summit on Obesity Prevention and USDA's CSREES sponsored a workshop for CSREES grantees working on obesity prevention. Both groups were charged with identifying research needs and both groups identified the need for multidisciplinary research to address the multifaceted problem of obesity. As stated above, the Multistate Research approach is ideal for developing and conducting research that will bring us closer to solving the national obesity epidemic.

This Multistate Research project will be fully integrated with Extension and graduate education. Nitzke et al. (2004) describe the benefits of collaborations where Research and Extension professionals combined their expertise to design, pilot test, and implement recruitment, assessment, and intervention procedures. The research was conducted to test the efficacy of tailoring intervention materials based on the Transtheoretical Model of behavior change for promoting increased fruit and vegetable intake. The partnership between research faculty and Extension personnel resulted in the development of scientifically valid and theoretically sound materials and methods that also conformed to the needs of community-based educators and target audience. In addition, graduate students were key research partners in all but one of the 10 states that participated in this multistate research project. The graduate student involvement provided another perspective into the research design process and provided an often missing component (combined research and Extension experience) for the students.

In summary, previous methods to prevent obesity and interventions to promote weight loss/weight control have been unsuccessful at stemming the increase in weight gain among both children and adults. Low income and minority populations are especially vulnerable to obesity but reasons for this are unknown. It is clear that the causes of obesity are multi-factorial involving complex interactions between physiological, behavioral, social and environmental variables. This project seeks to establish protocols for biobehavioral research that will lead to obesity prevention and effective intervention.

Objectives

1. Develop valid, reliable measurements of family and individual consumer understandings, attitudes, beliefs and perceptions related to obesity with special attention given to vulnerable population subgroups
   
2. Determine valid, reliable measurements of physiological and behavioral factors related to obesity.
   
3. Examine salient behavioral and physiological factors associated with obesity in the context of related understandings, attitudes, beliefs and perceptions.
   
4. Develop and pilot test culturally competent interventions for obesity prevention
   

Methods

All objectives provide methodological approaches and strategies to support joint planning and data sharing. The proposed five year research will begin with method development/adaptation and pilot testing to ensure standardized methods that are valid and reliable. Committee members will collaborate to develop a single set of methods used by all stations and findings will be maintained in a database that all members can access. Each collaborator will pursue research in their area of expertise (e.g., biomarker development, qualitative research design, intervention testing) using similar sets of measures, timelines, and statistical tools. The committee will establish a shared time frame. Every station involved will contribute to each objective. This will allow the proposed project to reach the required sample size for each ethnic group and gender. The greatest challenge in halting the obesity epidemic is the lack of standardized methods that serve as specific and sensitive behavioral and physiological markers. The development of valid, reliable behavioral markers is especially challenging. There are very few physiological markers that specifically link to behavior. Before we can determine obesity prevention and intervention, we must understand its origins, factors that sustain it and ways to measure progress toward achieving healthy weight control. Objectives 1 and 2 address this need for standardized, valid and reliable assessments. Phase I. Objective 1. Measurement development. Little is known about the understandings, beliefs and perceptions of obesity and overweight among low income, rural and minority populations in the U.S. Preliminary data suggests that there are significant differences among racial and ethnic groups as to how overweight and obesity are even defined (Briley and Betts, 2005; Baughcum et al, 2000; Myers and Vargas, 2000). African-Americans disagreed with health care providers or misunderstood growth charts indicating that their child was obese. They also believed that body size was due to "fate" or "destiny" and could not be changed. Recent immigrants from Mexico did not recognize the link between food intake, body weight and health. More is known about the level of knowledge and perceptions of the majority population who are at the middle and upper socio-economic levels but very little is known about lower-income and rural Caucasians. The fundamental methods for discovering beliefs, perceptions and understandings that influence behavior are qualitative. The type of in-depth questioning and analysis required by most qualitative methods limits the sample size. Quantitative methods can reach a larger sample but may not address the most salient variables or may not address them appropriately. Newer mixed methods approaches reduce the disadvantages of both methods while increasing the advantages. Questions to be answered under Objective 1, "Develop valid, reliable methods to identify, assess, and compare by racial/ethnic group the family and individual consumer understandings, attitudes, beliefs and perceptions related to obesity and health" include: 1. How do minority, low income and rural families define childhood obesity and the relationships between food intake, exercise and health? 2. How do minority, low income and rural families perceive, interpret and use U.S. dietary guidance? 3. What are perceived barriers to and benefits of following healthy eating and exercise habits among minority, low income and rural families? 4. What are sources of information about eating and exercise among minority, low income and rural families? To address objective one, a mixed methods approach based on a concurrent transformative strategy will be used. With this design, quantitative questionnaires reflecting understandings, beliefs, attitudes and perceptions about obesity and health will be developed from previous literature and survey findings. Concurrently, qualitative interview protocol will be developed to answer questions not clearly addressed in previous literature or in previous questionnaires. The quantitative and qualitative data collection will occur at the same time. Comparing the findings from each method will verify the important themes for further study and will also assist in revising the questions for both methods. Any areas identified by qualitative findings that are not adequately addressed by the quantitative instruments will be re-tested using both qualitative and quantitative methods. Any questionnaire items have limited validity will be re-tested using qualitative followed by quantitative methods. The expected outcomes are culturally competent quantitative instruments that are valid and reliable for measuring understandings, attitudes, beliefs and perceptions. Quota sampling will be conducted across participating station to ensure sufficient respondents from the following groups: Low income, African-American, Hispanic, Native American, rural. Each state will focus on the sample populations that are accessible in their states (e.g. all stations rural low income, AZ, CA, NV Hispanic, OK & CA Native Americans, HI Pacific Islander, most stations African-American). Training for interviewing will be conducted by each state using standard training methods (Ruud and Betts, 2001). Phase I, Objective 2, Measurement development. Valid, reliable measurements of body composition, physical activity and food intake for use in childhood obesity studies are limited (Golan, 1998; Gelbrich et al., 2005; Guillaume, 1999). Standardized definitions of child overweight and obesity are needed. Differences in definitions by race are vitally needed. Also, methods that are sensitive for measuring change following intervention are essential to determine whether interventions are making the desired impact. Eating behavior is controlled by elaborate physiological mechanisms that are linked with emotional and environmental factors (e.g. motivation, stress, rewards, energy status). These relationships are complex and only beginning to be characterized (Olszewski and Levine, 2004). Hildebrand and de Wied (2002) conducted an extensive review of neuropeptide influences on food intake and body weight status. They concluded that while several peptides enhance the appetite in well fed animals or reduce food intake in starved animals, little is known about the nuances of the effects especially in varying situational contexts. The invasive nature of neuropeptide research limits conducting similar studies in humans. Noninvasive methods for measuring how food intake and food cravings affect the brain hold a great deal of promise for examining physiology and behavior. Pelchat et al. (2004) used functional magnetic resonance imaging (fMRI) to identify changes in specific areas of the brain related to food cravings. Recent research has been conducted with fMRI to identify areas of the brain stimulated by odors and by flavors (Gottfried et al., 2002, Kikuchi et al., 2005). Another novel, non-invasive measurement includes salivary cortisol to measure emotional stress (Bjorntorp, 2001; Rosamond et al., 2000). In these studies, stress was linked to overeating and under-exercising which, in turn, were related to overweight, high blood pressure and insulin resistance. In addition, salivary cortisol levels were linked to genetic and neuropeptide markers and may provide a sensitive non-invasive method of examining these markers. Question to be answered under Objective 2, "Determine valid, reliable measurements that identify physiological and behavioral responses related to body weight and health status" include: 1. How will overweight and obesity be defined especially in children and by racial group? 2. What are the best methods for measuring overweight and obesity especially in children that will be sensitive to measuring changes following intervention? 3. What are the best methods for measuring dietary intake and physical activity that will be sensitive to measuring changes following intervention? 4. What physiological markers identify behaviors related to food intake and physical activity? To answer these questions, a thorough review of the literature will be conducted. Methods found to be valid, reliable, sensitive to change and feasible for a larger population study will be adapted and pilot tested with small samples drawn from minority, low income and rural populations. Researchers from MN, CO, OK, IA and other stations to be recruited will focus on this objective in accord with their expertise. Protocols for brain imagining using fMRI and stress reactions using salivary cortisol under varying conitions will be developed and tested. Phase II, Objective 3. Quantitative study The methods and protocols for objective 3, "Examine salient behaviors and physiological responses in the context of understandings, attitudes, beliefs and perceptions related to obesity and health," will be developed based on findings from Phase I. Salient behaviors related to overweight and obesty among population subgroups will be identified in Phase I, objective 1. Standardized methods to measure body weight status, food intake, physical activity will be identified in Phase I, objective 2. Non-invasive methods for examining genetic and neuropeptide will also be established as will physiological markers that associate with changes in behaviors. Thus, by Phase II, we will be ready to converge methods for measuring multiple facets of overweight and obesity. Protocols that converge measurements will be developed and tested. Samples of families and individuals will be selected using stratified random sampling where possible with the stratification based on each participating state's minority, rural, and low-income population characteristics. Questions to be addressed in Phase II, objective 3 include: 1. What are the most prominent understandings, attitudes, beliefs and perceptions among vulnerable population subgroups related to obesity? 2. Do understandings, attitudes, beliefs and perceptions differ by ethnic and racial subgroups? 3. Are physiological markers consistent among ethnic and racial groups and within individuals under different situations? 4. What are the behaviors that, if changed, should result in obesity prevention and weight control/maintenance? Phase III. Objective 4. Intervention development To be effective, intervention strategies must be tailored to the understandings, attitudes, beliefs and perceptions of the target group (NIH, 2004). Because little is known about low income, rural and minority populations in relation to obesity, few interventions have been developed with these groups even though there is a disproportionately higher incidence of obesity among them. Phases I and II of this project will identify the obesity-related knowledge, behaviors, environments and biological characteristics of vulnerable subgroups and determine behavioral and environmental factors that contribute to weight gain and obesity. In the final year of the project, we will develop prototype tailored interventions based on the findings from Phases I and II. Questions to be answered will include. 1. Which theoretical model would provide the most relevant basis for subgroup intervention based on the subgroups specific needs? 2. How can an intervention's methods be made culturally competent? 3. What delivery modalities would be the best for reaching low income, rural and minority population groups? Measurement of Progress and Results: Outputs from Phase I, Objectives 1 and 2 include valid, reliable methods for measuring psychological (understandings, attitudes, beliefs and perceptions), physiological and behavioral components of food intake, physical activity and related behaviors. These methods will become the standards of measurement allowing later studies to build on findings from this study. Additional outputs will be an understanding of cultural and socioeconomic group differences in knowledge and perceptions of obesity. Methods of tailoring interventions in ways that will be most effective for specific subgroups will be determined. More effective Extension programs and student experiences with Extension and research will result from this project. Advances in the study of links between genomics and proteomics, neuroendocrinology, metabolism and behavior will be made. Outcomes from accomplishing the objectives include an array of valid, reliable methods accessible to other researchers that will promote continued systematic exploration using standardized tools. Additional outcomes will be information for developing culturally sensitive interventions related to obesity. Impacts will include tailored interventions that effectively assist the population in obesity prevention and healthy weight maintenance. The interventions will be transferable to Extension and similar community-level programming. Obesity prevention and healthy weight maintenance will reduce risks for development of chronic disease and reduction in health care costs. This project will provide a model for transdisciplinary ways of working to solve problems and for evidence-based intervention development. In addition, a means for developing more consistent and standardized Extension and similar community-based programming will be an important output from this project.

Measurement of Progress and Results

Outputs

• valid, reliable methods for measuring psychological, physiological and behavioral components of food intake, physical activity and related behaviors. These methods will become the standards of measurement allowing later studies to build on findings from this study.
• an understanding of cultural and socioeconomic group differences in knowledge and perceptions of obesity. Methods of tailoring interventions in ways that will be most effective for specific subgroups will be developed.
• more effective Extension programs and student experiences with Extension and research will result from this project.
• advances in the study of links between genomics and proteomics, neuroendocrinology, metabolism and behavior will be made.

Outcomes or Projected Impacts

• valid, reliable methods accessible to other researchers that will promote continued systematic exploration using standardized tools.
• information for developing culturally sensitive health care and education.
• tailored interventions that effectively assist the population in obesity prevention and healthy weight maintenance
• interventions transferable to Extension and similar community-level programming.
• obesity prevention and healthy weight maintenance will reduce risks for development of chronic disease and reduction in health care costs.
• a model for transdisciplinary ways of working to solve problems and for evidence-based intervention development
• a means for developing more consistent and standardized Extension and similar community-based programming.

Milestones

(2006): To conduct pilot and validation studies in 2007, physiological assessments, interview questions, and survey items must be selected based on previous research findings and pre-tested.

(2007): To develop tailored interventions by 2008, pilot testing of assessments, interviews and surveys must be completed in 2007.

(2008): To produce effective intervention methods that can be used with broad audiences and in Extension program development by 2010, intervention development and testing must be completed during 2009-2010.

(2009): To produce effective intervention methods that can be used with broad audiences and in Extension program development by 2010, intervention testing must be completed during 2009-2010.

(2010): completed interventions, dissemination to scientific community and stakeholders, adaptation of intervention for broader use

Projected Participation

View Appendix E: Participation

Outreach Plan

Methods developed for this study will be disseminated through refereed scientific publications and presentations and other peer reviewed venues. There is a great need for valid, standardized methods in the study of obesity and chronic disease risk behaviors thus critical review will be sought to ensure wide acceptance. Likewise, there has been limited agreement on markers of nutrient intake, physical activity, body weight status and effects of changes. There are few studies examining effects of behavior on physiological markers or physiological events on behavior and vice versa. All of these outputs and outcomes will be disseminated in the most appropriate manner.

Preparing culturally sensitive survey instruments and interventions will require input from Extension Educators and others who work closely with the targeted communities. Evidence-basaed ducational programming will be more effective. The outputs from this project will benefit educators and will lead to more consistent messages. The outputs will also assist others in understanding diverse groups' needs. Dissemination will be accomplished through In-service workshops and similar training sessions.

Organization/Governance

Standard systems of organization and governance will be used for the umbrella project with annual election of the chair and secretary. Researchers with specific expertise will form smaller focus area groups. Each focus area group will elect two individuals to serve on an Executive Committee. The function of the Executive Committee will be to oversee completion of tasks, communicate progress to the chair, and organize dissemination of findings.

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Attachments

Land Grant Participating States/Institutions

AR, AZ, CA, CO, CT, DE, IA, ID, KY, LA, MA, MD, MI, MN, MO, MT, NE, NJ, NM, NV, NY, OH, OK, PA, SD, UT, VA, WA, WV

Non Land Grant Participating States/Institutions