Special Article Pathways to Obesity Prevention: Report of a National Institutes of Health Workshop1 Shiriki K. Kumanyika* and Eva Obarzanek† Abstract obesity prevention issues. Further insights derived from the KUMANYIKA, SHIRIKI K. AND EVA OBARZANEK. workshop deliberations are reflected in a detailed list of Pathways to obesity prevention: report of a National recommendations for future obesity prevention research. Institutes of Health workshop. Obes Res. 2003;11:1263-1274. There is an extensive research base on obesity treatment and Key words: health promotion, children, families, inter- on the health benefits of weight loss, but relatively little ventions, weight control research has focused on obesity prevention. This article summarizes results of a workshop conducted by investiga- tors funded under a National Institutes of Health initiative Introduction designed to stimulate novel research for obesity prevention. Apart from the continuing study of how to improve The 20 pilot studies funded under this initiative involved success in treating those who are already obese (1–3), the study populations that were diverse with respect to life stage prevention of obesity has risen to the top of the list of public and ethnicity, were conducted in a variety of natural and health priorities (4). The proportion of children and adults research settings, and involved a mix of interventions, in- who are obese has already reached alarming levels (5–8), cluding face-to-face group and individual counseling, as particularly in some ethnic and socioeconomic status groups well as mail, telephone, and internet-based approaches. The (4,6–9). Reliance on treatment approaches, even if fully workshop, which occurred approximately halfway through effective, is neither practical nor desirable (4,10,11). The the 3-year funding period, emphasized concepts and expe- burden of obesity in the population, particularly when cer- riences related to initiating and conducting obesity preven- tain high-risk and currently underserved populations are tion studies. Investigators discussed theoretical perspectives considered, is likely to exceed the capacity of the health care as well as various challenges encountered, for example, in delivery system to deliver such treatment either for obesity study implementation in different clinical and community itself or for the associated conditions (12). Furthermore, settings, in working with children and families, and in obesity treatment cannot necessarily remove or reverse the studying pregnant and postpartum women. Other topics adverse effects of obesity on health status and quality of life, discussed included the difficulty of motivating individuals particularly for obesity of long duration (1,13). for prevention of weight gain, relevant cultural and racial/ Although effective interventions for obesity prevention ethnic considerations, and the particular need for valid and may share some similarities with those used for weight loss, practical measures of energy balance, body composition, the science of obesity prevention—which includes identifi- and physical fitness in obesity prevention research. A key cation of those aspects that are unique to prevention com- conclusion was that using obesity treatment as the primary pared with treatment—is only now emerging. This article paradigm may be a limiting perspective for considering summarizes the results of an inaugural workshop on scien- tific directions in obesity prevention convened by NIH in August 2001. The core participants and workshop planners 1 The online version of this article (available at http://www.obesityresearch.org) contains an were investigators funded under a special NIH initiative for appendix that includes principal investigators and project descriptions. obesity prevention studies (14) and scientific program staff Received for review January 3, 2003. Accepted in final form August 18, 2003. from the participating NIH institutes. Several principal in- *Department of Biostatistics and Epidemiology, University of Pennsylvania School of vestigators of other relevant studies were also invited. Medicine, Philadelphia, Pennsylvania; and †Prevention Scientific Research Group, Division Workshop objectives were 1) to exchange information on of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland. study designs used to addresses obesity prevention issues Address correspondence to: Shiriki Kumanyika, Center for Clinical Epidemiology and and on the lessons learned in the early stages of protocol Biostatistics, 8th Floor, Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021. E-mail: [email protected] implementation; 2) to identify the ways in which these Copyright © 2003 NAASO studies advance the science of obesity prevention and treat- OBESITY RESEARCH Vol. 11 No. 10 October 2003 1263 Obesity Prevention Research, Kumanyika and Obarzanek ment; and 3) to derive insights about long-term goals and other 12 studies were in adults, reached in medical, work- future directions for obesity prevention research. This report site, community, or home settings and through the internet. presents the main workshop findings in order to reinforce the Some studies focused specifically on women and some on need for research in this area, provoke thinking about new high-risk periods for weight gain, such as the postpartum or directions, and attract investigators with diverse perspectives perimenopausal period or after smoking cessation. The de- and expertise to participate in this line of research as it evolves. gree of selectivity for weight status, e.g., broad weight range, normal weight only, or obese only, varied. The studies were conducted in several U.S. regions, with some Background in rural populations, and approximately one-half focused on or included substantial numbers of African-American or Funding to Stimulate Obesity Prevention Research Latino/Hispanic participants. The limited amount of research with obesity prevention as the stated outcome of interest is far from adequate to address this major public health problem, even when this Workshop Planning and Format area of research is defined broadly to include the cardiovas- This first investigators’ workshop took place approxi- cular disease prevention studies in which obesity was one of mately midway during the 3-year funding period and, there- several outcomes addressed (15,16). In 1998, when the NIH fore, focused on study design and implementation. Each obesity prevention research initiative was being developed, principal investigator was asked to provide, in a standard- the research base included only a few published studies of ized format, basic information about his or her project, obesity prevention in adults (17–19), small pilot studies in including study design, sample size, population target in children (20,21), a small number of school-based studies terms of age, sex, and ethnicity, and intervention descrip- (22–24), and some research in progress (25). The funding tion, to be compiled for distribution to workshop attendees. initiative described here (14) was developed to stimulate Principal investigators were also assigned to one or more novel research into methods to prevent obesity, beginning working groups (termed panels), charged with developing with pilot studies limited to 3 years in duration and workshop content around six themes (see the listing of $125,000 in direct costs per year. The request for applica- panels in Table 1). The panels were asked to comment on tions (RFA)2 specified a comprehensive set of obesity pre- certain general issues, as well as on specific challenges vention outcomes: prevention of weight gain in children and relevant to the assigned perspective, e.g., the nature of the adults who are not yet overweight; treatment of overweight research setting (panel 1), study population (panels 2 and 4), children to prevent obesity in adulthood; prevention of intervention focus (panels 3 and 5), and intervention ap- weight regain after weight loss in obese children and adults; proach (panel 6). Panels met by conference call during the prevention of further weight gain in overweight adults; and months before the workshop and were given 30 minutes to weight control for pregnancy and the postpartum period. present their findings at the 1-day workshop. The workshop Attention to segments of the U.S. population that are par- chair (the first author of this article) synthesized overall ticularly vulnerable to obesity, e.g., ethnic minority popu- findings and impressions in a closing summary. lations, was also encouraged. To ensure high-quality re- search and rigor in research design, the RFA specified that interventions be based on behavior change theory and that a Findings comparison group be followed, with random assignment to As shown in Table 1, the types of issues and challenges the intervention and comparison conditions preferred. identified differed across the different thematic foci. The Twenty research projects were funded as a result of this panel that considered issues specific to working with orga- initiative, through grants from five different NIH institutes, nizations brought together investigators working with with supplementary funding from other federal agencies or churches, primary care clinics, schools, day care centers, offices. The projects were diverse in terms of study popu- federal feeding program sites, and a not-for-profit women’s lations, research questions, outcomes