We need a whole systems approach to tackle obesity

25 January 2016 | Policy

Bruce Y LeeDr Bruce Y. Lee is Director of the Global Obesity Prevention Center and Associate Professor of International Health at Johns Hopkins Bloomberg School of Public Health.

Obesity has become a truly global problem. No longer is obesity simply a high-income country or adult problem. All ages and nearly all countries are at risk. Today, obesity is starting earlier and earlier in childhood, making the far-reaching psychological, behavioural, social, economic and health effects all the more substantial.

Although many solutions have been offered and tried during the past three decades, none seem to be reversing this global epidemic. In fact, with each passing year, the epidemic continues to spread worldwide, with no clear change in sight. Obviously we need new approaches and strategies.

Obesity is the result of a range of factors

A major challenge is that obesity results from a complex system of policy, economic, environmental, social, behavioural and physiological factors and relationships. Changing only parts of the system may have little effect or, even worse, unintended consequences. For example, introducing certain exercise programmes or diet foods can actually increase caloric consumption. Even when changing parts of the system have positive effects, the benefits are usually not sustainable. It’s like replacing a single small part, when an entire engine is malfunctioning.

Fix the entire system, not just parts of it

We need to address this enduring problem by figuring out how each factor, component, process and stakeholder fits together and then finding win-win solutions that actually fix the system. A solution won’t work if major stakeholders - such as governments or manufacturers - are not on board.

Think of how so many of the greatest challenges of the past century have been overcome. Space travel, tracking weather systems and connecting the world by communications resulted from systems approaches - an understanding of the entire system and leveraging the widest range of expertise available - including disciplines new to addressing the challenge (such as engineering and computer science), and key stakeholders working together to find mutually beneficial solutions.

How a systems approach works

Systems approaches have been key to tackling major problems in the past and to transforming many fields and disciplines such as meteorology, air traffic control, transportation, communications, finance, and manufacturing. Computational simulation modelling is one method that can facilitate systems approaches. Unaided, the human brain can process only a limited number of relationships and amount of information at a time. Without assistance, we may be able to see simpler cause and effect relationships but often miss more complicated and subtle relationships and effects. Computational models can provide that assistance. Think (if you can) about what meteorology was like before the use of computational simulation modelling. Weather maps are essentially generated by computational models that bring together and integrate disparate information and data (eg. temperatures, barometric pressure, cloud cover, ocean levels and tides, wind speed and direction) from many different sources to help us better understand weather systems. Before such models, people had to rely on much more guesswork and could not see far beyond the current day and immediate horizon.

Our Global Obesity Prevention Center (GOPC) is developing and utilising techniques such as systems mapping and modelling to better understand and address the complex systems that are causing obesity. Simulation models can help decision makers such as funders, policymakers, health officials, and businesses identify key targets and areas where more data is needed as well as test the effects of different possible obesity-prevention policies and interventions in the “safety” of a computer before implementing them in the real world. All of this in turn will help make more informed and strategic decisions.

Global problems require global approaches

A major part of a systems approach to obesity prevention and control is a global approach. Communities, cities and countries are increasingly interconnected via food, trade, financial, transportation, media, and communications systems. Any factor, change, policy or intervention within one portion of society can have worldwide reverberations. Recall how quickly social and behavioural norms can go “viral”. Therefore, tackling the obesity epidemic requires communities, countries and stakeholders to cooperate and learn from each other. World Cancer Research Fund International’s policy database, NOURISHING, is a good resource for countries that are looking to learn from policies being implemented elsewhere. Experts, stakeholders and projects from around the world need to work together to develop and implement innovative, organised systems strategies to control obesity on a global level.

Obesity results from a complex system


Simply telling people to eat less and exercise more will not address the obesity epidemic. We are all deeply influenced by the systems around us – for example, you can’t eat healthy food if you don’t have ready access to healthy food. Let’s join together to tackle obesity - and the systems leading to obesity.

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Dr Bruce Y. Lee | 25 January 2016

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