The leading causes of morbidity and mortality in the U.S. include chronic disease such as the following:
As researchers, we know that in order to prevent and manage chronic diseases, we must also understand and address contextual elements such as health care access and affordability, neighborhood environment and exposure to stressors and discrimination, all of which influence behavioral risk factors associated with chronic diseases, including:
- Poor diet quality
- Physical inactivity
- Tobacco use
- Alcohol use
Thus, we approach our work to combat chronic disease through the lens of these social determinants of health, conducting research to improve risk factors across individual, family, community, health care and population levels. Our efforts also aim to improve treatment adherence and patient-provider communication, reduce disease symptoms and enhance quality of life.
Research within this realm is multidisciplinary in nature, and we are proud to collaborate with key stakeholders outside our department. Our research methods range from efficacy trials to dissemination and implementation efforts.
Co-Investigator: Jessica LaRose, Ph.D.
Funding Source: National Institutes of Health, National Institute of Child Health and Human Development
Project Summary: There is an urgent need for innovative approaches to adolescent obesity treatment, particularly among African Americans (AA), a population at increased risk of obesity and its associated morbidity and mortality. There is a particular dearth of research on the long-term efficacy of adolescent obesity treatments. Further, research and clinical practice guidelines consistently recommend that parents should be included in their adolescents' obesity treatment, yet the most effective strategy to engage parents in adolescent obesity treatment remains unclear.
Towards that end, this investigation (informed by R21HD084930) will conduct a fully powered, randomized controlled trial to examine the efficacy of two distinct approaches to involving parents in their adolescents' obesity treatment. Participants will be 210 12-16-year-old adolescents (BMI>85th percentile) and parents (BMI>25 kg/m2) with overweight or obesity. Families will be randomized to one of two 4-month treatments: 1) TEENS+Parents as Coaches (PAC), engaging parents as helpers in their child's weight management via parent skills training, or 2) TEENS+Parent Weight Loss (PWL), engaging parents in their own behavioral weight management.
All adolescents will participate in the TEENS+ protocol, which includes nutrition education with dietary goals, supervised physical activity, and behavioral support, and integrates motivational interviewing to enhance treatment engagement. Assessments of anthropometrics, dietary intake, physical activity, parenting and home environment variables will be completed at 0, 2, 4, 8, and 12 months with the primary endpoint at 12m follow-up. Results of this investigation have the potential to significantly advance science in this area and ultimately inform clinical practice guidelines related to the role of parents in adolescent obesity treatment.
Principal Investigator: Jessica LaRose, Ph.D.
Funding Source: Massey Cancer Center Pilot Funds
Project Summary: Obesity and chronic inflammation influence the development and progression of many types of cancer. These conditions share several of the same causes, including physical inactivity, poor nutrition, stress and insufficient sleep. Emerging adulthood (ages 18-25) represents an important developmental period in which to address behaviors and psychological variables that affect both weight status and inflammation. At least 40% of emerging adults have overweight/obesity, and this transition from adolescence to early adulthood is associated with significant increases in fast food consumption, decreases in physical activity, unpredictable sleep schedules and alarmingly high rates of depression and perceived stress.
Despite this high risk for obesity, very few weight loss interventions are designed specifically for emerging adults. Preliminary findings from weight loss interventions targeting this population have shown some promise, but generally produce modest outcomes with less consistent effects than programs in older adults. Depression and stress have been found to interfere with weight loss among emerging adults and may be in part responsible for poorer outcomes. This proposal will develop and test an integrated lifestyle intervention (ILI) that comprehensively addresses both psychological distress and traditional weight management targets. This novel approach has not been tested before and has the potential not only to enhance weight loss outcomes in this high-risk population, but also to produce reductions in markers of inflammation beyond those achievable by weight loss alone.
Co-Investigator: Bernard Fuemmeler, Ph.D.
Funding Source: National Institutes of Health, Grant No. U24DA041147
Project Summary: The adolescent brain cognitive development (ABCD) study is the largest long-term study of brain development and child health in the United States. The National Institutes of Health (NIH) funded leading researchers in the fields of adolescent development and neuroscience to conduct this ambitious project. The ABCD Research Consortium consists of a coordinating center, a data analysis and informatics center and 21 research sites across the country, which will invite approximately 10,000 children ages 9-10 to join the study.
Researchers will track their biological and behavioral development through adolescence into young adulthood. VCU is one of 21 institutions nationwide enrolling families who wish to participate in the ABCD study and is one of only four unique sites inviting twin families to take part as well. While every family who participates in the ABCD study are extremely important to this invaluable research, twin pairs provide additional insight to help unravel how certain environmental and genetic factors impact brain and cognitive development. The Mid-Atlantic Twin Registry (MATR) of VCU is the initial point of contact for twin families who wish to be a part of this exciting project. All the families who enroll in the ABCD study will complete their study visit at the Collaborative Advanced Research Imaging (CARI) facility.
Principal Investigator: Bernard Fuemmeler, Ph.D.
Funding Source: National Institutes of Health, Duke University
Project Summary: This project seeks to evaluate a model of childhood obesity that begins with maternal pre-pregnancy obesity as a distal risk factor contributing to the development of appetite dysregulation and poor executive functioning, increasing a child's risk for excess weight gain.
The study will take advantage of a perinatal birth cohort with over 2,000 births that has obtained prospectively collected data from the first trimester through infancy, inclusive of pre-pregnancy weight at the first prenatal visit, gestational weight gain, surveys regarding nutrition, stress and lifestyle behaviors, data from medical records on pregnancy and birth complications, maternal blood at the first trimester, and umbilical cord blood at delivery. The proposed study will recruit mother/child dyads from this cohort and conduct detailed assessments of IQ, executive functions (attention, inhibitory control, memory, affective-based decision making), appetite regulation using the eating in the absence of hunger laboratory paradigm, dietary intake and anthropometric growth among 400 children at ages 4 years and two years later at 6 years.
Maternal blood specimens collected during the first trimester and cord blood at birth will be used to assay Interleuken-6 (IL-6) and monocyte chemoattractant protein 1 (MCP-1), two cytokines important in both metabolism and normal brain development. The primary hypothesis is that maternal obesity influences neurodevelopmental processes that regulate appetite and executive functions resulting in increased risk for obesity in offspring. A secondary/exploratory hypothesis is that markers of prenatal neuro-inflammatory processes mediate the effect of maternal obesity on adverse child outcomes.
Conducting this study in the context of an established perinatal birth cohort provides a cost-effective opportunity to achieve our aims. The study will aid in disentangling the associations between maternal pre-pregnancy obesity, childhood appetite regulation, executive functions and child weight gain. By understanding how developmental factors shape individual differences that predict child obesity, it is possible to markedly improve prevention interventions by targeting key risk factors for childhood obesity at earlier developmental periods and create tailored prevention programs that shift children's weight trajectory toward more healthy outcomes.
Principal Investigator: Jessica LaRose, Ph.D.
Funding Source: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases
Project Summary: Obesity is a public health crisis among adults from economically disadvantaged backgrounds, with more 85% experiencing overweight or obesity and associated health ailments. To date, lifestyle interventions targeting this high-risk group have produced modest weight losses. Thus, effective interventions for this vulnerable population are urgently needed.
New evidence from behavioral economics suggests that targeting lack of reinforcement and bias for the present may improve treatment outcomes in adults from disadvantaged backgrounds. Specifically, impoverished environments have been shown to have few sources of healthy reinforcement, which makes responding to basic sources of reinforcement (e.g., palatable food) more resistant to change. Moreover, all humans have been shown to have bias for the present, or a preference for immediate rewards (palatable food) over future rewards (improved health), and studies suggest that individuals from disadvantaged backgrounds have even greater bias for the present (perhaps due to life demands, stress, and cognitive load). Addressing these two processes (lack of reinforcement and bias for the present) in obesity treatment may uniquely meet the needs of this high-risk, underserved population and result in weight loss success.
The proposed study will test the efficacy of a mHealth behavioral economics weight loss intervention that addresses lack of reinforcement and bias for the present. Lack of reinforcement will be addressed with small monetary reinforcers delivered at the beginning of treatment. Reinforcers will taper during the initial treatment period and eventually end. As reinforcers taper, participants will be trained in episodic future thinking (EFT), which has been shown to reduce bias for the present and may improve longer-term weight loss outcomes. This two-pronged, phased approach that first addresses lack of reinforcement and then bias for the present is essential. Providing reinforcement immediately at treatment start is necessary to engage participants straightaway. Then, as participants are developing success experiences with weight loss, which naturally provides its own reinforcement (improved mood, health, appearance), reinforcers will taper. During this time, EFT training will begin.
This novel behavioral economics mHealth intervention will be compared to a mHealth only intervention. The two interventions will be delivered primarily via a mobile platform, include treatment material tailored to this population, and be matched for contact. Thus, the only way the two interventions will differ is in the inclusion of behavioral economics strategies in BE mHealth. Our primary hypothesis is that the behavioral economics intervention will yield significantly better weight losses at month 12 (treatment end). Mediators (food reinforcement, bias for the present), moderators (stress, resilience, obesogenic environment), and cost-effectiveness will also be explored. If effective, this mHealth behavioral economics intervention would be a new and transformative intervention approach that significantly improves obesity treatment outcomes in a high-risk, underserved population.