RFA-R14-003: Healthy Weight

DRDC Solicitation #:  RFA-R14-003

Project Title: Validating and/or modifying mainstream health weight interventions for people with disabilities

Maximum Funding Year 1: $350,000 (includes direct and indirect costs)
NOTE: The budget shown is subject to the availability of funding.
Project period:  up to 3 years
Anticipated Number of Awards:  1-3
Project start date:  September 30, 2014

Eligible Applicants:

Universities, non-profit and other research organizations.

Description:

Healthy People 2020 Focus Area(s) aligned with this project:

  1. Promote health and reduce chronic disease risk through the consumption of healthful diets and achievement and maintenance of healthy body weights.
  2. Improve health, fitness, and quality of life through daily physical activity
  3. Promote the health and well-being of people with disabilities.


CDC Research winnable battles
aligned with this research project:
Improve nutrition, physical activity, obesity.

Center/Division goal(s) and priorities aligned with this research project: Inclusion of people with disabilities in mainstream health promotion programs.

Purpose: The purpose of the research is to build empirical evidence for mainstream healthy weight interventions that are effective at 1) reaching and including people with mobility impairments and/or limb loss/differences and 2) impacting the weight status of people with mobility impairments and/or limb loss/differences.  Equally as important is identifying mainstream healthy weight interventions that are not appropriate or effective for this population as implemented and, if applicable, building the empirical evidence for how modifications to the intervention can make it more appropriate and effective.

Evidence-based mainstream healthy weight interventions would be modified and or tailored to insure that they reach and are inclusive of people with disabilities. (See the Guide to Community Preventative Services).

Background: Researchers and practitioners are beginning to identify interventions that are effective at impacting the weight status of the general population.  The Community Guide to Preventive Services provides a list and description of those interventions specific to nutrition, physical activity, and obesity.  However, people with mobility impairments and limb loss or limb differences are often excluded from the research and practice behind these interventions, so it is not known if they are effective in this population. The most appropriate measurement of healthy weight for people with a variety of disability conditions (e.g., limb loss, abnormal muscle physiology, short stature, contractures) has not been well studied or standardized.   Several resources (journal articles, evaluation/technical reports, fact sheets) exist that provide suggestions given by experts and/or people with mobility impairments and/or limb loss/differences on how to modify interventions to be inclusive and effective in this population.  It is rare, though, that the modifications are implemented and studied to provide empirical evidence for the improved inclusiveness and effectiveness of the intervention.  Recognizing that people with disabilities experience obesity at higher rates than people without disabilities and participate in less physical activity, it is critical that mainstream interventions designed to impact the weight status of the general population are also inclusive of and effective for people with disabilities.

Research Goals and Objectives:
Goal: To empirically determine if mainstream evidence-based healthy weight interventions are appropriate and effective for people with mobility impairments and/or limb loss/differences; and, if not, to empirically determine what modifications lead to better participation and outcomes for this population.

Researcher can identify the most appropriate experimental approach within their context, accounting for the guidelines outlined below:

  • Intervention: The intervention should be one that was originally designed to impact physical activity, healthy eating, and/or health status in the general population and that has not been studied among people with mobility impairments and/or limb loss/ differences.  The researcher may choose to implement a newly developed intervention or may choose to capitalize on opportunities with existing interventions.  Applicants are encouraged to reference the Community Guide to Preventive Services for types of interventions to be studied.
  • Population: The target population is people with mobility impairments and/or limb loss/differences.  The researcher can choose to further restrict the population within this umbrella category, if desired.  There should be assurance that the sample size is of adequate power to test the hypothesis.
  • Research design: While there is much flexibility in the research design, it should include primary data collection on intervention effectiveness gathered from individuals with mobility impairments and/or limb loss/difference experiencing the intervention in its original and/or modified form.  It should also insure that issues related to accurate measurement of weight and height for people with mobility impairments and/or limb loss/differences are considered.
  • Scalability:  The research should take into account clear deliverables for anticipated funding for years one, two and three, including adjustments to anticipated funding.

Describe the potential public health impact of this opportunity:

Building the evidence for healthy weight interventions that are effective at improving the weight status of people with mobility impairments and/or limb loss/differences will improve the public health workforce’s capacity to improve the health status of and reduce health disparities experienced by this population.

References:

Armour, B.S., Courtney-Long, E.A., Campbell, V.A., et al. (2013). Disability prevalence among healthy weight, overweight, and obese adults. Obesity (Silver Spring), 21(4), 852-855.

Drum, C.E., Peterson, J.J., Culley, C., et al. (2009). Guidelines and criteria for the implementation of community-based health promotion programs for individuals with disabilities. American Journal of Health Promotion, 24(2), 93-101.

Fox MH, Witten MH, Lullo C. Reducing Obesity among People with Disability. Journal of Disability Policy Studies. 2013 July 12. Doi: 1044207313494236. [Epub ahead of print]. Available at: http://dps.sagepub.com/content/early/2013/07/12/1044207313494236.abstract

Kahn, E.B., Ramsey LT, Brownson R, et al. The effectiveness of interventions to increase physical activity: a systematic review. Am J Prev Med 2002;22(4S):73-107.

Keener, D., Goodman, K., Lowry, A., Zaro, S., & Kettel Khan, L. (2009). Recommended community strategies and measurements to prevent obesity in the United States: Implementation and measurement guide. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.

Rajan, S., McNeely, M.J., Warms, C., et al. (2008). Clinical assessment and management of obesity in individuals with spinal cord injury: A review. Management of Obesity, 31(4), 361-372.

Rimmer, J.H., Wolf, L.A., Armour, B.S., et al. (2007). Physical activity among adults with a disability – United States, 2005. Morbidity and Mortality Weekly Report, 56, 1021-1024.

Yamaki, K, Rimmer, J.H., Lowry, B.D., Vogel, L.C. (2011). Prevalence in obesity-related chronic health conditions in overweight adolescents with disabilities. Research in Developmental Disabilities, 32, 280-288.

The Guide to Community Preventive Services: http://www.thecommunityguide.org/index.html