Multilevel Interventions Targeting Obesity: Research Recommendations for Vulnerable Populations.
BACKGROUND
The origins of obesity are complex and multifaceted. To be successful, an intervention aiming to prevent or treat obesity may need to address multiple layers of biological, social, and environmental influences.


METHODS
NIH recognizes the importance of identifying effective strategies to combat obesity, particularly in high-risk and disadvantaged populations with heightened susceptibility to obesity and subsequent metabolic sequelae. To move this work forward, the National Heart, Lung, and Blood Institute, in collaboration with the NIH Office of Behavioral and Social Science Research and NIH Office of Disease Prevention convened a working group to inform research on multilevel obesity interventions in vulnerable populations. The working group reviewed relevant aspects of intervention planning, recruitment, retention, implementation, evaluation, and analysis, and then made recommendations.


RESULTS
Recruitment and retention techniques used in multilevel research must be culturally appropriate and suited to both individuals and organizations. Adequate time and resources for preliminary work are essential. Collaborative projects can benefit from complementary areas of expertise and shared investigations rigorously pretesting specific aspects of approaches. Study designs need to accommodate the social and environmental levels under study, and include appropriate attention given to statistical power. Projects should monitor implementation in the multiple venues and include a priori estimation of the magnitude of change expected within and across levels.


CONCLUSIONS
The complexity and challenges of delivering interventions at several levels of the social-ecologic model require careful planning and implementation, but hold promise for successful reduction of obesity in vulnerable populations.
Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Epidemiology, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address: june_stevens@unc.edu.
June
J
Stevens
Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland.
Charlotte
C
Pratt
Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland.
Josephine
J
Boyington
Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland.
Cheryl
C
Nelson
Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Kimberly P
KP
Truesdale
Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Dianne S
DS
Ward
Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Leslie
L
Lytle
HealthPartners Institute for Education and Research, Bloomington, Minnesota.
Nancy E
NE
Sherwood
Department of Pediatrics, Stanford University School of Medicine, Stanford, California; Department of Medicine, Stanford University School of Medicine, Stanford, California.
Thomas N
TN
Robinson
Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio.
Shirley
S
Moore
Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
Shari
S
Barkin
Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York.
Ying Kuen
YK
Cheung
Division of Program Coordination, Planning, and Strategic Initiatives, NIH, Bethesda, Maryland.
David M
DM
Murray
D006801:Humans; D009765:Obesity / Q000628:therapy*; D012107:Research Design; D035862:Vulnerable Populations