Pediatric obesity increases the risk of later-life obesity and chronic diseases. Basic research to better understand factors associated with excessive weight gain in early life and studies translating research findings into preventive and therapeutic strategies are essential to our ability to better prevent and treat childhood obesity. This overview describes several National Institutes of Health efforts designed to stimulate basic and translational research in childhood obesity prevention and treatment. These examples demonstrate the value of research in early phase translational pediatric obesity research and highlight some promising directions for this important area of research.
Key points
- •
Pediatric obesity is a common and important risk factor for future obesity and for chronic diseases.
- •
Basic behavioral research and early phase trials that translate knowledge into interventions to prevent or reduce obesity are important.
- •
The National Institutes of Health (NIH) supports basic and early phase translational behavioral research related to pediatric obesity through a variety of mechanisms.
- •
Findings from NIH-supported research in basic and early phase translational behavioral science are producing new discoveries that can be used to develop novel targets for pediatric obesity interventions.
- •
NIH support is critical to ensure progress in developing, testing, and ultimately implementing new and more effective interventions to reduce pediatric obesity.
Introduction
Excessive, early weight gain has been found to increase risk for obesity later in life, and is a risk factor for many diseases, such as cancer, cardiovascular disease, and diabetes. Pediatric obesity has been increasing steadily over the past 3 decades and, despite evidence that this increase may be slowing or stabilizing, especially in very young children, obesity in childhood remains a significant behavioral risk factor and an important target of National Institutes of Health (NIH) funding efforts. In addition, wide disparities in obesity rates remain among population subgroups, with minority and low-income children and adolescents showing the highest rates of obesity. Thus, an important focus of pediatric obesity research is identifying and implementing more effective interventions to reduce obesity in vulnerable and underserved groups, such as minority and low-income children and families.
NIH support for childhood obesity research spans the translational spectrum, from basic research on the psychological, behavioral, biological and social processes that characterize early childhood development and present potential targets for obesity-related treatments, to studies that translate knowledge about these processes into obesity-related interventions for children, to efficacy and effectiveness trials, and finally, to dissemination and implementation of treatments in clinical and community settings. NIH research in these areas has undoubtedly contributed, along with efforts at local, state, and national levels, to recent progress in achieving lower obesity levels in young children.
This overview focuses on selected examples of NIH-funded early phase translational studies that use basic behavioral science findings to inform obesity interventions for children at all stages of development, from infancy through adolescence. It is not intended to be comprehensive, because an in-depth review of work in this area is beyond the scope of this article. Instead, by highlighting several promising lines of NIH-supported pediatric obesity research in the basic-to-clinical arena, this article seeks to illustrate how such research can contribute to efforts to reduce childhood obesity and ultimately, the chronic diseases resulting from it.
Introduction
Excessive, early weight gain has been found to increase risk for obesity later in life, and is a risk factor for many diseases, such as cancer, cardiovascular disease, and diabetes. Pediatric obesity has been increasing steadily over the past 3 decades and, despite evidence that this increase may be slowing or stabilizing, especially in very young children, obesity in childhood remains a significant behavioral risk factor and an important target of National Institutes of Health (NIH) funding efforts. In addition, wide disparities in obesity rates remain among population subgroups, with minority and low-income children and adolescents showing the highest rates of obesity. Thus, an important focus of pediatric obesity research is identifying and implementing more effective interventions to reduce obesity in vulnerable and underserved groups, such as minority and low-income children and families.
NIH support for childhood obesity research spans the translational spectrum, from basic research on the psychological, behavioral, biological and social processes that characterize early childhood development and present potential targets for obesity-related treatments, to studies that translate knowledge about these processes into obesity-related interventions for children, to efficacy and effectiveness trials, and finally, to dissemination and implementation of treatments in clinical and community settings. NIH research in these areas has undoubtedly contributed, along with efforts at local, state, and national levels, to recent progress in achieving lower obesity levels in young children.
This overview focuses on selected examples of NIH-funded early phase translational studies that use basic behavioral science findings to inform obesity interventions for children at all stages of development, from infancy through adolescence. It is not intended to be comprehensive, because an in-depth review of work in this area is beyond the scope of this article. Instead, by highlighting several promising lines of NIH-supported pediatric obesity research in the basic-to-clinical arena, this article seeks to illustrate how such research can contribute to efforts to reduce childhood obesity and ultimately, the chronic diseases resulting from it.
Support from the National Institutes of Health for basic and early phase translational behavioral research in pediatric obesity
Understanding the basic biological, behavioral, social, and psychological processes that underlie childhood obesity is key to identification of new treatment targets and the development of more effective interventions to tackle this behaviorally based risk factor (see for an excellent overview of basic science findings in pediatric obesity research). Much of the NIH-supported basic behavioral research examining the influence of factors such as cognitive and affective processes, stress and stress reactivity, social relationships and dynamics, and the built environment on obesity-related health behaviors has involved the funding of investigator-initiated grants and Institute-specific research initiatives (see for information and resources related to NIH’s obesity research portfolio, strategic plan, and funding opportunities). Recently, however, several large NIH-initiated efforts have been developed that support work in these areas.
National Institutes of Health Basic Behavioral and Social Science Opportunity Network
In recognition of the importance of basic behavioral research to health, the NIH initiated the Basic Behavioral and Social Science Opportunity Network (OppNet) in November 2009 to support research on the underlying basic mechanisms and processes that influence health-related behaviors (available: ).
OppNet has supported several lines of research on the psychological, social, cognitive, and neural mechanisms underlying obesity-related behaviors in children. These endeavors include investigation of the effects of regular exercise on neural circuitry and brain structure, which demonstrated improvements in frontotemporal white matter integrity and alterations in neural circuitry supporting cognitive control in overweight, sedentary children. OppNet-supported research to identify environmental moderators of pediatric weight loss maintenance found that reduced consumption of food eaten away from home was associated with a lower body mass index (BMI) and body fat in children and identified changes in diet quality as a potential mechanism for this effect. Finally, an OppNet-funded project focusing on links between stress, eating behavior, and obesity in low-income children has sought to identify the biologic and behavioral pathways through which stress may affect obesity in children, for example, by potentially increasing sensitivity to food as a reward or reducing ability to delay gratification for food (Lumeng and Miller, principal investigators, 1R01DK098983). Further details on these and other OppNet-funded projects can be found at along with relevant funding opportunity announcements related to basic behavioral science research.
Transdisciplinary Research on Energetics and Cancer
The National Cancer Institute’s Transdisciplinary Research on Energetics and Cancer (TREC) program aims to reduce cancer linked with obesity, poor diet, and low levels of physical activity by integrating diverse disciplines to find effective interventions across the lifespan (available: https://www.trecscience.org/trec/default.aspx ). TREC was established in 2005 in response to a growing body of evidence that obesity plays a role in the development of many types of cancer. In the initial phase of TREC (2005–2010), 4 TREC Research Centers and 1 Coordination Center were funded, each including scientists from multiple disciplines and encompassing projects spanning the basic biology and genetics of behavioral, sociocultural, and environmental influences on nutrition, physical activity, weight, energy balance, energetics, and cancer risk.
Several TREC projects focused on basic and epidemiologic research in children and adolescents that could be used to develop novel obesity-related interventions. For example, a project led by Susan Redline and colleagues at Case Western Reserve University aimed to define the relationship between risk factors, such as insufficient sleep and sleep apnea in children and adolescents, and changes in both weight and biochemical indices of metabolic pathways implicated in cancer to enable development of targeted interventions for high-risk children. Results from this study demonstrated that chronic insufficient sleep duration, measured longitudinally from infancy to middle childhood, is associated with a lower quality diet in children, with children who had the least favorable diets and sleep duration throughout childhood having the highest estimated BMI z -scores, suggesting that sleep duration and diet quality are important intervention targets in efforts to prevent childhood obesity.
In another TREC project, researchers at the University of Southern California TREC Research Center, led by Michael Goran and his team, explored the physiologic, metabolic, genetic, behavioral, and environmental influences on obesity and cancer risk in minority children. One study in this set of projects, which examined the role of neighborhood-level factors on progression toward overweight and obesity in children, found a significant relationship over an 8-year period between traffic density and BMI in a cohort of 3318 children living in multiple communities in Southern California. These findings implicate traffic, a pervasive feature of urban environments, as a major but potentially modifiable risk factor for the development of obesity in children, and thus provide important information to guide the development of future environmentally based pediatric obesity interventions.
Obesity-Related Behavioral Intervention Trials
Research translating basic behavioral science discoveries into new behavioral interventions for behaviorally based risk factors has not been as well-recognized or resourced as similar early phase translational research in the biomedical arena. Especially in the case of obesity, a complex risk factor based on a combination of biological, behavioral, social, psychological, and environmental influences, accelerating early phase translational research is increasingly being viewed as an important area of need.
In response to this need, in 2009 the NIH initiated the Obesity-Related Behavioral Intervention Trials Consortium (ORBIT; available: www.nihorbit.org ), a trans-NIH cooperative agreement program led by the National Heart, Lung, and Blood Institute in collaboration with the National Cancer Institute, the National Institute of Diabetes and Digestive and Kidney Diseases, the Eunice Shriver Kennedy National Institute on Child and Human Development, and the NIH Office of Behavioral and Social Sciences Research. The ORBIT consortium consists of interdisciplinary teams of researchers at 7 research sites and a Resource Coordinating Unit, who are developing and testing novel interventions that translate findings from basic research on human behavior (eg, habituation, motivation, habit formation, stress, and social networks) into more effective clinical, community, and population interventions to reduce obesity and alter obesity-related health behaviors (eg, diet, physical activity). Investigators at each site are conducting several types of studies over the 5-year funding period, including formative research, experimental and proof-of-concept studies, and feasibility pilot studies, to identify and test promising new approaches to reducing obesity and improving obesity-related behaviors.
The ORBIT program is notable for the diversity of its targeted populations; many of its studies focus on vulnerable and underserved groups, including Latino and African American adults, African American adolescents, low-income populations, pregnant women, and women beginning the menopausal transition. The interventions being developed to address obesity and obesity-related behaviors in these groups include a wide range of strategies, including promoting small changes in eating behaviors and physical activity, reducing stress-related eating, improving sleep patterns, increasing motivation to adhere to weight loss strategies, and engaging an individual’s social networks and communities to encourage physical activity.
Three of the 7 ORBIT sites are focused on children and adolescents: Reynolds and colleagues at Claremont University conducted research to create a novel intervention based on basic behavioral science findings on habit formation and neurocognition to improve nutrition behavior and reduce risk for obesity in adolescents from low-income families. Naar-King and her team at Wayne State conducted an adaptive 6 month intervention with Community Health Workers using a sequential randomized assignment trial (SMART design) that included skills training modules, motivational conversations and contingency management in African American adolescents and their primary caregivers. Finally, Epstein and colleagues at the University of Buffalo conducted a series of studies to translate habituation theory into interventions for pediatric obesity by reducing the variety of less healthy, high energy density foods to lower their intake while simultaneously increasing the variety of healthier, low energy density options to increase their intake. Findings and implications from these studies are discussed in a later section.
The Obesity-Related Behavioral Intervention Trials Model
In addition to the individual ORBIT projects, a major product of the ORBIT consortium has been the development of a framework to guide the behavioral intervention development process. The ORBIT model consists of a phased approach similar to the drug development model, but adapted for behavioral treatment development. It encompasses 2 overarching phases of intervention development, entitled “phase I” (intervention design) and “phase II” (preliminary testing) and each includes 2 distinct subphases. In phase Ia, treatment targets and components are initially defined, including the degree of change in the treatment target needed to demonstrate a clinically meaningful effect in ultimate health outcome. In phase Ib, these components are tested and refined to achieve a well-defined treatment “package.” Phase IIa involves “proof-of-concept” testing, which aims to determine if the treatment package can achieve a clinically significant degree of change in the prespecified treatment target; phase IIb involves further pilot testing using larger samples, randomized designs and a determination of feasibility.
Key features of the ORBIT model include (1) an emphasis on beginning with “with the end in mind”; that is, starting with a “significant clinical question” from providers, patients or others intimately involved in the behavioral issues and/or disease processes at hand to ensure that the intervention being developed will ultimately have “real-world” meaning and impact; (2) using basic behavioral science findings to understand the “drivers” of the behavior or disease being addressed, to identify appropriate and modifiable treatment targets, and define essential interventional components; (3) a focus on achieving not just statistically significant, but clinically meaningful, changes in behavioral treatment targets that are tied to prevention or mitigation of disease risk and outcomes; and (4) progression through a series of flexible, increasingly rigorous phases and study designs as the intervention is designed, refined, optimized and tested, culminating in efficacy and effectiveness trials, and ultimately resulting in the dissemination and implementation of an intervention that has a significant impact on clinical endpoints in a clinical and/or community setting.
Science of Behavior Change Common Fund Program
The Science of Behavior Change Program (SOBC; available: ) is an NIH Common Fund initiative that promotes basic and early phase translational research on the initiation, personalization, and maintenance of behavior change. Several projects related to pediatric obesity were funded as part of the initial phase of SOBC. An example is work by Lumeng and colleagues that examines relationships among self-regulation, salivary cortisol and alpha amylase, emotional eating behavior, and weight status in low-income toddlers to better understand the biobehavioral mechanisms of excessive childhood weight gain, potentially leading to more effective, novel, targeted prevention approaches ( provides information on this and all SOBC funded research projects).
More recently, the SOBC initiated a program of research based on an “experimental medicine approach” to the development of mechanistically based interventions for preventing and treating unhealthy behaviors linked to disease. This approach is congruent with and expands on the ORBIT model’s earliest phase (phase I) by providing a detailed set of steps for identifying and validating behaviorally based treatment targets, including (1) identifying a set of putative targets within a psychological or behavioral domain that is implicated in health behavior, (2) leveraging existing or developing new experimental or intervention approaches to engage the targets, (3) identifying or developing appropriate assays (measures) to permit verification of target engagement, and (4) testing the degree to which engaging the targets produces a desired change in health behaviors that lead to clinically significant outcomes or endpoints. One of the projects funded by this program, led by Alison Miller at the University of Michigan, involves measuring childhood self-regulation targets known to be associated with obesity risk and testing whether intervening on these mechanisms can improve self-regulation and adherence to weight management regimens in school-age low-income children (for more information, see ).
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
