INNOVATIVE APPROACHES TO PREVENTION OF OBESITY

Release Date:  January 22, 1999

RFA:  DK-99-010

P.T.

National Institute of Diabetes and Digestive and Kidney Diseases
National Heart, Lung, and Blood Institute
National Institute on Aging
National Institute of Child Health and Human Development
Office of Research on Women's Health
Office of Disease Prevention

Letter of Intent Receipt Date:  March 26, 1999
Application Receipt Date:  April 27, 1999

PURPOSE

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK),
National Heart, Lung, and Blood Institute (NHLBI), National Institute on Aging
(NIA), National Institute of Child Health and Human Development (NICHD), Office
of Research on Women's Health (ORWH), and the Office of Disease Prevention (ODP)
invite applications for pilot studies to explore interventions for prevention of
obesity in high risk individuals or populations.  Applications incorporating
unique cultural or social features specific for women or for special populations
defined by race/ethnicity and/or socioeconomic status are encouraged.

HEALTHY PEOPLE 2000

The Public Health Service (PHS) is committed to achieving the health promotion
and disease prevention objectives of "Healthy People 2000," a PHS-led national
activity for setting priority areas.  This RFA, Innovative Approaches to
Prevention of Obesity, is related to one or more of the priority areas. 
Potential applicants may obtain a copy of "Healthy People 2000" (Full Report:
Stock No. 017-001-00474-0 or Summary Report: Stock No. 017-001-00473-1) through
the Superintendent of Documents, Government Printing Office, Washington, DC
20402-9325 (telephone 202-512-1800).

ELIGIBILITY REQUIREMENTS

Applications may be submitted by domestic and foreign, for-profit and non-profit
organizations, public and private, such as universities, colleges, hospitals,
laboratories, units of State and local governments, and eligible agencies of the
Federal Government.  Racial/ethnic minority individuals, women, and persons with
disabilities are encouraged to apply as Principal Investigators.

MECHANISM OF SUPPORT

This RFA will use the National Institutes of Health (NIH) research project grant
(R01) award mechanism.  Responsibility for the planning, direction, and execution
of the proposed project will be solely that of the applicant.  Awards will be
administered under NIH grants policy as stated in the NIH Grants Policy
Statement.

Applicants from institutions that have a General Clinical Research Center (GCRC)
funded by the NIH National Center for Research Resources may wish to identify the
GCRC as a resource for conducting the proposed research.  If so, a letter of
agreement from either the GCRC program director or principal investigator should
be included with the application.

This RFA is a one-time solicitation.  Future unsolicited competing continuation
applications will compete with all investigator-initiated applications and be
reviewed according to the customary peer review procedures.  The total requested
project period for an application submitted in response to this RFA may not
exceed three years.  In keeping with the pilot nature of these studies, grants
will be limited to $125,000 in direct costs in the first year and a maximum of
$375,000 in direct costs over a three year period.  The anticipated award date
is September 30, 1999.

FUNDS AVAILABLE

For the initial year of funding, approximately $2,400,000 will be committed to
fund applications submitted in response to this RFA.  It is anticipated that 12
to 15 awards will be made.  However, this funding level is dependent upon the
receipt of a sufficient number of applications of high scientific merit. Although
this program is provided for in the financial plans of the NIDDK, NHLBI, NIA,
NICHD, ORWH and ODP, the award of grants pursuant to this RFA is also contingent
upon the availability of funds for this purpose.

RESEARCH OBJECTIVES

Background

The prevalence of obesity has increased dramatically over the past 10 years
across virtually all populations and age groups.  Over 50 percent of adult
Americans are now either overweight (BMI greater than 25.0) or obese (BMI greater
than or equal to 30.0) (Flegal et al, 1998).  Twenty-five percent of U.S.
children are overweight or at risk of becoming overweight and this number also
has been increasing rapidly (Troiano and Flegal, 1998).  In addition, obesity
disproportionately affects many minority populations and some lower income groups
(NHLBI and NIDDK, 1998).  Obese individuals experience numerous adverse health
consequences including increased risk for cardiovascular disease, diabetes,
stroke, some cancers, osteoarthritis, sleep apnea, gallbladder disease, and
higher mortality rates from all causes than normal weight people (NHLBI and
NIDDK, 1998).  In addition, the higher prevalence of obesity in minority
populations and individuals with lower income and education levels contributes
to excess disease and mortality rates experienced by these groups.  Weight loss
interventions are costly, difficult, and often unsuccessful at long-term
maintenance of weight loss. In addition, it is unknown if weight loss in those
individuals already obese reduces disease risk to the same level as that observed
in those who were never obese (Andres et al, 1993; Williamson et al, 1995). 
Current estimates of the cost of obesity approach $100 billion per year (Wolf and
Colditz, 1998), a cost projected to increase as the number of obese individuals
in the population increases and as those who are currently obese suffer increased
consequences of obesity-related comorbidities.  Taken together, all these factors
make the prevention of obesity a public health imperative.

Obesity is a complex condition that results from interaction of genetic,
behavioral, and environmental factors.  Family studies and recent advances in
understanding of the molecular genetics of obesity have made it clear that
genetic factors predispose certain individuals to develop obesity and its
comorbidities (Comuzzie and Allison, 1998).  Behavioral and environmental factors
that may contribute to obesity include: the increased availability of convenient,
palatable, and inexpensive high energy density foods; increased sedentary
behavior and decreased opportunity for physical activity; and psychosocial and
cultural factors such as family environment (Hill and Peters 1998).

Epidemiological studies have observed that specific stages of life confer high
risk for the development of obesity in susceptible individuals.  These include: 
the prenatal period, the period of adiposity rebound in childhood, adolescence,
marriage, early adulthood, postpregnancy, and menopause.  Health-related
behaviors (e.g., smoking cessation or initiating use of prescription drugs such
as corticosteroids) may confer risk of weight gain as well (Gill, 1997).  Many
minority populations, individuals of low socioeconomic status, and individuals
with a family history of obesity also are at high risk for developing obesity.

Prevention of obesity in childhood is a particularly important issue.  Because
persons who become obese as children are more likely to be obese as adults
(Dietz, 1998) and because obesity in parents is a major risk factor for the
development of obesity in their offspring (Whitaker et al., 1997; Whitaker and
Dietz, 1998), these patterns may amplify the problem of obesity in the future. 
Family-based interventions offer the opportunity to provide integrated treatment
and prevention interventions to multiple family members, an approach that also
may strengthen social support aspects of intervention.  For example, one study
has reported reduction in the progression of obesity 10 years after treatment of
obese children in a family oriented program (Epstein et al, 1990).  A recent
review of obesity treatment in children (Epstein et al, 1998) has proposed a
number of research opportunities in this area, including research on behavior
change and relapse behavior, methods to individualize treatment based on
theoretical constructs, and energy balance regulation.  Although a few studies
have tested obesity prevention interventions in children, they have been too
short-term to be able to make conclusions (Fitzgibbon et al., 1995; Stolley and
Fitzgibbon, 1997).  Prevention-oriented interventions have been conducted
primarily in school-based studies (Donnelly, 1996).  However, major school-based
research interventions have generally been aimed at fostering healthy lifestyles
by focusing on cardiovascular factors, physical fitness, substance abuse, and
general nutrition, rather than on obesity prevention.  For instance, the Child
and Adolescent Trial for Cardiovascular Health (CATCH) succeeded in increasing
students' physical activity in physical education classes, as well as improving
knowledge and selection of healthful food choices, but did not result in BMI or
skinfold thickness differences between treatment groups (Luepker, et al., 1996).

While obesity treatment in adults frequently produces significant weight loss,
long-term maintenance of weight loss remains a major challenge.  A small number
of obesity prevention studies have been conducted in adults.  A few community-
based studies have attempted to prevent weight gain in adults by altering the
environment.  Two community studies (Minnesota Heart Health Program, Stanford
Five City Study) did not succeed in preventing weight gain, while in the
Pawtucket Heart Health Program, BMIs in intervention communities were held
constant compared to weight gains in control communities.  The Pound of
Prevention Study, a three-year randomized, controlled population-based study of
obesity prevention using low intensity interventions (newsletters and semiannual
classes) in adults, achieved increased knowledge in the intervention groups. 
However, the study was not able to demonstrate significant differences in weight
gain between the intervention and control groups (Jeffrey and French, in press).

The need for an obesity prevention initiative has been recognized by a number of
NIH advisory groups.  In 1994, the National Task Force on Prevention and
Treatment of Obesity developed a long range plan focused on prevention of obesity
(National Task Force on Prevention and Treatment of Obesity, 1994) and recently
reaffirmed obesity prevention as a priority area for clinical research. The
recently issued NHLBI/NIDDK Clinical Guidelines on the Identification,
Evaluation, and Treatment of Overweight and Obesity in Adults include a
discussion of the importance of preventing obesity and suggestions for strategies
to be attempted (NHLBI and NIDDK, 1998).  The International Life Sciences
Institute sponsored a review of The Causes and Health Consequences of Obesity in
Children and Adolescents (ILSI, 1998) as part of its Physical Activity and
Nutrition Program for Children and Adolescents.  This review includes
recommendations for research on obesity prevention.  The February 1998 NHLBI
Report of the Task Force on Behavioral Research in Cardiovascular Lung and Blood
Health and Disease also has recommended development of obesity prevention
research efforts (NHLBI 1998).

Research Goals and Topics

This RFA responds to the need for systematic studies of obesity prevention.  The
sponsoring organizations encourage submission of grants for innovative pilot
studies to prevent obesity in high risk individuals, families, or populations. 
For purposes of this RFA, prevention of obesity includes the primary prevention
of overweight and/or obesity, the prevention of additional weight gain or
increase in body fat in those already overweight and/or obese, and prevention of
weight regain following weight loss.  It is intended that the three years of
funding provided for these pilot studies will allow 18-24 months of treatment
and/or follow-up to be included in the proposed study designs.

Applications should address: the content of the intervention (e.g., relative
focus on aspects of diet, physical activity, both, or other factors), the setting
of the intervention (e.g., in health care settings, community groups, social
groups, home, school), and the method of intervention delivery (e.g., individual,
group, computer-aided, internet-based, mass media).  Novel or innovative aspects
and the rationale for their use should be highlighted.

The examples listed below are illustrative, and are not meant to comprise an
exhaustive list.  It is expected that additional important strategies and topics
will be identified by investigators who respond to this RFA.  Theory-based
interventions are encouraged; however, due to the pilot nature of these projects
and the need to explore innovative approaches, "experience-based" interventions
not based on formal theory and other less well-developed concepts will be
considered if they are well-justified.

Examples of topics that can be addressed in pilot studies include:

-- Interventions for high-risk populations, defined by family history, genetic
characteristics, demographics, life transitions/stages (e.g., during smoking
cessation or during the postpartum period), or other factors.

-- Interventions to prevent increased incidence of overweight in young and
middle-age adults

-- Interventions for individuals at high risk of obesity based on behavioral or
metabolic factors, e.g., fat preference, eating behaviors, behavioral response
to caloric restriction, resting metabolic rate

-- Interventions delivered in primary care settings

-- Interventions that integrate obesity treatment and prevention in high-risk
families

-- Interventions that incorporate unique cultural and social features specific
to special populations defined by race/ethnicity and/or socioeconomic status

-- Interventions that are community-based or based on partnerships with community
organizations, for example, schools, clubs, churches, work-sites

-- Interventions to prevent weight regain after weight loss

-- Comparisons of behavioral approaches for obesity prevention or maintenance of
long-term weight loss

-- Innovative nutrition and physical activity education programs to promote
behavior change

-- Interventions incorporating new knowledge of child development, learning, and
psychobiology

-- Interventions incorporating learning theory, e.g., response extinction and
recovery

-- Prevention or treatment of binge-eating disorders as a means of preventing
obesity

-- Interventions to increase physical activity and/or decrease inactivity as a
means of preventing obesity

-- Identification of factors which may contribute to differences among age-groups
(including older persons age 65 years and older) in the safety and efficacy of
exercise interventions to prevent weight gain

-- Environmental interventions that address societal contributors to over-
consumption of calories and barriers to increased physical activity.  These could
include interventions directed at food marketing practices, food labeling,
subsidization of healthy food consumption practices,  transportation patterns,
opportunities for physical activity, and urban design to promote physical
activity.

-- Interventions incorporating weight loss medications to prevent weight regain
after weight loss

-- Interventions to prevent weight gain in individuals undergoing long-term
treatment with medications, such as psychotropic agents, that are associated with
weight gain

SPECIAL REQUIREMENTS

o  Applicants should include plans to assess the feasibility of the intervention
for long-term use by the target population. This process evaluation should
address adherence, acceptability, and ease of delivery of the intervention.  It
is anticipated that some interventions may be ongoing up to the point of
assessment, whereas others may include a brief, defined intervention with post-
intervention follow-up at a later time; however, applicants are encouraged to
assess program effectiveness at least 18-24 months from the beginning of the
intervention.

o  Applicants should state their willingness to participate in one-day annual
meetings and a final workshop to track progress of studies and promote exchange
of experiences and ideas.  Attendees will include the grantees funded under the
RFA and investigators from obesity prevention studies receiving other funding
from NIH.  Funds for travel to the Washington D.C. area for the principal
investigator (and coinvestigator, if appropriate) should be included in the
budgets for each year.

o  The grants to be funded under this RFA are intended to serve as pilot studies
that may be developed into clinical trials if appropriate, or to gather data on
feasibility of new approaches that may lead to a pilot clinical study.

o  It is expected that proposed studies will include a control group.

o  Eligibility criteria and recruitment strategies should be well-specified.

o  Primary outcomes should be clearly justified and should include a measure of
weight.  Secondary outcomes relating to metabolic and/or physical fitness
independent of weight loss also should be assessed where feasible.  Applicants
also may evaluate the effects of intervention on other factors such as body
composition (e.g., percent body fat, bone density, visceral adiposity).

o  Psychosocial influences that may influence successful behavioral change should
be assessed if possible (e.g., knowledge, attitudes, body image, social support,
self-efficacy, quality of life, etc.).

INCLUSION OF WOMEN AND MINORITIES IN RESEARCH INVOLVING HUMAN SUBJECTS

It is the policy of the NIH that women and members of minority groups and their
sub-populations must be included in all NIH supported biomedical and behavioral
research projects involving human subjects, unless a clear and compelling
rationale and justification is provided that inclusion is inappropriate with
respect to the health of the subjects or the purpose of the research.  This
policy results from the NIH Revitalization Act of 1993 (Section 492B of Public
Law 103-43).

All investigators proposing research involving human subjects should read the
"NIH Guidelines For Inclusion of Women and Minorities as Subjects in Clinical
Research," which was published in the Federal Register of March 28, 1994 (FR 59
14508-14513), and in the NIH Guide For Grants and Contracts, Vol. 23, Number 11,
March 18, 1994, available on the web at:
https://grants.nih.gov/grants/guide/notice-files/not94-105.html.

Investigators may also obtain copies from these sources or from the program staff
or contact person listed under INQUIRIES.  Program staff may also provide
additional relevant information concerning the policy.

INCLUSION OF CHILDREN AS PARTICIPANTS IN RESEARCH INVOLVING HUMAN SUBJECTS

It is the policy of NIH that children (i.e., individuals under the age of 21)
must be included in all human subjects research, conducted or supported by the
NIH, unless there are scientific and ethical reasons not to include them.  This
policy applies to all initial (Type 1) applications submitted for receipt dates
after October 1, 1998.

All investigators proposing research involving human subjects should read the
"NIH Policy and Guidelines on the Inclusion of Children as Participants in
Research Involving Human Subjects" that was published in the NIH Guide for Grants
and Contracts, March 6, 1998, and is available at the following URL address:
https://grants.nih.gov/grants/guide/notice-files/not98-024.html

LETTER OF INTENT

Prospective applicants are asked to submit, by March 26, 1999, a letter of intent
that includes a descriptive title of the proposed research; the name, address,
and telephone number of the Principal Investigator; the identities of other key
personnel and participating institutions; and the number and title of the RFA in
response to which the application may be submitted.

Although a letter of intent is not required, is not binding, and does not enter
into the review of a subsequent application, the information that it contains
allows NIH staff to estimate the potential review workload and avoid conflict of
interest in the review.

The letter of intent is to be sent to:

Barbara Harrison, M.S.
Division of Digestive Diseases and Nutrition
National Institute of Diabetes and Digestive and Kidney Diseases 45 Center Drive
MSC 6600
Bethesda, MD  20892-6600
Telephone:  (301) 594-8858
FAX:  (301) 480-8300

APPLICATION PROCEDURES

The research grant application form PHS 398 (rev. 4/98) is to be used in applying
for these grants.  These forms are available at most institutional offices of
sponsored research and may be obtained from the Division of Extramural Outreach
and Information Resources, National Institutes of Health, 6701 Rockledge Drive,
MSC 7910, Bethesda, MD 20892-7910, telephone 301-710-0267, email:
grantsinfo@nih.gov.

The RFA label available in the PHS 398 (rev. 4/98) application form must be
affixed to the bottom of the face page of the application.  Failure to use this
label could result in delayed processing of the application such that it may not
reach the review committee in time for review.  In addition, the RFA title and
number must be typed on line 2 of the face page of the application form and the
YES box must be marked.

Submit a signed, typewritten original of the application, including the
Checklist, plus five signed photocopies, in one package to:

CENTER FOR SCIENTIFIC REVIEW
NATIONAL INSTITUTES OF HEALTH
6701 ROCKLEDGE DRIVE, ROOM 1040, MSC 7710
BETHESDA, MD 20892-7710
BETHESDA, MD 20817 (for express/courier service)

Applications must be received by April 27, 1999.  If an application is received
after that date, it will be returned to the applicant without review.  The Center
for Scientific Review (CSR) will not accept any application in response to this
RFA that is essentially the same as one currently pending initial review, unless
the applicant withdraws the pending application.  The CSR will not accept any
application that is essentially the same as one already reviewed.  This does not
preclude the submission of substantial revisions of applications previously
reviewed, but such applications must include an introduction addressing the
previous critique.

REVIEW CONSIDERATIONS

Applications that are complete and responsive to the RFA will be evaluated for
scientific and technical merit by an appropriate peer review group convened in
accordance with NIH peer review procedures.  As part of the initial merit review,
all applications will receive a written critique and undergo a process in which
only those applications deemed to have the highest scientific merit will be
discussed, assigned a priority score, and receive a second level review by the
National Diabetes and Digestive and Kidney Diseases Advisory Council; the
National Heart, Lung, and Blood Advisory Council; the National Advisory Council
on Aging; or the National Advisory Child Health and Human Development Council.

Review Criteria

The goals of NIH-supported research are to advance our understanding of
biological systems, improve the control of disease, and enhance health.  In the
written comments, reviewers will be asked to discuss the following aspects of the
application in order to judge the likelihood that the proposed research will have
a substantial impact on the pursuit of these goals.  Each of these criteria will
be addressed and considered in assigning the overall score, weighting them as
appropriate for each application.  Note that the application does not need to be
strong in all categories to be judged likely to have a major scientific impact
and thus deserve a high priority score.  For example, an investigator may propose
to carry out important work that is not innovative but is essential to move a
field forward.

o Significance:  Does this study address an important problem?  If the aims of
the application are achieved, how will scientific knowledge be advanced?  What
will be the effect of these studies on the concepts or methods that drive this
field?

o Approach:  Are the conceptual framework, design, methods, and analyses
adequately developed, well-integrated, and appropriate to the aims of the
project?  Does the applicant acknowledge potential problem areas and consider
alternative tactics?

o Innovation:  Does the project employ novel concepts, approaches or method? Are
the aims original and innovative?  Does the project challenge existing paradigms
or develop new methodologies or technologies?

o Investigator:  Is the investigator appropriately trained and well suited to
carry out this work?  Is the work proposed appropriate to the experience level
of the principal investigator and other researchers (if any)?

o Environment:  Does the scientific environment in which the work will be done
contribute to the probability of success?  Do the proposed experiments take
advantage of unique features of the scientific environment or employ useful
collaborative arrangements?  Is there evidence of institutional support?

In addition to the above criteria, in accordance with NIH policy, all
applications will also be reviewed with respect to the following:

o  Adequacy of plans to include both genders, minorities and their subgroups, and
children as appropriate for the scientific goals of the research.  Plans for the
recruitment and retention of subjects will also be evaluated.

o  Reasonableness of the proposed budget and duration in relation to the proposed
research.

o  Adequacy of the proposed protection of humans, animals, or the environment,
to the extent that they may be adversely affected by the project proposed in the
application.

The initial review group will also examine the provisions the safety of the
research environment.

o  Availability of special opportunities for furthering research programs through
the use of unusual talent resources, populations, or environmental conditions in
other countries which are not readily available in the United States or which
provide augmentation of existing U.S. resources.

AWARD CRITERIA

The anticipated date of award is September 30, 1999.

Award criteria that will be used to make award decisions include:

o  Scientific and technical merit as determined by peer review

o  Availability of funds

o  Programmatic priorities

o  Availability of appropriate high risk populations for study, including racial
and ethnic minorities, and under-served populations.

INQUIRIES

Inquiries concerning this RFA are encouraged.  The opportunity to clarify any
issues or questions from potential applicants is welcome.

Direct inquiries regarding programmatic issues to:

Barbara Harrison, M.S.
Division of Digestive Diseases and Nutrition
National Institute of Diabetes and Digestive and Kidney Diseases
45 Center Drive MSC 6600
Bethesda, MD  20892-6600
Telephone:  (301) 594-8858
FAX:  (301) 480-8300
Email:  HarrisonB@extra.niddk.nih.gov

Eva Obarzanek, Ph.D., R.D.
Division of Epidemiology and Clinical Applications
National Heart, Lung, and Blood Institute
6701 Rockledge Drive, Room 8136
Bethesda, MD  20892-7936
Telephone:  (301) 435-0377
FAX:  (301) 480-1773
Email:  ObarzanE@gwgate.nhlbi.nih.gov

Chhanda Dutta, Ph.D.
Geriatrics Program
National Institute on Aging
7201 Wisconsin Avenue, Suite 3E-327
Bethesda, MD  20892-9205
Telephone:  (301) 435-3048
FAX:  (301) 402-1784
Email:  DuttaC@exmur.nia.nih.gov

Direct inquiries regarding fiscal and administrative matters to:

Gilman Grave, M.D.
Endocrinology, Nutrition, and Growth Branch
National Institute of Child Health and Human Development
6100 Executive Boulevard, Room 4B11
Bethesda, MD  20892-7510
Telephone:  (301) 496-5593
FAX:  (301) 480-9791
Email:  GraveG@exchange.nih.gov

Direct inquiries regarding fiscal and administrative matters to:

Sharon Bourque
Division of Extramural Activities
National Institute of Diabetes and Digestive Kidney Diseases
45 Center Drive MSC 6600
Bethesda, MD  20892-6600
Telephone:  (301) 594-8846
FAX:  (310) 480-4237
Email:  BourqueS@extra.niddk.nih.gov

Marie A. Willett
Division of Extramural Affairs
National Heart, Lung, and Blood Institute
6701 Rockledge Drive, Room 7156, MSC 7926
Bethesda, MD  20892-7926
Telephone:  (301) 435-0144
FAX:  (301) 480-3310
Email:  Marie_Willett@nih.gov

Mr. Joseph Ellis
Grants and Contracts Management Office
National Institute on Aging
7201 Wisconsin Avenue, Suite 2N212
Bethesda, MD  20892-9205
Telephone:  (301) 496-1472
FAX:  (301) 402-3672
Email:  EllisJ@exmur.nia.nih.gov

Douglas Shawver
Office of Administrative Management
National Institute of Child Health and Human Development
6100 Executive Boulevard, Room 8A07, MSC 7510
Bethesda, MD  20892-7510
Telephone:  (301) 435-6999
FAX:  (301) 402-0915
Email:  ds117g@nih.gov

The National Institute of Mental Health (NIMH), although not a cosponsor of this
RFA, has continuing active research programs in eating disorders and associated
comorbidity.  Research applications are encouraged that investigate the
prevention and clinical treatment of these serious disorders, as well as their
underlying brain and behavioral substrates.  Studies are needed on the prevention
of weight gain and obesity commonly observed in patients who are given
psychotropic medication.  NIMH is very interested in studies on the prevention
of eating disorders such as recurrent binge eating, or compulsive dieting, since
many of these individuals also suffer from bulimia nervosa and anorexia nervosa.

Investigators interested in NIMH programs supporting studies of eating disorders
may contact:

Benedetto Vitiello, M.D.,
Division of Services and Intervention Research
National Institute of Mental Health
Telephone:  (301) 443-4283
FAX:  (301) 443-4045
Email:  bvitiell@nih.gov

AUTHORITY AND REGULATIONS

This program is described in the Catalog of Federal Domestic Assistance No.
93.848, 93.837, 93.866, and 93.865.  Awards are made under authorization of the
Public Health Service Act, Title IV, Part A (Public Law 78-410, as amended by
Public Law 99-158, 42 USC 241 and 285) and administered under PHS grants policies
and Federal Regulations 42 CFR 52 and 45 CFR Part 74.  This program is not
subject to the intergovernmental review requirements of Executive Order 12372 or
Health Systems Agency review.

The PHS strongly encourages all grant and contract recipients to provide a smoke-
free workplace and promote the non-use of all tobacco products.  In addition,
Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking in certain
facilities (or in some cases, any portion of a facility) in which regular or
routine education, library, day care, health care or early childhood development
services are provided to children.  This is consistent with the PHS mission to
protect and advance the physical and mental health of the American people.

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Comuzzie AG and Allison DB.  The Search for Human Obesity Genes.  Science 1998;
280: 1374-77.

Dietz WH.  Health Consequences of Obesity in Youth:  Childhood Predictors of
Adult Disease.  Pediatrics 1998; 101(3) 518-25.

Donnelly JE, Jacobsen DJ, Whatley JE, Hill JO, Swift LL, Cherrington A, Polk B,
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Epstein LH, Valoski A, Wing RR, McCurley J.  Ten-year follow-up of behavioral,
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Fitzgibbon ML, Stolley MR, & Kirschenbaum DS. An obesity prevention pilot program
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Flegal KM. Carroll MD, Kuczmarski RJ, and Johnson CL.  Overweight and Obesity in
the United States:  Prevalence and Trends, 1960-1994.  Int J of Obesity 1998; 22:
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Gill TP.  Key issues in the prevention of obesity.  Brit Med Bull 1997; 53(2):
359-88.

Hill JO and Peters JC.  Environmental Contributions to the Obesity Epidemic. 
Science 1998; 280: 1371-73.

ILSI.  The Causes and Health Consequences of Obesity in Children and Adolescents. 
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Jeffrey, RW and French SA.  Prevention of Weight Gain in Adults.  Am J Public
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Luepker RV, Perry CL, McKinlay SM, Nader PR, Parcel GS, Stone EJ, Webber LS,
Elder JP, Feldman HA, Johnson CC, Kelder SH, Wu M.  Outcomes of a Field Trial to
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National Task Force on Prevention and Treatment of Obesity.  Towards Prevention
of Obesity:  Research Directions.  Obesity Research 1994; 2(6): 571-84.

NHLBI.  NHLBI Report of the Task Force on Behavioral Research in Cardiovascular
Lung and Blood Health and Disease.  1998.  Available at 
http://www.nhlbi.nih.gov/nhlbi/sciinf/taskforc.htm

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