 So Barr's professor of psychiatry and behavioral science, he's developing and evaluating innovative electronic and computer-assisted programs to make treatments that have been proven effective for treating various lifestyle and psychosocial problems more cost-effective and more available. So these include prevention programs for obesity in college-aged women and in older adolescents. You just saw he recently collaborated with Mikhail Kirnan and hopefully this meeting and these presentations will spark even more of those collaborations. Take it away, Barr. Thanks. Thank you very much, Chris. It's I'm delighted to be here and it's a privilege to reconnect with a lot of folks that I haven't seen for a while. So thank you very much. I'm going to speak quickly and cover a fair amount of territory because I really want to leave you with a general idea of what I think a new opportunity to begin to approach obesity from a public health standpoint. I really live in two worlds, well, many worlds. But one, I do a lot of work with eating disorder prevention and also with obesity. And over the past five years, I've noticed a shift in the world of school work that I do that has actually allowed us to begin to synthesize what really are joined messages about healthy weight regulation has made my work a lot easier. So essentially, a little bit of background. I've worked for the past 15 years in dozens of schools, involved thousands of students, a main focus on healthy weight regulation and including eating disorder prevention, as Chris had mentioned. I think the goals are pretty obvious to what we would, I think you would all understand these. I don't need to go through them. But here's a message that I think is important because I get a lot of concern from the eating disorder world. I think a message is quite unequivocal that healthy weight regulation practices and recommendations for weight maintenance and loss as needed do not increase eating disorders. I'm not going to go through the database for this, but it's really important because, as you all know, we get a lot of criticism when we go into schools even trying to get weights and people say, well, this is going to create problems. It's a myth. It's not true. So in fact, I think the opposite is really what is important that you can combine eating disorder and obesity prevention. There's a co-occurrence of these diagnoses, overweight increase the risk for eating disorders. Integrating eating disorder and obesity programs is practical. We can do it at reduced costs. There's a unified message to students that minimizes risk of unintentional harm. There's a lot of areas of overlap including media literacy use, body acceptance, healthy eating, and exercise. So we have an ambitious agenda in trying to then deal with not only the issues of obesity, weight loss, maintenance, prevention of eating disorders, but also more generally body acceptance and not stigmatizing students as we provide an array of programs to schools. And I think there's an urgent need for inexpensive, easily disseminated, effective school based online weight and shape improvement obesity and eating disorder prevention programs. That's the end of my talk, but I want to give you a little bit more. I'd actually like to see us expand in schools from the need for math and English education to including two other streams. One is to look at healthy weight regulation and the other one is to look at emotional regulation as part of what is I think the schools that see as a burden but I think is a great opportunity to really turn around what's happening in this country. But in order to do that, we have to be able to provide effective, inexpensive, easily disseminated techniques that are appealing to schools. And it's a challenge. But this is how we think of it. Here's the population I'm interested in, ninth grade students. And if you're interested in the discussion, we can talk about why ninth grade. But we really have focused on this particular age group. So these are all the students in the school. Now, people say, well, yeah, but the internet already does this. But the little tiny blob in the middle of this shows you what happens if you go and ask kids in schools whether they're having access to what are many wonderful programs available for healthy weight regulation on the internet. It's a little tiny number. We want to get all the kids because this is the population that we want to focus on. And it's a very different type of approach if you define the population as pretty much all the kids in a school. So our basic approach is that we've started with women at risk for any disorders. We use 18, 16 online programs use cognitive behavioral things. We generally include online discussions. And we've done various themes in moderation. The programs are pretty boring actually and given by current standards of graphics and so forth and not all that compelling. But just give you an idea of what they look like. But we do make them personal and interactive. And I won't go through the summary of these, but we've now done studies with thousands of students, many controlled trials all over the world. Essentially, we have good effect sizes for preventing eating disorders. So the next challenge was really what do you do about obesity prevention and how do you integrate these together? So we developed a new program called Stain Fit. So we took student bodies, we expanded it to provide universal healthy weight regulation practices. And then we've done studies and beginning studies in this area. It's very exciting to be here because this is actually a bit of a preliminary work for us. So without going through this, a part of the issue has been how to make interactive monitoring tools that kids in schools can use. This is a previous draft. We've actually gotten a little bit better at with our current one, which we kind of focus on. Stain between starving and stuffed. And we have simple ways for kids to monitor what they're doing. So we have and continue to develop these monitoring tools. In a previous study that was done by a Megan Jones here at Stanford, we showed that in a study collected from the community with overweight kids, we were able to get a pretty good sustained weight loss at a year's follow-up. And we replicated this study with someone else. So we were optimistic that the approach for a highly selected group, using some of the new monitoring tools and some of our, we think, our fresh ideas for approaching this problem would be useful. And the next challenge was then to go into schools. So we did a study last year at Woodside High School. This is kids on their duff. You can see that they had been exercising. We stole them and put them in front of their computers. But the point I wanted to make is that these are a low Hispanic population. Maybe the kids of Dr. Stafford were talking about. They've actually been engaged in these particular programs. And we can run a very large number of kids with our volunteer staff. Here it is in action. 400 students in which we are simultaneously providing the intervention to a large number of kids. And we'll do it again on Monday, because amazingly enough, the schools actually wanted us back again. So we have looked at a number of measures, and this is a measure of engagement. The way we design our programs is we wrap around them a lot of information. Because our general direction of where we want to go is to make these whole things a very interactive, dynamic, and organic. So that programs within schools unfold over time. Because we think it's been a bit of a mistake to develop one particular program and offer it to all schools, given the enormous differences among schools, individuals, and populations. So we have to find ways to have programs that will be exciting for those populations. And I'll tell you a little bit about how we're thinking about doing this. This just shows you, at Woodside, we have in the blue line a decrease in kids completing the log. There's a problem. But for those who did, an increase in fruit, and vegetables, and beans, we looked at there were decrease in red foods. And there is some indication, in a very small sample, if you look at the bar graph to the right, that, and this is for all of the kids in the school, that there was a mean decrease in BMI over the course of the intervention last year. And we also replicated this with an African-American population in St. Louis with some of our other colleagues. So these very small effect sizes, 0.2 in the public health world, when we can make a difference of 0.2 spread across large populations, we're very happy. So we're astounded by these results. I wouldn't take them as definitive until we do proper studies. But we're excited in part because the general population increased a little bit. So it wasn't simply report. It was a convergent with what we'd expect in that population. And very consistent with what we had seen in our control populations. Fortunately, we're also doing a number of studies in Australia and elsewhere to begin to look at these in more large control populations. But let me tell you really what I think is exciting for us and next steps. We want to get 50,000 students in 12, 12 to 13. And I think it's possible, actually, because in the old days when Joel Killen, a lot of other folks and Larry and others would go to schools and try to do any sort of prevention program in schools, we'd basically get a big yawn. About a year ago when we went to schools and said we would like to introduce an internet-based program for schools, we've actually found a lot of excitement for actually unfortunate reasons. There's a huge decrease in physical activity in a lot of the schools. There's the curriculum of stuff. They don't have time to do this yet. Still state guidelines that needs to be done. But the good news is we found a receptivity that has been very positive. So we think it will be possible to recruit students. And what we want to do then is to create a database for a dynamic population modeling, in which we begin to think of we're moving a population towards goals. So if you think of the way we've tended to do these population modeling in the past, we use moderators and mediators. But as many of you know, with unfolding new statistical models in what's called adaptive populations, it becomes possible with a large number of individuals monitored reasonably frequently over a long period of time to begin to look within population. And I think really we need to use different kinds of designs to move us ahead. So we've done the moderator, mediator analysis. We don't need to worry about that. Just to show you how we can make kind of cool graphs. And from that, we've identified groups, which again, I don't think we need to go into. But this is the point that I want to make. If you look on the left, we now have models where we can look within a population. And we've also developed an authoring tool so we can begin to change programs very rapidly within schools. We can actually change a program while it's occurring in the school. And we can reauthor it and offer it again within that school within a month's period of time to try to begin to mold a program that fits the particular needs and interests. And once you have done that with that particular skeleton, we can begin to, we also, by the way, stratify populations in schools. So we use risk factors and develop a set of programs. And I saw that Debbie Belfance is in the group with Wes Ellis and Megan Jones and others actually doing this at Stanford, where we're offering a set of programs based on needs. So the kids don't actually know which program they may be involved with. But simultaneously, they're giving something of general messages, but maybe specific to their needs. So we have various models to do it. But this is what we see happening over time, essentially, that within populations and schools emerge a series of programs that could be effective. And then once we have the skeleton, we can do things like adding games. There are many, many games out there that are very interesting for kids. I know that Tom has some resources to begin to look at these games. We need to begin to add combinations of virtual reality and social networks. Given the structure we have with our core program, we can plop these into them to make them more exciting. We didn't need a lot more stealth activities. I need to add that as another graph. We're beginning to look at apps and ways to add apps to these particular programs. And then I want to emphasize the need to combine with environmental activities as a community. We see all we have is a very small effect skeleton of which we begin to add muscles, maybe not fat, to an order to create a model that would be very appealing to schools. So we do sub-studies where we begin to look at combined things for activities. So that's where we're going. 50,000 kids, we want to get a whole bunch of schools. Hopefully many of you will help us with these activities over the coming years and participate in our work. So thank you very much. The preceding program is copyrighted by the Board of Trustees of the Leland-Stanford Junior University. Please visit us at med.stanford.edu.