March is National Nutrition Month®, a time to encourage everyone to make informed food choices and develop healthful eating habits. What you eat affects your overall health and, importantly, your weight. Research is unraveling how best to help people boost their health by improving their diet.
In the United States, obesity is the major health challenge related to nutrition. According to the US Centers for Disease Control and Prevention, more than one-third of American adults and one-sixth of children are obese, and so at higher risk for heart disease, diabetes, some cancers, and other causes of preventable death.
What are the most effective ways to guide people to achieve and maintain healthy weights? Simply advising people to consume fewer calories often isn’t enough. Any weight control method has to fit with a person’s physical condition, lifestyle, and preferences. That approach is what PCORI brings to all the research we fund, including studies on ways to improve weight management. PCORI-funded studies seek to produce evidence that’s relevant in the real world by involving patients and clinicians throughout the research—from developing the questions that studies ask to sharing the findings.
Healthy Eating, Healthy Weight
PCORI-funded studies compare strategies to encourage people to adopt good eating habits and other practices that maintain healthy weight.
- A study in Boston, which focused on disadvantaged communities where obesity is common, borrows ideas from previously overweight children who have achieved healthier weights despite cultural and environmental challenges. The researchers then used the lessons from these interviews to develop a clinical program involving health coaches and linking children and their families to community resources. They are now testing whether this new program, which includes tips for healthy eating and increased physical activity, works better than standard care for helping children attain a healthy weight. (Read more about this study in Learning from the Success Stories.)
- In another project, researchers in Los Angeles are testing the US government’s MyPlate approach to healthy eating. The study randomly assigned low-income patients to receive training in one of two approaches. The MyPlate program emphasizes consuming more fruits and vegetables while also eating less sugar, sodium, and saturated fat. The other program teaches participants to count calories. The research team predicts that after a year, all the patients will have lost weight, but those using MyPlate will report feeling less hungry and more effective.
In the Doctor’s Office
Patients receive most of their care in primary care offices, but clinicians there often lack training in nutrition and weight management. What’s more, insurance reimbursement for the treatments can be inconsistent. Several PCORI-funded studies are examining approaches, with nutrition components, delivered in primary care settings to put patients on the path toward a healthy weight.
- A Louisiana study in underserved communities compares a culturally adapted comprehensive lifestyle intervention, provided by specially trained health coaches embedded within primary care practices, with a lifestyle intervention provided by primary care physicians.
- A study in rural Kansas, Nebraska, Wisconsin, and Iowa tests a lifestyle intervention for obesity provided by primary care physicians against two evidence-based approaches. In these approaches, patients receive a comprehensive lifestyle intervention delivered by obesity treatment specialists either in a patient-centered medical home setting or in a disease-management setting, both of which provide coordinated, comprehensive care.
- A Boston study is comparing standard care and an online weight-management program, by itself or supported by staff members at primary care practices.
- A study In Denver is testing several weight-loss treatments—such as replacement meals, fitness center membership, weight-loss medication, and a group weight-loss program—provided free to a low-income population through a primary care practice.
It Takes a Network
Finding better ways to reduce the burden obesity places on patients, their families, and the healthcare system as a whole is one of the areas of focus for PCORnet, the National Patient-Centered Research Network. PCORnet brings together Clinical Data Research Networks and Patient-Powered Research Networks to leverage the power of health data and unique partnerships to allow us to conduct health research faster, more effectively, and less expensively than was previously possible. PCORI has awarded approximately $9 million to support the use of PCORnet for two large studies related to obesity that look at patient data previously collected by health systems.
One of the studies compares the health benefits and safety of the three most common types of weight-loss surgery that people with severe obesity may turn to when diet and exercise haven’t helped them lose weight. Researchers in Seattle are examining outcomes for 60,000 patients with obesity who have undergone Roux-en-Y gastric bypass, adjustable gastric banding, or sleeve gastrectomy. Previous research suggested that all of these surgeries, when followed by healthy eating and regular exercise, reduce weight and lower rates of diabetes and death. The new study will determine which procedure works best to create these positive outcomes, and whether different types of surgery do better for different types of patients. It also will look at the risks that each surgery carries, such as an increased occurrence of hernias or higher rates of death.
The other PCORnet study follows up on research suggesting that treating infants with antibiotics increases childhood obesity. Researchers in Boston are using the medical records of 600,000 children to find out how often and when they received antibiotics during their first two years of life and whether they had obesity at ages 5 and 10. The study will distinguish between broad-spectrum antibiotics and antibiotics specifically targeted to particular bacteria while looking for associations between early antibiotic use and obesity. The study will seek trends both across all participants and in subgroups, such as racial and ethnic minorities.
Through these studies and others, PCORI is helping answer questions that patients, their families, and clinicians have about the most effective ways to obtain a healthy weight. We look forward to sharing the results of these studies. If you have ideas for additional research about nutrition or obesity, please share them in the comments below.