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Energy Balance

Background

Considerable evidence indicates that factors related to energy balance – the integrated effects of diet, physical activity, and genetics on growth and body weight – are known risk factors for many chronic diseases and conditions, such as several forms of cancer and cardiovascular disease. Recent systematic reviews and meta-analyses of observational studies suggest that being overweight or obese increases risk for initial cancers, recurrence, and second cancers and decreases overall survival among cancer survivors.  These results also suggest that physical activity decreases cancer risk and mortality.  Interest is rapidly increasing in the role sedentary behavior as a unique disease risk factor.

Research Opportunities

Research is needed to more clearly understand the mechanisms through which obesity, weight control, and physical activity and inactivity, along with genetic and environmental factors, interact over a lifetime to influence cancer risk and prognosis. It is essential that future studies consider the interrelationships among these factors and explore their combined and independent effects in research designs incorporating state-of-the-science measures of each. Research is also needed to assess the effects of obesity-related policy interventions, as policies to address diet, physical activity, and weight are relatively recent phenomena, and new policies are frequently proposed and implemented.

Energy-balance Factors in Relation to Cancer Risk, Prognosis, and Survivorship

What are the biological mechanisms through which obesity, healthy weight maintenance, fitness, physical activity and inactivity influence cancer risk and prognosis?  What works for whom?

Does sedentary behavior represent a unique physiological stimulus or is the effect due to a lack of activity?

What are the biobehavioral and cognitive-affective mechanisms of behavior change that can be targeted for intervention to increase the adoption and maintenance of physical activity? Do these mechanisms of behavior change differ by stage of development or placement along a cancer continuum?

Energy-related Early Life Origins of Cancer

Are there other cancers related to early-life energy balance behaviors and risk factors?

What are new methods or alternative data sources to assess past diet or other energy balance risk factors and later cancer risk?

Is growth trajectory in childhood relevant to later cancers?

What methodologic studies could be used to evaluate the mechanism by which identified energy balance factors influence cancer risk?

What are effective interventions to improve energy balance behaviors and risk factors in early life?

What are the social determinants that moderate the effectiveness or ability to disseminate efficacious interventions?

What are the social determinants of energy balance-related behaviors across the lifespan?

How can studies better ascertain information about diet, physical activity, and BMI from periods early in life?

Geospatial Approaches

How can the quality of spatially referenced data concerning food and physical activity resources, such as commercially available data sets, be improved?

What analytical methods are needed to improve our understanding of multilevel influences on health behaviors; such as the integration of data from diverse instruments including GPS systems for location, motion sensing devices for physical activity, ecological momentary assessment with cell phones, and remote sensing with other devices?

What methods research can refine common data elements and data harmonization procedures for geospatial analyses related to energy balance?

How can geospatial data be used in intervention research as a moderating factor or as an integrated component of intervention delivery?

Parent-child Dynamics of Energy Balance-relevant Health Behaviors

What role does cultural variability and cultural sensitivity play in the context of the importance of relationships in cancer-relevant health behaviors?

How can the theoretical acknowledgement that relationships are bidirectional (i.e., spouses influence each other, children can influence parents) in the context of health behaviors be evaluated?

How do adult energy balance-relevant health behaviors (e.g., fruit and vegetable intake and physical activity) “spill over” to influence behaviors of others within the home including other adults (e.g., spouses) and children?

Physical Activity Assessment and Intervention

What improvements can be made in data management and processing architecture to support analyses of large volumes of high-resolution sensor data?

How can we enhance the development, evaluation, and comparison of analytic methods for processing sensor data into predictive or descriptive metrics?

What analytic methods can help integrate self-reported and sensor-based measures of activity and contextual data?

How can the development, evaluation, and comparison of analytic methods for the collection and analysis of high-resolution inertial, physiologic, and location-based sensor data and collection and analysis of self-reported time-use and contextual information using real-time data capture methods be improved?

How can surveillance and monitoring of physical activity be better integrated within national health surveillance systems?

What methods research is needed for population-based activity assessment and monitoring for clinical or behavioral research utilizing mobile and wireless technologies?

Obesity Policy Research

What are the most promising policies in terms of feasibility, implementation cost, and size of effect related to dietary and physical activity behavior to reduce obesity rates?

Do policies intended to improve dietary and/or physical activity behavior and weight outcomes lead to differential effects in subpopulations at highest risk for obesity?

How best can economic assessments of policies related to diet and/or physical activity behavior and weight outcomes be incorporated into obesity policy evaluation research?

What is the best approach for engaging all stakeholders in this field of research?

Dietary Patterns

What are the most appropriate methods to identify, characterize, analyze, and visualize relevant dietary patterns?

What are the most promising ways to capture the multidimensionality of dietary patterns (including time, place, and environmental context) that might relate to energy balance and disease risk?

Which modeling strategies are most appropriate to investigate dietary pattern/disease relationships?

What types of infrastructure support (such as databases) are needed to facilitate examination of dietary patterns at all levels of the food stream?

Which dietary patterns are most relevant for weight and cancer outcomes, and what are the mechanisms of influence?

How can systems modeling help us understand the complexities inherent in dietary patterns and their relationship to health and disease?