For the first time in North America, a multi-disciplinary, international team of experts in physiology, behaviour patterns, family medicine, and community health will focus on physical activity rather than diet to prevent and reduce obesity. The $1.5-million study is led by Queen's physiologist Dr. Robert Ross, and funded through a New Emerging Team (NET) grant by the Canadian Institutions of Health Research (CIHR) Institute of Nutrition, Metabolism and Diabetes.
In its assessment of the proposal, the CIRH review committee stated: "This approach is novel and has great public health importance."
Dr. Ross, who has conducted extensive groundbreaking research in the area of obesity, describes this study as the most exciting of his career. "You're always excited to receive new funding for your research, but this one is different because it has such large public health implications," he says. "We believe it has the potential to change the way primary care practice is delivered in Canada."
The five-year initiative, named PROACTIVE (Prevention and Reduction of Obesity through Active Living), is based on earlier findings by Dr. Ross and his team that exercise – without caloric restrictions – is the best ("most efficacious") way to reduce obesity. This study will examine whether such an approach can also be shown to be "effective", i.e. whether people will actually use it by making lasting changes to their sedentary lifestyles.
Other Queen's members of the team are: Dr. Marshall Godwin, head of Queen's Network for Studies in Primary Care; Dr. Peter Katzmarzcyk and Dr. Lucie Lévesque from the School of Physical and Health Education; and Dr. Yuk-Miu Lam, Dept. of Community Health and Epidemiology.
As well, two experts from the internationally-renowned Cooper Institute for Aerobics Research in Dallas, Texas will assist with the study. President and CEO of research at the institute, Dr. Steven Blair, is a chronic disease epidemiologist and regarded as the world leader in the area of physical activity and chronic disease. Dr. Andrea Dunn is associate director of the institute's Division of Epidemiology and Clinical Applications.
In Canada, where 15 per cent of adults are obese and more than a third are overweight, the most common source of help for this problem is the family doctor. "Family physicians remain the cornerstone of our health care delivery, but they don't have the time or the training to manage lifestyle-based disease by changing people's behaviour," says Dr. Ross. "And physicial inactivity – a primary cause of most cases of obesity – is a behavioural problem."
Recognizing the need to incorporate primary care in this solution, Dr. Ross invited Dr. Godwin to join the research team. As a result of this partnership, two Kingston family medicine centres have agreed to provide space in their clinics for a health educator trained by the research team, who will work with referred patients classified as abdominally obese.
By the end of the randomized study, 250 men and women will have participated in a two-year behavioural-based program aimed at changing their levels of physical activity, and 250 will receive the treatment currently available. The researchers predict that those from the first group will achieve better results in waist circumference and metabolic risk than patients from the "usual care" group.
"The new approach is to look for risk, and eliminate that before the onset of serious problems like heart disease and diabetes," says Dr. Ross. "Hopefully, for the first time we'll have effectiveness-based evidence that physical activity is a cost-effective way to reduce the health risks of obesity. It changes our whole concept of being 'healthy'."