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Developing a Partnership for Change: The National Collaborative on Childhood Obesity Research

      Rising obesity rates in the U.S. over the past several decades, particularly among children and adolescents, led to an increased focus on research addressing obesity prevention and public- and private-sector initiatives on healthy eating and physical activity. Groups conducting prevention initiatives recognized that their ability to achieve and sustain cross-sector environmental, policy, and systems-level solutions was hampered by limited evidence in those areas. In 2007, the Centers for Disease Control and Prevention, NIH, and the Robert Wood Johnson Foundation began to discuss forming a partnership that could accelerate progress to prevent childhood obesity by coordinating research and evaluation agendas and collaboratively building an evidence base. This paper describes the formation, structure, and operations of the National Collaborative on Childhood Obesity Research, the resulting partnership between the Centers for Disease Control and Prevention, NIH, the Robert Wood Johnson Foundation, and since 2010, the U.S. Department of Agriculture. It includes a discussion of lessons learned from, and benefits of, this collaborative model.

      Introduction

      At the close of the 20th century, rates of obesity in the U.S. were rising across most states. Particularly concerning was the documented increase in the rates of childhood obesity since the 1970s.
      • Ogden C.L.
      • Flegal K.M.
      • Carroll M.D.
      • Johnson C.L.
      Prevalence and trends in overweight among U.S. children and adolescents, 1999–2000.

      Ogden CL, Carroll MD. Prevalence of obesity among children and adolescents: United States, trends 1963–1965 through 2007–2008. Health E Stats. www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.htm. Published June 2010.

      Between 1976–1980 and 1999–2000, obesity increased from 5.0% to 10.4% among preschool children aged 2 to 5 years and from 6.5% to 19.6% among those aged 6 to 11 years. During the same time period, obesity increased from 5.0% to 18.1% among adolescents aged 12 to 19 years.
      In response to this public health problem, the focus on obesity research increased and a number of new initiatives across many public and private organizations were launched. In 2003, NIH, the leading federal agency that supports biomedical research, released its first trans-NIH strategic plan for obesity research,
      • Spiegel A.M.
      • Alving B.M.
      Executive summary of the strategic plan for the National Institutes of Health Obesity Research.
      which was followed by initiatives addressing the prevention and control of obesity among children and pregnant women. Similarly, the Centers for Disease Control and Prevention (CDC), the nation’s leading public health agency, responded to President Bush’s 2003 Healthier U.S. Initiative with Steps to a Healthier U.S., a major public health investment to prevent and manage asthma, type 2 diabetes, and obesity.
      • Nichols P.
      • Ussery-Hall A.
      • Griffin-Blake S.
      • Easton A.
      The evolution of the Steps program, 2003–2010: transforming the federal public health practice of chronic disease prevention.
      In October 2004, the U.S. Department of Agriculture (USDA) held its first obesity prevention conference,
      • Hurst M.D.
      USDA Obesity-prevention conference targets research.
      which focused attention on applied human nutrition and food research needs.
      The research and practice communities increasingly agreed that they had complementary needs—that practice and research needed to inform each other. Private and nonprofit sectors also became engaged in obesity efforts,

      Alliance for a Healthier Generation. www.healthiergeneration.org/about_us/our_story/. Accessed September 15, 2017.

      Convergence Partnership. www.convergencepartnership.org/about-convergence/who-we-are. Accessed October 1, 2017.

      which complemented the federal government’s activities. In 2005, the Robert Wood Johnson Foundation (RWJF), the largest domestic health-oriented philanthropy, funded initiatives to rapidly assess programs and policies and supported research initiatives addressing the prevention of childhood obesity, including efforts to advance healthy eating (Healthy Eating Research)

      Healthy Eating Research. http://healthyeatingresearch.org/who-we-are/about-us/. Accessed October 1, 2017.

      and increase everyday physical activity (Active Living Research).

      Active Living Research. http://activelivingresearch.org/aboutus. Accessed October 1, 2017.

      However, the ability for these initiatives to achieve effective cross-sector solutions (Figure 1) was hampered by the fact that applied obesity prevention research focused on the influences of environmental- and systems-level factors was in its early stages. These issues were first discussed in a focused way among researchers in the public and private sectors in a workshop held in June 2007, and those discussions led to the development of the model shown in (Figure 1).
      • McKinnon R.A.
      • Orleans C.T.
      • Kumanyika S.K.
      • et al.
      Considerations for an obesity policy research agenda.
      Figure 1
      Figure 1Obesity policy research topic areas.
      Source: McKinnon RA, Orleans CT, Kumanyika SK, et al. Considerations for an obesity policy research agenda. Am J Prev Med. 2009;36(4):351–357. doi:10.1016/j.amepre.2008.11.017.
      In 2007, RWJF provided early and substantial impetus to these discussions by committing $500 million to childhood obesity prevention over 5 years. This commitment provided a catalyst for the three major funders of childhood obesity research, RWJF, NIH, and CDC, to discuss a formal collaboration in this area. The thinking was that, working together, these funders could identify research priorities, coordinate research agendas, and build a stronger evidence base to accelerate progress efficiently and rapidly. An initial analysis of CDC, NIH, and RWJF childhood obesity prevention research and practice investments showed that, together, these portfolios were beginning to address determinants and outcomes across multiple sectors and the full social ecologic model—from biological research to applied home, health care, school, and other community-based interventions, and across population-level policy, environmental, and economic factors (Figure 2).
      Figure 2
      Figure 2Socio-ecologic model.
      Source: Caprio S, Daniels SR, Drewnowski A, et al. Influence of race, ethnicity, and culture on childhood obesity: Implications for prevention and treatment: A consensus statement of Shaping America’s Health and the Obesity Society. Diabetes Care. 2008;31(11):2211–2221. doi:10.2337/dc08-9024. License to use.
      The concept for a formal collaboration was further informed by a number of national and international calls to action that outlined research gaps and opportunities, including reports from the National Academy of Medicine
      and WHO.
      WHO
      Obesity: Preventing and Managing the Global Epidemic Report of a WHO Consultation, WHO Technical Report Series 894.
      Subsequent events and initiatives supported these calls to action. For example, the American Recovery and Reinvestment Act of 2009 provided substantial funding for CDC initiatives that encouraged community-based health improvement programs.

      National Center for Chronic Disease Prevention and Health Promotion, CDC. Community based interventions 2010–2013. Brief Executive Summary. Atlanta, GA: CDC. www.cdc.gov/nccdphp/dch/programs/communitiesputtingpreventiontowork/pdf/community-based-interventions-executive-brief-update.pdf. Accessed March 3, 2017.

      In 2010, then First Lady Michelle Obama launched the Let’s Move initiative,

      Let’s Move. https://letsmove.obamawhitehouse.archives.gov/. Accessed September 15, 2017.

      which placed a spotlight on the importance of promoting healthy eating and increased physical activity among children and their families.
      This article describes the development of the National Collaborative on Childhood Obesity Research (NCCOR), which emerged from these events and discussions. The article addresses the seldom documented operational approaches that are necessary to build and sustain a dynamic and effective public–private research funding partnership. The authors describe the formation and the structure of NCCOR, explain how the Collaborative operates currently, and note the significant benefits of this partnership model. The accomplishments of NCCOR in building the field of childhood obesity prevention research are described in a companion publication.
      The Writing Group for the National Collaborative on Childhood Obesity Research (NCCOR)
      A national collaborative for building the field of childhood obesity research.
      Detailed information about NCCOR activities can be found on the NCCOR website.

      National Collaborative on Childhood Obesity Research. www.nccor.org. Accessed March 3, 2017.

      The focus is on the details of creating this Collaborative, which is designed to facilitate, coordinate, and expand the childhood obesity work of the NCCOR partners. This work aims to advance research that identifies solutions-based approaches to preventing and controlling the childhood obesity epidemic. This focus was selected because NCCOR has been repeatedly approached by researchers within public and private organizations about the details and chronology of how NCCOR was created and has been maintained. Many of these queries have come from researchers seeking best approaches for addressing other large-scale and complex public health problems, such as drug addiction or health equity, and looking for detailed information on effective models for public–private partnerships. This article characterizes the following key aspects of creating an effective organization structure for this partnership: detailed planning to align with member organizations, defining mission and goals, establishing a managerial infrastructure, ensuring active communication, facilitating early products, building strength through capital, and expanding capacity through strategic alliances.

      Formation Of NCCOR

      In 2007, CDC, NIH, and RWJF began to explore the idea of a partnership to support research and evaluation and how they could be applied to tackle the childhood obesity epidemic. These three organizations were likely partners: they had collaborated successfully on the Youth Tobacco Cessation Collaborative, a similar national-level research collaboration,
      • Orleans C.T.
      • Arkin E.B.
      • Backinger C.L.
      • et al.
      Youth Tobacco Cessation Collaborative and National Blueprint for Action.
      and worked together in the past on nutrition, physical activity, and obesity-related initiatives, including initiatives to enhance relevant health-monitoring systems. The staff within these organizations understood the value and operational strategies required for effective collective action to address entrenched public health problems and had experience generating and communicating research evidence and evidence-based practice guidelines that were nationally influential.
      CDC, NIH, and RWJF began by each identifying scientific leads, who were engaged in guiding their organization’s research, to form a planning committee. This committee developed a vision statement and discussed common research priorities across the organizations that could build upon the strengths of each organization. Several leading national researchers also were engaged in early meetings
      • Nichols P.
      • Ussery-Hall A.
      • Griffin-Blake S.
      • Easton A.
      The evolution of the Steps program, 2003–2010: transforming the federal public health practice of chronic disease prevention.
      that identified major research needs and gaps stemming from the dearth of published literature on interventions and strategies with promise for reversing the childhood obesity epidemic. This planning phase was central to the success of NCCOR, ensuring that staff across the organizations and leading national childhood obesity prevention researchers familiar with critical research gaps and needs became well informed about each organization’s differing missions and goals and how their research initiatives and funding priorities reflected those goals. Early in 2008, the planning committee met with senior CDC, NIH, and RWJF leadership to make the case for the scientific agenda that would become the NCCOR focus. They presented a rationale for a collaborative, proposing that it could:
      • build the nation’s capacity for multilevel integrated research to examine the potential effects of individual, sociocultural, economic, environmental, and policy forces that influence eating behaviors, physical activity, and obesity at the population level, with special attention to the needs of high-risk priority populations (e.g., low-income groups and racial and ethnic subpopulations) in which childhood obesity rates were highest and rising fastest;
      • increase the effectiveness of research, translation, dissemination, and evaluation initiatives across participating organizations through coordination to reduce redundancy and ensure attention to priority needs;
      • enhance capacity for rapid translation and dissemination of effective interventions in obesity prevention at the population level; and
      • achieve greater and more rapid impact than would be possible through individual efforts.
      The committee carefully considered the full range of research relevant to childhood obesity and determined a focus on research areas most closely aligned with the intersection of the mission focus for the three partners. Because of that alignment across missions, the group chose not to include clinical, pharmacologic, or basic research as part of this collaborative. Instead, the Collaborative focused on research to explore the environmental, policy, and system-level factors influencing childhood obesity prevention.
      In addition to clarifying the collaborative purpose and research focus, another significant planning decision was the three partners agreeing to the need for a third party to act as a coordinating center for the Collaborative, a practice that had proven invaluable in the Youth Tobacco Cessation Collaborative.
      • Orleans C.T.
      • Arkin E.B.
      • Backinger C.L.
      • et al.
      Youth Tobacco Cessation Collaborative and National Blueprint for Action.
      Furthermore, in 2009 the three original organizations involved in the partnership developed a memorandum of understanding that established the processes for working together in the Collaborative. This memorandum of understanding has been amended as needed to include the fourth organization, USDA, and to detail the criteria for engaging in strategic alliances on specific projects with other organizations.

      Defining the Mission and Goals

      With strong support from CDC, NIH, and RWJF leadership in relevant parts of the agencies, the planning committee met over several months to share their organization’s specific strategic priorities in childhood obesity research, collectively define the most pressing research needs, and identify the Collaborative’s roles in developing the evidence required to guide and catalyze effective national efforts to halt and reverse the rise in U.S. childhood obesity levels (and specifically to address disparities in prevalence and tolls on health). These early discussions led to efforts to map research funding investments to identify gaps and complementarity, which helped in the development of a shared mission statement and goals for action, and laid the groundwork for building an actionable field of childhood prevention research.
      NCCOR was formally launched in February 2009 with three partners—CDC, NIH, and RWJF. Its mission was to improve the efficiency, effectiveness, and application of childhood obesity research and to halt—and reverse—the current childhood obesity trend through enhanced coordination and collaboration. The initial four goals of the Collaborative were items (1–4) listed below and in 2011, as part of ongoing strategic planning and the recognition that solutions to effectively address childhood obesity prevention needed to engage partnerships outside of health-related fields, NCCOR developed a fifth goal (Item 5):
      • Identify, design, and evaluate practical and sustainable interventions, especially in high-risk populations and communities.
      • Increase and improve national, state, and local surveillance of childhood obesity.
      • Improve the ability of childhood obesity researchers and program evaluators to conduct research and program evaluation.
      • Provide national leadership to accelerate implementation of evidence-informed practice and policy and to seek to engage other public and philanthropic funders with potential to advance these core goals.
      • Work with non-traditional health partners to integrate childhood obesity priorities with synergistic initiatives (e.g., environmental design and sustainability, food systems, food marketing, disabilities, or economics).

      Expanding the Partnership

      In initial developmental discussions, senior leadership within the three partner organizations cautioned that rapid expansion of the Collaborative could limit its effectiveness. However, they also recognized that trans-federal efforts were needed as suggested by the White House report on childhood obesity,
      White House Task Force on Childhood Obesity
      Solving the Problem of Childhood Obesity Within a Generation.
      NCCOR members were aware that the USDA mission had been revised to include, for the first time, childhood obesity prevention. In addition, USDA is a major federal funder of human nutrition research relevant to its programs and the provider of food and nutrition assistance to at-risk populations. Therefore in 2010, the USDA accepted an invitation to join NCCOR. USDA added valuable funding, national research capabilities, and expertise to the collaborative, especially in the areas of food policy, economics, and food systems research; nutrient composition databases; and nutrition surveillance research. Given its unique knowledge of and responsibility for the nation’s food assistance programs, USDA also was in a position to enhance NCCOR’s goals and capacity to address obesity-related issues of those populations most adversely affected by obesity, including low-income and racial and ethnic groups that were experiencing the highest and most rapid increases in childhood obesity and associated increases in diabetes and other adverse consequences.
      Today, NCCOR’s membership across its four partner organizations includes expertise in the fields of nutrition and physical activity science (e.g., applied nutrition, exercise physiology, and nutrition and physical activity surveillance) as well as public health, medicine, psychology, child development, policy, and behavioral research, economic and social sciences, behavioral economics, modeling and systems science, food systems, agriculture, active transport, architecture, and design. NCCOR strategically applies multi- and trans-disciplinary approaches and resources to work together to build an informative research engine and evidence base for reversing the childhood obesity epidemic and reducing its broad and disparate health and economic harms that are addressed with more detail in the companion paper “A National Collaborative for Building the Field of Childhood Obesity Research.”
      The Writing Group for the National Collaborative on Childhood Obesity Research (NCCOR)
      A national collaborative for building the field of childhood obesity research.

      Establishing a Managerial Infrastructure

      An early priority was to establish an infrastructure to guide and coordinate NCCOR’s work. This infrastructure included two entities that have proved to be central to efficient decision making and adoption of new priorities: a Steering Committee, composed of representatives from each partner organization, and a Coordinating Center, housed under contract within a nonprofit human development organization, FHI 360.

      FHI 360. www.fhi360.org. Accessed March 3, 2017.

      The Steering Committee provides strategic guidance, obtains consensus on operational decisions, and coordinates funding for NCCOR functions and activities. Each Steering Committee member is responsible for regularly communicating with and engaging leaders and NCCOR members within their agencies, coordinating the funding for the NCCOR Coordinating Center from their agency, providing updates to their agency leadership, and guiding and managing NCCOR projects as needed.
      The Coordinating Center supports the work of NCCOR through strategic planning (such as surveys of researchers, surveys of members, or interviews with experts); coordination of NCCOR activities (calls, meetings, and workshops); communication (both internal and external); and evaluation (assessing both NCCOR operations and project impact/outcomes).
      In addition, NCCOR established an NCCOR External Scientific Panel (NESP) to ensure that the partners benefited from the guidance of the wider, national childhood obesity prevention research community. NESP members provide suggestions to NCCOR on specific projects, and emerging work; inform NCCOR about new science, research ideas, and connections between extramural research and practice; and serve as a valuable liaison between NCCOR and the extramural research community. NESP members contribute to the ongoing refinement of NCCOR's strategic plan, including helping to establish key performance indicators and other metrics associated with evaluating the impact of the Collaborative. The Steering Committee has developed a strategic plan, with 2- and 5-year objectives, to work toward achieving the goals. The strategic plan is periodically reviewed and updated with member and NESP input.

      Ensuring Active Communication on Mission, Goals, and Activities

      Early in its development, NCCOR recognized that open and continuous communication was key to building both the field of childhood obesity prevention research and a vibrant childhood obesity research community. Managed by the Coordinating Center, NCCOR’s website,

      National Collaborative on Childhood Obesity Research. www.nccor.org. Accessed March 3, 2017.

      e-newsletter, and social media channels have become a national resource of information about childhood obesity research tools, results, and recommendations. Coordinating Center staff work closely with NCCOR partner organizations to present NCCOR’s tools, findings, and recommendations in national meetings and a popular Connect & Explore webinar series, which features leading national and international experts presenting on emerging developments, opportunities, and challenges in childhood obesity prevention research, practice, and policy. The Coordinating Center develops an external communication plan each year and coordinates with communication officers at each partner organization to get input on communication activities and to engage partner communication channels to maximize NCCOR’s reach. In addition, NCCOR’s Coordinating Center maintains internal communications with members and their institutions through regular conference calls, in-person member meetings three times a year, publicly available annual reports, and face-to-face meetings with the senior leaders of its organizational members. These meetings provide a forum for ensuring that NCCOR’s activities are aligned and responsive to NCCOR member organizations’ evolving priorities.

      How NCCOR Works

      As shown in Figure 3, new NCCOR projects go through a comprehensive development process. First, an idea is vetted by a preliminary review by the Steering Committee and then presented to the membership for approval. For a proposal to be considered, at least two NCCOR partners must commit to lead and support the proposed effort. The Steering Committee evaluates its fit with NCCOR’s core mission and goals, the likelihood of success, and the adequacy of available funding. Proposals that satisfy these criteria are endorsed by NCCOR members during member calls, and once approved, the project is advanced by a workgroup of NCCOR members who develop and manage the project. In addition to this NCCOR-wide process, the individual partners have supported the long-term sustainability of this effort by incorporating it as a formal part of their organizational structure. For example, the NCCOR initiative is a formal subgroup of the NIH Obesity Research Task Force, which engages scientific staff working on obesity across NIH. Similarly, CDC has regular internal meetings of CDC staff involved in the NCCOR initiative. Both of these processes have been effective at engaging new scientific staff who can contribute expertise required for NCCOR projects.
      Figure 3
      Figure 3Structural development of NCCOR projects.
      Note: This is intended to reflect the general process for NCCOR-generated activities and projects. Some projects may follow other processes based on strategic, funding, or timing needs.
      NCCOR, National Collaborative on Childhood Obesity Research.
      Early on, member-driven projects focused on initiatives with potential to strategically and rapidly enhance national childhood obesity prevention findings, resources, and capacities. Projects included an easy-to-use registry of valid measures of food intake and physical activity

      NCCOR. Measures Registry. www.nccor.org/nccor-tools/measures. Accessed March 3, 2017.

      and a catalog of local, state, and national surveillance systems useful for tracking progress in childhood obesity and its drivers.

      NCCOR. Catalogue of Surveillance Systems. www.nccor.org/nccor-tools/catalogue. Accessed March 3, 2017.

      These basic and unifying research tools enhanced investigators’ capacity to evaluate the growing number of natural policy experiments within communities working to promote healthy eating and active living for children, families, and organizations by supporting the use of common measures and data sources for systematic cross-study analyses and comparisons.
      In addition to its collaborative work in developing the Connect & Explore webinar series to introduce emerging research challenges and opportunities, NCCOR early efforts addressed the creation of new research funding mechanisms and new areas of research, such as the systems science initiatives Envision and Collaborative Obesity Modeling Network,

      NCCOR. Envision. www.nccor.org/projects/envision. Accessed March 3, 2017.

      a group of interrelated computational and statistical modeling networks designed to estimate the individual and population impact of policies and interventions. NCCOR members also participated in the conceptual design of the National Heart Lung and Blood Institute/NIH Healthy Communities Study, which is examining community programs and policies in more than 130 demographically diverse U.S. communities, with an estimated 5,000 children and their parents participating.

      National Heart, Lung, and Blood Institute. Healthy Communities Study. www.nhlbi.nih.gov/research/resources/hcs. Accessed March 3, 2017.

      In recent years, NCCOR efforts have focused on supporting longer-term initiatives, often with primary funding from one partner organization, but with coordinated and technical input from all NCCOR partners. An example of this is the National Institutes of Child Health and Development’s research initiative, the Global Obesity Prevention Center, which through its rapid response funding mechanism, enabled applicants to capitalize on evaluations of promising policy and environmental changes with the potential to reduce childhood obesity levels and disparities. NCCOR also has funded think tanks, which bring together representatives from diverse disciplines to consider research findings and needs in fields such as retail and food service to address healthy food incentives; behavioral economics–based retail store interventions to nudge healthier food choice; active transport and architectural design to enhance active living; and work within schools, early care, and education centers to enhance healthy eating and active living. Recent NCCOR efforts also have drawn on childhood obesity efforts in other countries to inform innovations within the U.S.

      NCCOR. Lessons learned from global efforts. www.nccor.org/projects/globallessons. Accessed March 3, 2017.

      Building Strength Through Capital

      A defining element of NCCOR’s work as a Collaborative is the concept of capital, that is, the time, resources, assets, and abilities necessary to develop and carry out a project.
      • Lin N.
      Social Capital: A Theory of Social Structure and Action.
      By working collaboratively toward NCCOR goals, NCCOR partners create and strengthen social capital—the relationships and trust that are essential to success. Early efforts to fully understand each partner’s mission focus and priorities were a key driver in the development of the valuable personal and institutional relationships and collaborations created through NCCOR activities. With this social capital as a base, NCCOR members leverage one another’s intellectual, managerial, and financial capital. One benefit of a public–private collaborative like NCCOR is that the presence of private funding has the potential to increase NCCOR’s flexibility and responsiveness, particularly for early work in a field, allowing such public–private partnerships to act quickly and maximize opportunities.
      One key feature of NCCOR’s use of capital is that there is no single or set model, but rather, the different types of capital are applied in flexible combinations. The most efficient funding, management, and implementation structure is used based on the needs and design of the project. However, social capital is the underlying matrix that supports the entire effort, as shown in Figure 4. For example, the Healthy Communities Study (Figure 4A) is funded and managed by the National Heart, Lung, and Blood Institute, and CDC and RWJF contribute intellectual capital, providing suggestions on the proposal and study design, and participating in the study expert advisory group and subcommittees.
      Figure 4
      Figure 4Examples of combining “capital” to suit the needs of specific projects: (A) Healthy Communities Study; (B) Measures Registry; and (C) Healthy Food Incentives Workshops.
      CC, Coordinating Center; CDC, Centers for Disease Control and Prevention; RWJF, Robert Wood Johnson Foundation; USDA, U.S. Department of Agriculture.
      Another example is the Measures Registry. In its early development, all the partners supported the work through the Coordinating Center efforts to coordinate the working group; the RWJF and NIH provided additional funding through other mechanisms to bring in experts and to conduct the review of studies that were included in the Measures Registry. In this effort, NIH and Coordinating Center staff led the workgroup, and CDC, NIH, RWJF, and Coordinating Center staff contributed to the planning, design, implementation, and promotion (Figure 4B).
      NCCOR workshops may configure capital in other ways. For example, the Healthy Food Incentives Workshop: Perspectives from the Field was the first in a series of three workshops NCCOR held in 2014 to review the evidence base for strategies to encourage healthy food purchases among low-income consumers. Results from the workshops were intended to guide the next steps in NCCOR and other national research and evaluation agendas. The workshop series proposal was initiated by CDC with USDA collaborating to lead the project workgroup, which for the first time included experts from the field; NIH and RWJF provided suggestions during the planning process; and the Coordinating Center provided support to the workgroup and then managed the logistics, moderated the workshops, and handled the dissemination of the workshop summaries (Figure 4C). This project was the first NCCOR initiative to directly engage both researchers and practitioners, whose views and experiences provided critical intellectual capital beyond that of partners. Bringing together researchers and practitioners has now become a common tactic in moving the field forward more effectively.

      Expanding Capacity Through Strategic Alliances

      Since NCCOR’s inception, funders have approached the Collaborative with specific project ideas. In 2014, the Collaborative began to explore ways to accommodate funder alliances with non-NCCOR partners for specific projects of interest. The idea behind strategic alliances was to enable NCCOR to thoughtfully expand research in areas aligned with, but not specifically covered by, NCCOR members’ existing activities and funding. NCCOR’s inaugural Strategic Alliance was formed in 2015 with the JPB Foundation. The JPB Foundation supported the use and potential impact of the Measures Registry nationally and internationally by funding the development of four User Guides to help researchers use this research tool, thereby encouraging use of high-quality, comparable measures, and research and analytic methods across childhood obesity prevention studies. The guides also provide case examples and other information about which types of measures are most useful for varied research questions and designs—to enhance the consistency, quality, and comparability of results across diverse studies and program evaluations.

      Lessons from and Benefits of NCCOR’S Model

      Over the 7 years since NCCOR was launched, the Collaborative has gained insights into what it takes to create such a collaborative and what it can deliver. Some key requirements for creating NCCOR included early and sustained investments of time and resources, a careful planning process that identified how to support this new way to work together, shared ownership and openness that emphasizes the application of joint deliberations, and diverse research and practitioner expertise to understand key gaps in the field and identify strategies for addressing them, and on-going support of senior leadership. It took a significant amount of time and level of effort to create a shared vision across these different federal groups and a private organization. The first planning meetings for NCCOR began in May 2007, and the conceptual framework for NCCOR was released in February 2009. The creation of a Coordinating Center has been critical to sustaining NCCOR. This neutral coordinating body also allowed the creation of a shared ownership model and consideration of different ways of working together. Early discussions focused on how to overcome the many barriers to achieving joint funding of initiatives, such as different policies, approval processes, timing and mechanisms for funding of initiatives across the four member organizations, and inability to combine public and private funds to support the same activity. However, as NCCOR partners began to fully consider the actions needed to address specific problems, the Collaborative moved to a more distributed approach to identifying solutions that use the strength of the diverse areas of expertise, research and practice networks, and approaches to funding across the four partners. These new ways of working together took time to establish but were based on iterative joint deliberations and continued efforts to ensure staff with the appropriate expertise were sought to identify best approaches. As the scientific need evolves, this model requires that scientific staff address the implications of changing needs for NCCOR. Similarly, as a partner’s funding and other priorities, leadership, and staff change, there must be mechanisms to negotiate how to evolve roles and relationships, essential to maintaining a strong and relevant Collaborative. Addressing complex multilayered societal and public health problems requires involvement from multiple sectors across society. Public–private partnerships such as NCCOR have been successful in advancing progress in tobacco control
      • Orleans C.T.
      • Arkin E.B.
      • Backinger C.L.
      • et al.
      Youth Tobacco Cessation Collaborative and National Blueprint for Action.
      and may be useful to a number of other large-scale public health problems. Table 2 in the companion “Building the Field” paper describe selected NCCOR accomplishments.
      The Writing Group for the National Collaborative on Childhood Obesity Research (NCCOR)
      A national collaborative for building the field of childhood obesity research.
      The promise of what a collaboration such as NCCOR can deliver encompasses structural elements that ensure flexibility in responding to research needs, the ability to convene research and practice leaders in widely diverse disciplines to both analyze the problems and jointly identify solutions, and an emphasis on working across organizational boundaries and at multiple levels within those organizations. For example, the creation of an accountable Steering Committee that is empowered to make decisions and work across the many components of each partner organization allows the Collaborative and its members to move quickly and nimbly in response to the needs of the field and to develop innovative, cutting-edge initiatives. The communication infrastructure of NCCOR, led through the Coordinating Center, takes advantage of the exceptionally broad and diverse networks of NCCOR members, including researchers, practitioners, decision makers, and other stakeholders. This system has been particularly useful in ensuring wide distribution of and interest in new NCCOR initiatives.
      NCCOR’s model of partnership among leading research and practice funding organizations working to reduce childhood obesity has had several key benefits. Joint planning avoids duplication of effort; allows negotiation seeking to jointly fill gaps; provides strategic opportunities for joint learning (e.g., the many NCCOR-sponsored workshops and Connect & Explore webinar series); optimizes the strategic use and combined impact of pooled expertise and resources (e.g., creation of Surveillance Catalogue and Measures Registry Web resources and supporting more rapid distribution of national nutrition monitoring data); and overall has helped build a much needed field of childhood obesity prevention research and community of researchers.
      NCCOR has made significant contributions to efforts to reduce childhood obesity in the U.S.
      The Writing Group for the National Collaborative on Childhood Obesity Research (NCCOR)
      A national collaborative for building the field of childhood obesity research.
      This unique effort was recognized in 2010 with one of the first Health and Human Services Innovates Awards, which highlights effective public–private partnerships in health and encourages federal staff to build such partnerships. Therefore, NCCOR will continue to strive to provide a sound evidence base for promoting healthy eating and active living among children and families; enhance coordination and collaboration among researchers, investigators, and practitioners; and seek effective approaches that can broaden and accelerate efforts to create a healthy future for all children.

      Acknowledgments

      This article is part of a theme section entitled A Collaborative to Advance Solutions-Oriented Research for Childhood Obesity, which is sponsored by the Centers for Disease Control and Prevention (contract # 200-2016-F-90988 ) and National Institutes of Health (contract # GS-00F-0007M ), Agencies of the U.S. Department of Health and Human Services , as well as the Robert Wood Johnson Foundation (grant # 72463 ). The findings and conclusions in this publication are those of the authors and do not necessarily represent the official position of the National Institutes of Health, the Centers for Disease Control and Prevention, the U.S. Department of Health and Human Services, or the Robert Wood Johnson Foundation.
      The Writing Group for the National Collaborative on Childhood Obesity Research (NCCOR): Rachel M. Ballard, MD, MPH, Anne B. Rodgers, MA, Laura Kettel Khan, PhD, C. Tracy Orleans, PhD, Elaine Arkin, MS, and Todd M. Phillips, MS.
      Funding was obtained from NIH, Bethesda, MD (Ballard) ; FHI 360, Washington, DC (Rodgers, Phillips) ; Centers for Disease Control and Prevention, Atlanta, GA (Kettel Khan) ; and Robert Wood Johnson Foundation, Philadelphia, PA (Orleans, Arkin) . All authors have contributed substantially to the work of the NCCOR. Ballard and Rodgers were the primary authors of this paper. All other authors contributed to the conceptualization of the paper, critically reviewed the manuscript, and approved the final manuscript as submitted.
      We wish to acknowledge the contributions of Jay Variyam, one of the USDA NCCOR co-chairs, for his helpful review and suggestions. In addition, we wish to acknowledge the contributions of LaVerne Canady, who assisted in the conceptualization of the paper, and Amanda Samuels and Yanelis Valdes for their work to develop the figures and obtain necessary permissions for published figures that are used in this paper.
      The accomplishments of NCCOR are made possible by the many members of NCCOR. A list of the membership can be found on the NCCOR website (www.nccor.org).
      No financial disclosures were reported by the authors of this paper.

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