Table 1:

Promising research directions for obesity and type 2 diabetes

Study Designs	• Novel designs/methods for evaluating multi-level interventions including mixed methods research • Study designs other than the traditional RCTs to allow for flexible recruitment approaches and account for dynamic, pragmatic issues • Natural experiments to assess the impacts of population-level health programs and policies • Life course approaches to understand the interactions of various determinants of health and influences on disease onset and progression across the lifespan • Study designs to understand where or how human behavior may overcome the influence of environmental barriers (i.e., resilience factors) on health • Cohort studies (existing and new) and new analytic methods to better understand mechanisms driving obesity and type 2 diabetes (T2D) disparities • Engagement of diverse stakeholders (patients, medical staff, community, healthcare systems) in the full spectrum of science to promote appropriate research questions, approaches, interpretation and dissemination of findings • Prospective studies and simulation modeling techniques to increase understanding of comprehensive environmental change to reduce community-level risk of obesity and T2D • Approaches to systematically address the pervasive nature of culture in the experience of illness, in context, and demonstrating the value added by cultural and contextual adaptations from theoretical and programmatic perspectives
Metrics and Methods	• Core metrics of health equity and aspects of built environments and culture that may be key drivers of outcomes in obesity and T2D • Criteria for establishing novel partnership models in research and assessing commitment to sustainability of successful interventions beyond grant funding • Standard methods to examine the effects of socioecological stress on stress reactivity in various contexts (laboratory experimental, naturalistic settings) • Measures for business case analyses (e.g., alignment of financial incentives and supports for ongoing organizational investments)
Behavioral, Metabolic, and Environmental Phenotyping	• Deep environmental and behavioral phenotypes (environment and social factors, epigenetics, metabolic correlates) to characterize high-risk populations and develop effective interventions • Multi-level population datasets and systems to characterize elements of society (housing, education, food resources, activity space, stress levels, etc.) that affect health equity • Characterization of specific elements of ‘neighborhood deprivation’ that influence diabetes prevention, treatment, and control • Characterization of the unique pathophysiology of T2D among Asian Americans to facilitate the design of adequately powered studies to evaluate weight control approaches designed to address this pathophysiology • Phenotypes of specific characteristics within the historically highest risk sub-groups and the socioecological contexts related to poorer outcomes (e.g., Which African American men with T2D are at increased risk for amputations?)
Considerations for Stress and Resilience Research	• Strategies for preventing the over- and under-treatment of serious mental health conditions that address realities and perceptions about drug sensitivities, physician bias, and cultural preferences • Interactive roles of medications on stress-related disorders (e.g., depression) and diabetes • Culturally relevant sources of resilience and coping, and non-traditional interventions (e.g., mind-body interventions) to improve obesity and T2D outcomes in populations at high risk of various exposures to stress • Evaluation of intervention models to address DNA methylation to reduce risk for obesity and diabetes • Genetic-based research with sufficient racial/ethnic minority representation to study diverse characteristics (e.g., histories) and diverse settings to understand gene expression, stress, and chronic conditions
Innovative Partnership Models	• Biomedical research that is expanded to include the multi-sectoral and multidisciplinary nature (e.g., economists, architects, urban/regional planners) of built environment and health research • Novel partnerships to pursue research questions and designs relevant for diverse groups and health equity • Strategies for testing and supporting sustainable partnerships and collaboration practices
Intervention Approach and Delivery	• Multi-sectoral (e.g., academic institutions, government, community organization, public health entities) partnerships and designs to test the effectiveness of intervening on or compensating for the influence of systemic barriers (SDoH) on health • Linkages of neighborhood-level characteristics, health systems, and outcomes data • Cohort studies with design and planning of frequent, rapid interventions (e.g., cohorts as platform for interventions) to allow for adaptive trials • Different combinations of intervention delivery in various contexts to include use of CHWs and peer support, healthcare and social service team members, e-Health, and community support and mobilization • Remotely delivered interventions with sufficient racial/ethnic minority representation to allow for reporting research findings by sub-populations • Study designs that allow exploration of how intersections of various identities (race/ethnicity, gender, income, place, unemployment, low educational attainment, difficulty with access to care, etc.) influence intervention effectiveness • Effects of routine screening of SDoH in the medical encounter to inform care and/or facilitate referrals to address unmet health-related social or basic needs, and testing of different models to address these • Longitudinal studies to capture impacts of scaling-up efficacious obesity interventions through national and state programs to address unmet health-related social needs • Effective use of technology for interventions in rural areas with incomplete access to broadband • Patient-centered (i.e., patient/relative/friend/caregiver) communication such as informed decision-making processes to promote patients’ ability to participate equally in medical decisions and effects on outcomes (QoL, medical choice, maintaining medical regimen/patient’s medical choice; clinician-patient communication) in high-risk populations • Intervention approaches to improve treatment effect for non-responders and/or those who are less likely to engage fully in treatment
Implementation, Scalability, and Sustainability	• Understanding of the “active ingredients” of obesity prevention and treatment programs that can be delivered efficiently and disseminated broadly at relatively low cost • Approaches to sustain positive program outcomes after grant funding, including strategies for scaling-up programs whose initial success may be tied to non-reproducible features (charismatic leadership, etc.) and adapt them for diverse population groups with the community • Ways to support sustainable reimbursement models for CHWs and peer support in clinical and community contexts • Implementation issues that prevent adoption, achieved dose, and sustainability of effective programs • Broad dissemination of the “Screen at 23” campaign in Asian American subgroups; and systematic approaches to estimate risk of overweight and obesity in specific Asian subgroups