Research Led by Ammara Aqeel Offers New Approach in Combating Childhood Obesity

Fifth-year Ph.D. student Ammara Aqeel’s research uses genomics to verify dietary intake and amplify the efficacy of intervention programs targeting childhood obesity.

A new food-is-medicine approach in the form of grocery stipends combined with dietitian guidance holds potential for improving the dietary quality of children with obesity, according to a new paper published in Obesity. What’s more, the study used a novel genomics-based method, FoodSeq, to confirm that the foods purchased were indeed eaten by the participants. 

“We could actually see that the participants were consuming the groceries that were delivered to their house. That’s one of the biggest gaps between a food-as-medicine intervention and the actual outcomes that are reported,” says Ammara Aqeel, lead author of the paper. “You could argue that if participants are getting free food, they are incentivized to report better outcomes. But that exact gap is what dietary genomics helped us fill.”

The month-long study comprised 33 participants, ages 6 to 11 years old, whose body-mass indexes were in the 95th percentile or greater for their age. All participants and their caretakers received four weeks of intensive health behavior and lifestyle treatment (IHBLT), but the intervention group was also provided with groceries worth $25 per person (or up to $100 for a family of four or more), which were selected under the guidance of a registered dietitian. 

Participant questionnaires indicated improved eating patterns in general and in comparison to the control group. While previous studies have shown similar dietary improvements through food-is-medicine initiatives, these results rely on subjective dietary recalls that are prone to bias and memory error. FoodSeq, which amplifies and sequences residual food DNA, offers an objective and independent method to verify the self-reports.

“In the questionnaire, we saw this significant and comprehensive shift across all variables: increased fiber intake, increased whole grain intake, marginally increased fruits and vegetables.  We saw significant decreases in sugar and added sugars,” Aqeel explains. “The biggest question in my mind was: Is this shift actually happening or is it just being reported as such on this questionnaire? The FoodSeq results really bridged this gap by showing a significant correlation between foods we found in participant’s stool samples and what was purchased in grocery orders. The groceries really were being eaten, and the outcomes were rooted in a real behavioral change.”

FoodSeq also provides researchers with a means to standardize findings across cohorts, even when the studies vary in their questionnaires, sample size, study structure, and other variables. “When you start speaking in the language of DNA, it’s like a conversation between cohorts and samples that wasn’t possible before. Questions that were very difficult to ask suddenly become the natural next step,” Aqeel says.

Follow-up longitudinal studies with larger cohorts will help verify the positive impact of this pilot, which combines elements of existing interventional strategies, namely the financial support of programs like SNAP and the dietary counselling of IHBLT.

“I think this is possibly better than the financial incentives that we already have because you don’t know what kinds of foods recipients are buying with those benefits. So, the money is already there, but we are proposing that it be used in a more defined way that we have now shown works,” Aqeel says. While the dietitian-guided aspect of this food-is-medicine initiative would be an added cost, Aqeel believes the approach can be further refined through future studies to minimize such additional costs.

“This was a pilot, so we used the best practice possible, but there are definitely ways to overcome that. You could look at what the dietitian has recommended to 30 different families and then draw out the major patterns and design a pre-filled grocery cart based on those recommendations,” Aqeel says, adding that some studies have already implemented this type of strategy with college students and other adults. “I believe that we could have a similar approach for children.”

“We’re very excited to see now that this technique will be used in future pediatric studies to answer similarly challenging questions in pediatric health and nutrition,” she adds.

Aqeel is a fifth-year Ph.D. student in the Department of Molecular Genetics and Microbiology at Duke University. Her research focuses on the social and environmental modulators of diet, a dynamic relationship she studies at both the individual and community levels. Through her work, Aqeel hopes to elucidate the complex connections between diet and environment in a way that will transform public health strategies.