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O'Connor LE, Higgins KA, Smiljanec K, Bergia R, Brown AW, Baer D, Davis C, Ferruzzi MG, Miller K, Rowe S, Rueda JMW, Andres A, Cash SB, Coupland J, Crimmins M, Fiecke C, Forde CG, Fukagawa NK, Hall KD, Hamaker B, Herrick KA, Hess JM, Heuven LA, Juul F, Malcomson FC, Martinez-Steele E, Mattes RD, Messina M, Mitchell A, Zhang FF. Perspective: A Research Roadmap about Ultra-Processed Foods and Human Health for the United States Food System: Proceedings from an Interdisciplinary, Multi-Stakeholder Workshop. Adv Nutr 2023; 14:1255-1269. [PMID: 37722488 PMCID: PMC10721509 DOI: 10.1016/j.advnut.2023.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 09/20/2023] Open
Abstract
Our objective was to convene interdisciplinary experts from government, academia, and industry to develop a Research Roadmap to identify research priorities about processed food intake and risk for obesity and cardiometabolic diseases (CMD) among United States populations. We convened attendees at various career stages with diverse viewpoints in the field. We held a "Food Processing Primer" to build foundational knowledge of how and why foods are processed, followed by presentations about how processed foods may affect energy intake, obesity, and CMD risk. Breakout groups discussed potential mechanistic and confounding explanations for associations between processed foods and obesity and CMD risk. Facilitators created research questions (RQs) based on key themes from discussions. Different breakout groups convened to discuss what is known and unknown for each RQ and to develop sub-RQs to address gaps. Workshop attendees focused on ultra-processed foods (UPFs; Nova Group 4) because the preponderance of evidence is based on this classification system. Yet, heterogeneity and subjectivity in UPF classification was a challenge for RQ development. The 6 RQs were: 1) What objective methods or measures could further categorize UPFs, considering food processing, formulation, and the interaction of the two? 2) How can exposure assessment of UPF intake be improved? 3) Does UPF intake influence risk for obesity or CMDs, independent of diet quality? 4) What, if any, attributes of UPFs influence ingestive behavior and contribute to excess energy intake? 5) What, if any, attributes of UPFs contribute to clinically meaningful metabolic responses? 6) What, if any, external environmental factors lead people to consume high amounts of UPFs? Uncertainty and complexity around UPF intake warrant further complementary and interdisciplinary causal, mechanistic, and methodological research related to obesity and CMD risk to understand the utility of applying classification by degree of processing to foods in the United States.
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Affiliation(s)
- Lauren E O'Connor
- Agricultural Research Service, US Department of Agriculture, Beltsville, MD, United States.
| | - Kelly A Higgins
- Agricultural Research Service, US Department of Agriculture, Beltsville, MD, United States
| | | | - Robert Bergia
- Archer Daniels Midland (ADM), Decatur, IL, United States
| | - Andrew W Brown
- University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, AR, United States
| | - David Baer
- Agricultural Research Service, US Department of Agriculture, Beltsville, MD, United States
| | - Cindy Davis
- Agricultural Research Service, US Department of Agriculture, Beltsville, MD, United States
| | - Mario G Ferruzzi
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, United States; Arkansas Children's Nutrition Center, Little Rock, AR, United States
| | - Kevin Miller
- Bell Institute of Health & Nutrition, General Mills, Minneapolis, MN, United States
| | | | | | - Aline Andres
- University of Arkansas for Medical Sciences and Arkansas Children's Nutrition Center, Little Rock, AR, United States
| | - Sean B Cash
- Friedman School of Nutrition Science and Policy at Tufts University, Boston, MA, United States
| | - John Coupland
- Penn State University, University Park, PA, United States
| | - Meghan Crimmins
- University of Arkansas for Medical Sciences and Arkansas Children's Nutrition Center, Little Rock, AR, United States
| | - Chelsey Fiecke
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, United States; Arkansas Children's Nutrition Center, Little Rock, AR, United States
| | - Ciarán G Forde
- Wageningen University and Research, Wageningen, The Netherlands
| | - Naomi K Fukagawa
- Agricultural Research Service, US Department of Agriculture, Beltsville, MD, United States
| | - Kevin D Hall
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Bruce Hamaker
- Purdue University, West Lafayette, IN, United States
| | - Kirsten A Herrick
- National Cancer Institute, National Institutes of Health, Rockville, MD, United States
| | - Julie M Hess
- Agricultural Research Service, US Department of Agriculture, Grand Forks, ND, United States
| | - Lise Aj Heuven
- Wageningen University and Research, Wageningen, The Netherlands
| | - Filippa Juul
- New York University School of Global Public Health, New York, NY, United States
| | | | | | | | - Mark Messina
- Soy Nutrition Institute Global, Pittsfield, MA, United States
| | - Alyson Mitchell
- Food Science and Technology, University of California at Davis, CA, United States
| | - Fang Fang Zhang
- Friedman School of Nutrition Science and Policy at Tufts University, Boston, MA, United States
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2
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Mattes RD, Rowe SB, Ohlhorst SD, Brown AW, Hoffman DJ, Liska DJ, Feskens EJM, Dhillon J, Tucker KL, Epstein LH, Neufeld LM, Kelley M, Fukagawa NK, Sunde RA, Zeisel SH, Basile AJ, Borth LE, Jackson E. Valuing the Diversity of Research Methods to Advance Nutrition Science. Adv Nutr 2022; 13:1324-1393. [PMID: 35802522 PMCID: PMC9340992 DOI: 10.1093/advances/nmac043] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/08/2022] [Indexed: 12/13/2022] Open
Abstract
The ASN Board of Directors appointed the Nutrition Research Task Force to develop a report on scientific methods used in nutrition science to advance discovery, interpretation, and application of knowledge in the field. The genesis of this report was growing concern about the tone of discourse among nutrition professionals and the implications of acrimony on the productive study and translation of nutrition science. Too often, honest differences of opinion are cast as conflicts instead of areas of needed collaboration. Recognition of the value (and limitations) of contributions from well-executed nutrition science derived from the various approaches used in the discipline, as well as appreciation of how their layering will yield the strongest evidence base, will provide a basis for greater productivity and impact. Greater collaborative efforts within the field of nutrition science will require an understanding that each method or approach has a place and function that should be valued and used together to create the nutrition evidence base. Precision nutrition was identified as an important emerging nutrition topic by the preponderance of task force members, and this theme was adopted for the report because it lent itself to integration of many approaches in nutrition science. Although the primary audience for this report is nutrition researchers and other nutrition professionals, a secondary aim is to develop a document useful for the various audiences that translate nutrition research, including journalists, clinicians, and policymakers. The intent is to promote accurate, transparent, verifiable evidence-based communication about nutrition science. This will facilitate reasoned interpretation and application of emerging findings and, thereby, improve understanding and trust in nutrition science and appropriate characterization, development, and adoption of recommendations.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Leonard H Epstein
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | | | - Michael Kelley
- Michael Kelley Nutrition Science Consulting, Wauwatosa, WI, USA
| | - Naomi K Fukagawa
- USDA Beltsville Human Nutrition Research Center, Beltsville, MD, USA
| | | | - Steven H Zeisel
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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3
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Kyle TK, Stanford FC. Moving Toward Health Policy that Respects Both Science and People Living with Obesity. Nurs Clin North Am 2021; 56:635-645. [PMID: 34749901 PMCID: PMC8592383 DOI: 10.1016/j.cnur.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Through four decades of rising obesity, health policy has been mostly ineffective. Prevention policies failed to reverse rising trends in prevalence, partly because they are often based on biased mental models about what should work to prevent obesity, rather than empiric evidence for what does work. Bias toward people living with obesity harms health, while contributing to poor access to effective care that might serve to improve it. Better public policy will come from an increased application of objective obesity science, research to fill knowledge gaps, and respect for the human dignity of people who live with obesity.
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Affiliation(s)
- Theodore K Kyle
- ConscienHealth, 2270 Country Club Drive, Pittsburgh, PA 15241, USA.
| | - Fatima Cody Stanford
- Department of Medicine, Division of Endocrinology-Neuroendocrine, Massachusetts General Hospital, MGH Weight Center, 50 Staniford Street, Boston, MA 02114, USA; Department of Pediatrics, Division of Endocrinology, Nutrition Obesity Research Center at Harvard (NORCH), 50 Staniford Street, Boston, MA 02114, USA
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4
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Perriello G. Personalized and tailored management of obesity at individual target brings success. Eur J Intern Med 2021; 93:1-2. [PMID: 34656405 DOI: 10.1016/j.ejim.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 10/03/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Gabriele Perriello
- Endocrinology and Metabolic Diseases, S. Maria della Misericordia Hospital, Perugia, Italy.
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5
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BROWN ANDREWW, ASLIBEKYAN STELLA, BIER DENNIS, DA SILVA RAFAELFERREIRA, HOOVER ADAM, KLURFELD DAVIDM, LOKEN ERIC, MAYO-WILSON EVAN, MENACHEMI NIR, PAVELA GREG, QUINN PATRICKD, SCHOELLER DALE, TEKWE CARMEN, VALDEZ DANNY, VORLAND COLBYJ, WHIGHAM LEAHD, ALLISON DAVIDB. Toward more rigorous and informative nutritional epidemiology: The rational space between dismissal and defense of the status quo. Crit Rev Food Sci Nutr 2021; 63:3150-3167. [PMID: 34678079 PMCID: PMC9023609 DOI: 10.1080/10408398.2021.1985427] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
To date, nutritional epidemiology has relied heavily on relatively weak methods including simple observational designs and substandard measurements. Despite low internal validity and other sources of bias, claims of causality are made commonly in this literature. Nutritional epidemiology investigations can be improved through greater scientific rigor and adherence to scientific reporting commensurate with research methods used. Some commentators advocate jettisoning nutritional epidemiology entirely, perhaps believing improvements are impossible. Still others support only normative refinements. But neither abolition nor minor tweaks are appropriate. Nutritional epidemiology, in its present state, offers utility, yet also needs marked, reformational renovation. Changing the status quo will require ongoing, unflinching scrutiny of research questions, practices, and reporting-and a willingness to admit that "good enough" is no longer good enough. As such, a workshop entitled "Toward more rigorous and informative nutritional epidemiology: the rational space between dismissal and defense of the status quo" was held from July 15 to August 14, 2020. This virtual symposium focused on: (1) Stronger Designs, (2) Stronger Measurement, (3) Stronger Analyses, and (4) Stronger Execution and Reporting. Participants from several leading academic institutions explored existing, evolving, and new better practices, tools, and techniques to collaboratively advance specific recommendations for strengthening nutritional epidemiology.
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Affiliation(s)
- ANDREW W. BROWN
- Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
| | | | - DENNIS BIER
- Baylor College of Medicine, Houston, Texas, USA
| | | | - ADAM HOOVER
- Clemson University, Clemson, South Carolina, USA
| | - DAVID M. KLURFELD
- United States Department of Agriculture, Agricultural Research Service, Beltsville, Maryland, USA
| | - ERIC LOKEN
- University of Connecticut, Storrs, Connecticut, USA
| | - EVAN MAYO-WILSON
- Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
| | - NIR MENACHEMI
- Indiana University Fairbanks School of Public Health at IUPUI, Indianapolis, Indiana, USA
| | - GREG PAVELA
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - PATRICK D. QUINN
- Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
| | - DALE SCHOELLER
- University of Wisconsin-Madison Biotechnology Center, Madison, Wisconsin, USA
| | - CARMEN TEKWE
- Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
| | - DANNY VALDEZ
- Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
| | - COLBY J. VORLAND
- Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
| | - LEAH D. WHIGHAM
- University of Texas Health Science Center School of Public Health, El Paso, Texas, USA
| | - DAVID B. ALLISON
- Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
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6
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Yi SS, Lee M, Russo R, Li Y, Trinh-Shevrin C, Kwon SC. Dietary Policies and Programs: Moving Beyond Efficacy and Into "Real-World" Settings. Health Equity 2021; 5:194-202. [PMID: 33937605 PMCID: PMC8080927 DOI: 10.1089/heq.2020.0050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 12/19/2022] Open
Abstract
Purpose: Dietary behaviors are key modifiable risk factors in averting cardiovascular disease (CVD), the leading cause of morbidity, mortality, and disability in the United States. Before investing in adoption and implementation, community-based organizations, public health practitioners, and policymakers—often working with limited resources—need to compare the population health impacts of different food policies and programs to determine priorities, build capacity, and maximize resources. Numerous reports, reviews, and policy briefs have synthesized across evidence-based policies and programs to make recommendations, but few have made a deep acknowledgment that dietary policies and programs are not implemented in a vacuum, and that “real-world” settings are complex, multifaceted and dynamic. Methods: A narrative review was conducted of currently recommended evidence-based approaches to improving dietary behaviors, to describe and characterize applied and practical factors for consideration when adopting and implementing these dietary policies and programs across diverse settings. Results: From the narrative review, six key considerations emerged to guide community-based organizations, public health practitioners, and policymakers on moving from the evidence base, toward implementation in local and community settings. Conclusions: Considerations of “real-world” contextual factors are necessary and important when adopting and selecting evidence-based policies and programs to improve dietary behaviors and ultimately improve CVD outcomes. Promising approaches include those that apply community-partnered research and systems science to examine the equitable implementation of evidence-based dietary policies and programs.
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Affiliation(s)
- Stella S Yi
- Department of Population Health, NYU School of Medicine, New York, New York, USA
| | - Matthew Lee
- Department of Population Health, NYU School of Medicine, New York, New York, USA.,Department of Sociomedical Sciences, Columbia Mailman School of Public Health, New York, New York, USA
| | - Rienna Russo
- Department of Population Health, NYU School of Medicine, New York, New York, USA
| | - Yan Li
- Department of Population Health Science and Policy, Mt. Sinai Icahn School of Medicine, New York, New York, USA
| | - Chau Trinh-Shevrin
- Department of Population Health, NYU School of Medicine, New York, New York, USA
| | - Simona C Kwon
- Department of Population Health, NYU School of Medicine, New York, New York, USA
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7
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Halpern B, Louzada MLDC, Aschner P, Gerchman F, Brajkovich I, Faria-Neto JR, Polanco FE, Montero J, Juliá SMM, Lotufo PA, Franco OH. Obesity and COVID-19 in Latin America: A tragedy of two pandemics-Official document of the Latin American Federation of Obesity Societies. Obes Rev 2021; 22:e13165. [PMID: 33230898 PMCID: PMC7753730 DOI: 10.1111/obr.13165] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/12/2020] [Indexed: 12/25/2022]
Abstract
In May 2020, Latin America became the epicenter of the COVID-19 pandemic, a region already afflicted by social disparities, poor healthcare access, inadequate nutrition and a large prevalence of noncommunicable chronic diseases. Obesity and its comorbidities are increasingly prevalent in Latin America, with a more rapid growth in individuals with lower income, and currently a disease associated with COVID-19 severity, complications and death. In this document, the Latin American Association of Obesity Societies and collaborators present a review of the burden of two pandemics in Latin America, discuss possible mechanisms that explain their relationship with each other and provide public health and individual recommendations, as well as questions for future studies.
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Affiliation(s)
- Bruno Halpern
- Executive Committee, Latin American Federation of Obesity Societies (FLASO), Executive Committee, Santo Domingo, Dominican Republic.,Obesity Group, Department of Endocrinology, University of São Paulo, São Paulo, Brazil.,Weight Control Center, Hospital 9 de Julho, São Paulo, Brazil
| | - Maria Laura da Costa Louzada
- School of Public Health, University of São Paulo, São Paulo, Brazil.,Center of Epidemiology Research on Nutrition and Health, University of São Paulo, São Paulo, Brazil
| | - Pablo Aschner
- Javeriana University School of Medicine, San Ignacio University Hospital, Bogotá, Colombia
| | - Fernando Gerchman
- Internal Medicine Department, Post-graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul. Endocrine and Metabolism Division, Hospital de Clínicas, Porto Alegre, Brazil
| | - Imperia Brajkovich
- Department of Internal Medicine B-School of Medicine "Luis Razetti", University Hospital of Caracas-Universidad Central de Venezuela, Caracas, Venezuela
| | - José Rocha Faria-Neto
- Center for Clinical and Epidemiological Research (EpiCenter), School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Felix Escaño Polanco
- Executive Committee, Latin American Federation of Obesity Societies (FLASO), Executive Committee, Santo Domingo, Dominican Republic
| | - Julio Montero
- Executive Committee, Latin American Federation of Obesity Societies (FLASO), Executive Committee, Santo Domingo, Dominican Republic.,Executive Committee, Argentinian Society of Obesity and Alimentary Disorders, Buenos Aires, Argentina
| | - Silvia María Marín Juliá
- Executive Committee, Latin American Federation of Obesity Societies (FLASO), Executive Committee, Santo Domingo, Dominican Republic.,Obesity Group, Universidad de Ciencias Médicas de La Habana, Havana, Cuba
| | - Paulo Andrade Lotufo
- Department of Internal Medicine, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Oscar H Franco
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Holden SS, Zlatevska N, Parkinson J, Cadario R, Dubelaar C, Lei J, Moore E, Sayarh N, Van Kerckhove A, Werle C. Unpalatable food for thought: Let marketing research guide effective public obesity interventions. Obes Rev 2021; 22:e13141. [PMID: 32902093 DOI: 10.1111/obr.13141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/16/2020] [Accepted: 08/17/2020] [Indexed: 11/28/2022]
Abstract
The prevalence of obesity is growing unabatedly despite the considerable efforts directed at the problem. Although abundant research has contributed to our understanding of the multifactorial causes of obesity, there is less attention to research that is relevant for guiding social marketers, public health professionals and policymakers in delivering public health interventions for countering and/or preventing the problem of obesity. This review offers six points for identifying and developing research relevant for guiding community-wide obesity interventions based on the idea that an applied marketing research perspective offers a better model for identifying effective interventions than more theoretical academic research. Specifically, the research guiding public health and social marketing interventions needs to (1) provide information on ultimate outcomes (weight, health and unintended consequences) more than intermediate outcomes (beliefs, attitudes and behaviour), (2) report on observations collected over the longer term, (3) use natural settings (even at a cost of internal validity), (4) endeavour to overcome observer-effects, (5) report effect sizes (rather than statistical significance) and (6) use moderator analyses to capture variation in how a population responds to interventions.
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Affiliation(s)
- Stephen S Holden
- Macquarie School of Business, Macquarie University, Sydney, New South Wales, Australia
| | - Natalina Zlatevska
- Faculty of Business, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Joy Parkinson
- Griffith Business School, Griffith University, Brisbane, Queensland, Australia
| | - Romain Cadario
- Rotterdam School of Management, Erasmus University, Rotterdam, The Netherlands
| | - Chris Dubelaar
- Department of Marketing, Deakin University, Melbourne, Victoria, Australia
| | - Jing Lei
- Department of Management & Marketing, University of Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth Moore
- Mendoza College of Business, University of Notre Dame, South Bend, Indiana, USA
| | - Nada Sayarh
- Geneva School of Economics & Management, University of Geneva, Geneva, Switzerland
| | | | - Carolina Werle
- Grenoble Ecole de Management, Grenoble, France & IREGE, Université Savoie Mont Blanc, Chambery, France
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9
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Foti K, Foraker RE, Martyn-Nemeth P, Anderson CAM, Cook NR, Lichtenstein AH, de Ferranti SD, Young DR, Hivert MF, Ross R, Deedwania P, Whitsel LP, Appel LJ. Evidence-Based Policy Making for Public Health Interventions in Cardiovascular Diseases: Formally Assessing the Feasibility of Clinical Trials. Circ Cardiovasc Qual Outcomes 2020; 13:e006378. [PMID: 32981337 PMCID: PMC7674216 DOI: 10.1161/circoutcomes.119.006378] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Implementation of prevention policies has often been impeded or delayed due to the lack of randomized controlled trials (RCTs) with hard clinical outcomes (eg, incident disease, mortality). Despite the prominent role of RCTs in health care, it may not always be feasible to conduct RCTs of public health interventions with hard outcomes due to logistical and ethical considerations. RCTs may also lack external validity and have limited generalizability. Currently, there is insufficient guidance for policymakers charged with establishing evidence-based policy to determine whether an RCT with hard outcomes is needed before policy recommendations. In this context, the purpose of this article is to assess, in a case study, the feasibility of conducting an RCT of the oft-cited issue of sodium reduction on cardiovascular outcomes and then propose a framework for decision-making, which includes an assessment of the feasibility of conducting an RCT with hard clinical outcomes when such trials are unavailable. We designed and assessed the feasibility of potential individual- and cluster-randomized trials of sodium reduction on cardiovascular outcomes. Based on our assumptions, a trial using any of the designs considered would require tens of thousands of participants and cost hundreds of millions of dollars, which is prohibitively expensive. Our estimates may be conservative given several key challenges, such as the unknown costs of sustaining a long-term difference in sodium intake, the effect of differential cotreatment with antihypertensive medications, and long lag time to clinical outcomes. Thus, it would be extraordinarily difficult to conduct such a trial, and despite the high costs, would still be at substantial risk for a spuriously null result. A robust framework, such as the one we developed, should be used to guide policymakers when establishing evidence-based public health interventions in the absence of trials with hard clinical outcomes.
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Affiliation(s)
- Kathryn Foti
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Randi E. Foraker
- Department of Internal Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO
| | | | - Cheryl A. M. Anderson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Family Medicine and Public Health, UC San Diego School of Medicine, La Jolla, CA
| | - Nancy R. Cook
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Alice H. Lichtenstein
- Cardiovascular Nutrition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA
| | - Sarah D. de Ferranti
- Department of Cardiology, Boston Children’s Hospital, Boston MA
- Harvard Medical School, Boston, MA
| | - Deborah Rohm Young
- Director, Division of Behavioral Research; Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena CA
| | - Marie-France Hivert
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA
- Diabetes Unit, Massachusetts General Hospital, Boston, MA
| | - Robert Ross
- School of Kinesiology and Health Studies, Queen’s University, Kingston, Ontario, Canada
| | - Prakash Deedwania
- School of Medicine, University of California at San Francisco, Fresno CA1
| | - Laurie P. Whitsel
- Department of Policy Research and Translation, American Heart Association, Washington, DC
| | - Lawrence J. Appel
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD
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10
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Abstract
OBJECTIVES To develop a model to predict future socioeconomic inequalities in body mass index (BMI) and obesity. DESIGN Microsimulation modelling using BMI data from adult participants of Australian Health Surveys, and published data on the relative risk of mortality in relation to BMI and socioeconomic position (SEP), based on education. SETTING Australia. PARTICIPANTS 74 329 adults, aged 20 and over from Australian Health Surveys, 1995-2015. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcomes were BMI trajectories and obesity prevalence by SEP for four birth cohorts, born 10 years apart, centred on 1940, 1950, 1960 and 1970. RESULTS Simulations projected persistent or widening socioeconomic inequality in BMI and obesity over the adult life course, for all birth cohorts. Recent birth cohorts were predicted to have greater socioeconomic inequality by middle age, compared with earlier cohorts. For example, among men, there was no inequality in obesity prevalence at age 60 for the 1940 birth cohort (low SEP 25% (95% CI 17% to 34%); high SEP 26% (95% CI 19% to 34%)), yet for the 1970 birth cohort, obesity prevalence was projected to be 51% (95% CI 43% to 58%) and 41% (95% CI 36% to 46%) for the low and high SEP groups, respectively. Notably, for more recent birth cohorts, the model predicted the greatest socioeconomic inequality in severe obesity (BMI >35 kg/m2) at age 60. CONCLUSIONS Lower SEP groups and more recent birth cohorts are at higher risk of obesity and severe obesity, and its consequences in middle age. Prevention efforts should focus on these vulnerable population groups in order to avoid future disparities in health outcomes. The model provides a framework for further research to investigate which interventions will be most effective in narrowing the gap in socioeconomic disparities in obesity in adulthood.
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Affiliation(s)
- Alison Hayes
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Eng Joo Tan
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Anagha Killedar
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Thomas Lung
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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11
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Simulation modeling to assist with childhood obesity control: perceptions of Baltimore City policymakers. J Public Health Policy 2019; 39:173-188. [PMID: 29728599 DOI: 10.1057/s41271-018-0125-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Computational simulation models have potential to inform childhood obesity prevention efforts. To guide their future use in obesity prevention policies and programs, we assessed Baltimore City policymakers' perceptions of computational simulation models. Our research team conducted 15 in-depth interviews with stakeholders (policymakers in government and non-profit sectors), then transcribed and coded them for analysis. We learned that informants had limited understanding of computational simulation modeling. Although they did not understand how the model was developed, they perceived the tool to be useful when applying for grants, adding to the evidence base for decision-making, piloting programs and policies, and visualizing data. Their concerns included quality and relevance of data used to support the model. Key recommendations for model design included a visual display with explanations to facilitate understanding and a formal method for gathering feedback during model development.
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12
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Abstract
PURPOSE OF REVIEW An increasing trend in obesity prevalence since the early 1980s has posed a significant population health burden across the globe. We conducted a systematic review for studies using measured anthropometry to examine trends in obesity in the USA published from 2012 to 2018 and for systematic reviews to document trends in obesity across the globe published from 2014 to 2018. RECENT FINDINGS For the USA, the only nationally representative data source capturing trends in obesity in this period was the National Health and Nutrition Examination Survey, which uses repeated cross-sectional data to document national trends in obesity in the USA. For global trends, the only systematic reviews of obesity across the globe were the Global Burden of Disease Obesity study and the Non-communicable Disease Risk Factor Collaboration study. In general, the population distribution of body mass index (BMI) in the USA has shifted towards the upper end of its distribution over the past three decades. The global distribution has similarly increased, albeit with large regional differences. US and global studies suggest an increasing trend in obesity since the 1980s, and there is a dearth of nationally representative longitudinal studies using measured anthropometry to capture trends in adult obesity in the USA for the same individuals over time. Greater efforts are needed to identify factors contributing to the continued increases in obesity.
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Affiliation(s)
- Yosuke Inoue
- Carolina Population Center, The University of North Carolina at Chapel Hill, 123 W Franklin St, Chapel Hill, NC, 27516, USA
| | - Bo Qin
- Department of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903, USA
| | - Jennifer Poti
- Department of Nutrition, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Rebeccah Sokol
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Penny Gordon-Larsen
- Carolina Population Center, The University of North Carolina at Chapel Hill, 123 W Franklin St, Chapel Hill, NC, 27516, USA.
- Department of Nutrition, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
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