Integrating Systems
and Sectors Toward
Obesity Solutions
PROCEEDINGS OF A WORKSHOP
Emily A. Callahan, Rapporteur
Roundtable on Obesity Solutions
Food and Nutrition Board
Health and Medicine Division
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This activity was partially supported by the Academy of Nutrition and Dietetics; Alliance for a Healthier Generation; American Academy of Pediatrics; American College of Sports Medicine; American Council on Exercise; American Society for Nutrition; Banner Health; Bipartisan Policy Center; BlueCross BlueShield of North Carolina Foundation; Blue Shield of California Foundation; The California Endowment; General Mills, Inc.; Greater Rochester Health Foundation; Intermountain Healthcare; The JPB Foundation; The Kresge Foundation; Mars, Inc.; National Recreation and Park Association; Nemours; Novo Nordisk; Obesity Action Coalition; The Obesity Society; Partnership for a Healthier America; Reinvestment Fund; Robert Wood Johnson Foundation; SHAPE America; Society of Behavioral Medicine; Wake Forest Baptist Medical Center; Walmart; WW International, Inc.; and YMCA of the USA. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-67620-5
International Standard Book Number-10: 0-309-67620-7
Digital Object Identifier: https://doi.org/10.17226/25766
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2021. Integrating systems and sectors toward obesity solutions: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/25766.
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PLANNING COMMITTEE ON INTEGRATING SYSTEMS AND SECTORS TOWARD OBESITY SOLUTIONS1
CHRISTINA ECONOMOS (Co-Chair), Co-Founder and Director, ChildObesity180 and Professor and New Balance Chair in Childhood Nutrition, Friedman School of Nutrition Science and Policy, Tufts University
NICOLAAS (NICO) PRONK (Co-Chair), President, HealthPartners Institute and Chief Science Officer, HealthPartners
SARA BLEICH, Professor of Public Health Policy, Harvard T.H. Chan School of Public Health and Carol K. Pforzheimer Professor, Radcliffe Institute for Advanced Study
GISELLE CORBIE-SMITH, Kenan Distinguished Professor of Social Medicine, Director of Center for Health Equity Research, and Professor of Internal Medicine, University of North Carolina at Chapel Hill
SARA CZAJA, Professor of Gerontology in Medicine and Director of the Center on Aging and Behavioral Research, Weill Cornell Medical College
APRIL OH, Senior Advisor for Implementation Science and Health Equity, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health
DANIEL E. RIVERA, Professor of Chemical Engineering and Program Director of the Control Systems Engineering Laboratory, Arizona State University
Health and Medicine Division Staff
LESLIE J. SIM, Roundtable Director (through December 2020)
HEATHER DEL VALLE COOK, Roundtable Director
AMANDA NGUYEN, Program Officer
MEREDITH YOUNG, Research Associate
CYPRESS LYNX, Research Associate
ZARIA FYFFE, Senior Program Assistant
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteur and the institution.
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ROUNDTABLE ON OBESITY SOLUTIONS1
NICOLAAS (NICO) PRONK (Chair), HealthPartners Institute and HealthPartners, Bloomington, Minnesota
CHRISTINA ECONOMOS (Vice Chair), Tufts University, Boston, Massachusetts
IHUOMA ENELI (Vice Chair), American Academy of Pediatrics, Columbus, Ohio
SHARON ADAMS-TAYLOR, The School Superintendents Association, Alexandria, Virginia
KATIE ADAMSON, YMCA of the USA, Washington, DC
JAMY D. ARD, Wake Forest University, Winston-Salem, North Carolina
DANIELLE BERMAN, Food and Nutrition Service, U.S. Food and Drug Administration, Washington, DC
ROBIN P. BLACKSTONE, University of Arizona, Phoenix, Arizona
HEIDI MICHELS BLANCK, Centers for Disease Control and Prevention, Atlanta, Georgia
JEANNE BLANKENSHIP, Academy of Nutrition and Dietetics, Washington, DC
SARA N. BLEICH, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
DON W. BRADLEY, Duke University, Durham, North Carolina
HEIDI F. BURKE, Greater Rochester Health Foundation, Rochester, New York
JAMIE BUSSEL, Robert Wood Johnson Foundation, Princeton, New Jersey
MERRY DAVIS, BlueCross BlueShield of North Carolina Foundation, Durham, North Carolina
JENNIFER FASSBENDER, Reinvestment Fund, Philadelphia, Pennsylvania
AMENDA FISHER, Walmart, Betonville, Arkansas
GARY D. FOSTER, WW International, Inc., New York, New York
DAVID D. FUKUZAWA, The Kresge Foundation, Troy, Michigan
ALLISON GERTEL-ROSENBERG, Nemours Children’s Health System, Washington, DC
MARJORIE A. INNOCENT, National Association for the Advancement of Colored People, Baltimore, Maryland
JOHN JAKICIC, University of Pittsburgh, Pennsylvania
ELIZABETH A. JOY, Intermountain Healthcare, Salt Lake City, Utah
SCOTT I. KAHAN, The George Washington University, Washington, DC
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteur and the institution.
PETER T. KATZMARZYK, Pennington Biomedical Research Center, Baton Rouge, Louisiana
CATHERINE KWIK-URIBE, Mars, Inc., Germantown, Maryland
THEODORE KYLE, The Obesity Society, Pittsburgh, Pennsylvania
LISEL LOY, Bipartisan Policy Center, Washington, DC
KELLIE MAY, National Recreation and Park Association, Ashburn, Virginia
MYETA M. MOON, United Way Worldwide, Alexandria, Virginia
STEPHANIE A. MORRIS, SHAPE America, Reston, Virginia
JOSEPH NADGLOWSKI, JR., Obesity Action Coalition, Tampa, Florida
MELISSA NAPOLITANO, The George Washington University, Washington, DC
PATRICIA NECE, Obesity Action Coalition, Tampa, Florida
MEGAN NECHANICKY, General Mills, Inc., Minneapolis, Minnesota
BARBARA PICOWER, The JPB Foundation, New York, New York
SUE P. POLIS, National League of Cities, Washington, DC
AMELIE G. RAMIREZ, Salud America!, San Antonio, Texas
TOM RICHARDS, American Council on Exercise, San Diego, California
NANCY ROMAN, Partnership for a Healthier America, Washington, DC
SYLVIA ROWE, SR Strategy, LLC, Washington, DC
LAURIE STRADLEY, Alliance for a Healthier Generation, Asheville, North Carolina
SUSAN Z. YANOVSKI, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
LESLIE ZOLOV, Novo Nordisk, Washington, DC
Health and Medicine Division Staff
LESLIE J. SIM, Roundtable Director (through December 2020)
HEATHER DEL VALLE COOK, Roundtable Director
AMANDA NGUYEN, Program Officer
MEREDITH YOUNG, Research Associate
CYPRESS LYNX, Research Associate
ZARIA FYFFE, Senior Program Assistant
ANN L. YAKTINE, Director, Food and Nutrition Board
Food and Nutrition Board Liaison
SHIRIKI KUMANYIKA, Drexel University, Philadelphia, Pennsylvania
Consultant
WILLIAM (BILL) H. DIETZ, The George Washington University, Washington, DC
Reviewers
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings, nor did they see the final draft before its release. The review of this proceedings was overseen by SHARI BARKIN, Vanderbilt University Medical Center. She was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteur and the National Academies.
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Contents
Organization of This Proceedings
2 OVERVIEW OF SYSTEMS SCIENCE THEORIES, APPROACHES, AND APPLICATIONS
Overview and History of Systems Science
Systems Thinking to Understand and Improve Population Health
Applications of Systems Science: Context, Causality, and Communities
3 COMPLEX SYSTEMS IN SOCIETY AND THE CONTEXT FOR OBESITY
Power Dynamics and Structural Racism: Insights from Critical Race Theory
Social Networks and Relationships
4 IMPACTING COMPLEX SYSTEMS THAT CAN INFLUENCE OBESITY
Engaged and Participatory Systems Thinking
A Systems Science Approach to Education and Health
Humanistic Systems Science to Foster Behavior Change
Obesity-Related Opportunities for Systems Change in Communities
5 EXAMPLES FROM THE FIELD: APPLYING SYSTEMS THINKING TO POPULATION HEALTH ISSUES
Design of Multilevel Interventions for Obesity
Lessons from Community-Based Obesity Prevention in Australia
D BIOGRAPHICAL SKETCHES OF WORKSHOP SPEAKERS AND PLANNING COMMITTEE MEMBERS
Boxes and Figures
BOXES
1-1 Workshop Statement of Task
2-1 Key Terms Used in the Workshop
FIGURES
2-1 Map of measurable factors that drive obesity
2-4 The complex tobacco landscape
2-5 The first AIDS network graphic
2-6 Example of an organizational systems map
3-1 The triangular relapse pattern in health behavior change over time
3-2 Example of local, personal social networks with the potential to influence obesity risk