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NHLBI Obesity Education Initiative Expert Panel on the Identification, Evaluation, and Treatment of Obesity in Adults (US). Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report. Bethesda (MD): National Heart, Lung, and Blood Institute; 1998 Sep.

Cover of Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults

Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report.

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Chapter 6Future Research

Obesity is a heterogeneous chronic disorder that has many causes, although the fundamental basis is an imbalance between energy intake and energy expenditure. Future research needs to examine the most effective ways to treat and prevent obesity, the causes of obesity and their mechanisms, the influence of fat distribution on health risk, and the development of better methods for assessing energy intake and energy expenditure.

A. Intervention Approaches

Considerable research is needed on intervention approaches to treat and prevent obesity. Increased research on behavioral theory specifically addressing obesity treatment and prevention for all individuals, including children and adolescents, needs to be conducted. Intervention methods to prevent weight gain with smoking cessation are of particularly high priority in helping achieve smoking cessation.

More research is needed on behavioral intervention methods conducted in various settings, particularly the primary care setting. Effective programs to treat or prevent obesity in culturally, ethnically, and socioeconomically diverse populations need to be developed and tested. Simple screening tools should be tested for their predictive value in achieving lifestyle modifications that lead to weight loss or weight control practices. Research is needed on identifying appropriate and successful intervention content; for example, magnitude of weight loss goals (smaller changes versus larger changes), and goals for the rate of weight loss (1 lb versus 2 lb per week; initial weight loss goal of 5 percent of body weight and, subsequently, an additional 5 percent versus a single initial goal of 10 percent at the outset). Of particular importance is research on the optimal amount of physical activity to promote weight loss, the maintenance of weight loss, and the prevention of obesity. Also important are strategies which preserve muscle and bone in the face of weight loss. More research is needed on identifying the characteristics of individuals who have successfully maintained their weight loss over the long term.

Research on surgical interventions for weight loss should include evaluating surgical risk, including not only complications, morbidity, and mortality, but also long-term postoperative surveillance to monitor vitamin and mineral nutritional adequacy. Evaluation of the health benefits of weight loss from surgery should include changes in fat distribution; cardiorespiratory fitness; obesity-related comorbidities, including blood pressure, blood lipids, and glucose tolerance; and degree of success in long-term weight loss maintenance. Finally, research is needed on techniques for integrating behavioral methods to promote long-term maintenance of weight loss after surgical treatment. Likewise, research on pharmacologic interventions for weight loss should include evaluating changes in fat distribution, cardiorespiratory fitness, obesity-related comorbidities, and the degree of success of long-term weight loss maintenance. Better methods for integrating behavioral methods, along with pharmacologic treatment, should also be investigated.

Finally, research is needed on environmental and population-based intervention methods, including community- and school-based interventions, to augment public health approaches toward promoting weight maintenance and preventing obesity in the general population.

B. Causes and Mechanisms of Overweight and Obesity

The regulation of energy balance needs to be explored, including the neuroendocrine factors that control energy intake, energy expenditure, and the differentiation of adipose tissue resulting from excess calories. The genes that are important in human obesity need to be identified. These include those that alter eating and physical activity behaviors, those that affect thermogenesis, and those associated with the comorbidities of obesity. The roles of environmental and behavioral influences on metabolic factors important in obesity, as well as gene-environment interactions, need to be studied. Predictive factors should be examined to identify who is most at risk of developing obesity, and whether there are critical periods of life when these factors are most operative. In addition, the influence of the intrauterine environment on the development of obesity needs to be investigated, particularly to determine whether early deprivation leads to a later propensity for overweight and associated comorbidities, such as insulin resistance, or if high maternal weight gain and high birth weight are related to the risk of obesity and its comorbidities.

C. Abdominal Fat, Body Weight and Disease Risk

The influence of abdominal fat independent of total body fat on health risk needs to be further defined. More information is needed on the relationship between differential body fat compartments and increased risk, the distribution of body fat compartments among various racial group populations, and the relationship between abdominal fat and disease risk in racial groups. Weight loss studies should include measurements of abdominal fat, as well as cardiorespiratory fitness, to better assess health improvement. Intentional weight loss treatments need to be examined in terms of their acute and chronic effect on the development and progression of diabetes, heart disease, and overall mortality. Large prospective studies are needed to examine the relationship of body mass index and body fat distribution to overall mortality.

D. Assessment Methods

Much of the current research is hampered by the lack of good methods to accurately, objectively, and economically assess energy intake and expenditure, including physical activity, body composition and fat distribution, and behavioral and psychological variables. More research is therefore needed to focus on measures to assess intake of fat and other dietary components, levels of physical activity, energy metabolism, and body fat and visceral obesity. In addition, better methods for assessment of psychological, behavioral, and psychosocial variables that may be related to behavioral risk factors for obesity (such as poor diet and inactive lifestyle) are needed, and particularly so for special population segments based on race, ethnicity, and socioeconomic status. Methods for assessing culture, social integration, and psychological stress should also be developed.

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