Using Systems
Applications to Inform
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 supported in part 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; Blue Cross and Blue Shield of North Carolina Foundation; General Mills, Inc.; 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; and YMCA. 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: 978-0-309-68172-8
International Standard Book Number-10: 0-309-68172-3
Digital Object Identifier: https://doi.org/10.17226/25900

Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

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Printed in the United States of America

Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2021. Using systems applications to inform obesity solutions: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/25900.

PLANNING COMMITTEE ON USING SYSTEMS APPLICATIONS TO INFORM OBESITY SOLUTIONS¹

CHRISTINA ECONOMOS (Co-Chair), Co-Founder and Director, ChildObesity180; 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; Chief Science Officer, HealthPartners, Inc.; and Adjunct Professor, Harvard T.H. Chan School of Public Health

JAMY D. ARD, Professor, Department of Epidemiology and Prevention and Department of Medicine, Wake Forest University Baptist Medical Center

SARA CZAJA, Professor of Gerontology in Medicine, Weill Cornell Medicine

BRUCE Y. LEE, Professor, Health Policy and Management, City University of New York Graduate School of Public Health; Executive Director, Public Health Informatics, Computational, and Operations Research

DOUGLAS LUKE, Irving Louis Horowitz Professor in Social Policy and Director of the Center for Public Health Systems Science, Washington University in St. Louis

DAVID MENDEZ, Associate Professor, Department of Health Management and Policy, University of Michigan School of Public Health

DANIEL RIVERA, Professor of Chemical Engineering and Program Director of the Control Systems Engineering Laboratory, Arizona State University

STELLA YI, Assistant Professor, Department of Population Health, New York University Grossman School of Medicine

Health and Medicine Division Staff

LESLIE J. SIM, Roundtable Director (through December 2020)

HEATHER DEL VALLE COOK, Roundtable Director

AMANDA NGUYEN, Program Officer

CYPRESS LYNX, Research Associate

MEREDITH YOUNG, 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, Inc., Bloomington, Minnesota

CHRISTINA ECONOMOS (Vice Chair), ChildObesity180 and 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

ELLEN BECKJORD, UPMC Health Plan, Pittsburgh, Pennsylvania

ROBIN P. BLACKSTONE, University of Arizona, Phoenix

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

DEBBIE I. CHANG, Blue Shield of California Foundation, San Francisco

MERRY DAVIS, Blue Cross and Blue Shield of North Carolina Foundation, Durham

JENNIFER FASSBENDER, Reinvestment Fund, Philadelphia, Pennsylvania

AMENDA FISHER, Walmart, Rogers, Arkansas

GARY D. FOSTER, WW International, New York, New York

DAVID FUKUZAWA, The Kresge Foundation, Troy, Michigan

TODD GALATI, American Council on Exercise, San Diego, California

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

MONICA VALDES LUPI, The Kresge Foundation, Troy, Michigan

KELLIE MAY, National Recreation and Park Association, Ashburn, Virginia

STACY MOLANDER, Partnership for a Healthier America, Washington, DC

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, Alexandria, Virginia

MEGAN NECHANICKY, General Mills, Inc., Minneapolis, Minnesota

COURTNEY P. PAOLICELLI, Food and Nutrition Service, U.S. Department of Agriculture, Alexandria, Virginia

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, Arnold, Maryland

NANCY E. 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 PLATT ZOLOV, Novo Nordisk, Plainsboro, New Jersey

Health and Medicine Division Staff

LESLIE J. SIM, Roundtable Director (through December 2020)

HEATHER DEL VALLE COOK, Roundtable Director

AMANDA NGUYEN, Program Officer

CYPRESS LYNX, Research Associate

MEREDITH YOUNG, Research Associate

ZARIA FYFFE, Senior Program Assistant

ANN L. YAKTINE, Director, Food and Nutrition Board

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 RUSSELL R. PATE, University of South Carolina. He 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

1 INTRODUCTION

Introductory Remarks

Organization of This Proceedings

2 THE PROMISES AND PITFALLS OF SYSTEMS SCIENCE APPROACHES: A PRACTITIONER’S PERSPECTIVE

3 EXPLORING THE USEFULNESS OF SYSTEMS SCIENCE APPROACHES FOR STAKEHOLDERS IN DIFFERENT SECTORS

The Business and Private Sector: Project Play

Panel and Audience Discussion

Communities: Baltimore, Maryland

Panel and Audience Discussion

Policy Makers: SALURBAL

Panel and Audience Discussion

4 REFLECTIONS ON USING SYSTEMS SCIENCE APPLICATIONS TO INFORM OBESITY SOLUTIONS

Reflections and Discussion of Next Steps

Panel and Audience Discussion

Final Reflections

REFERENCES

APPENDIXES

A WORKSHOP AGENDA

B ACRONYMS AND ABBREVIATIONS

C BIOGRAPHICAL SKETCHES OF WORKSHOP SPEAKERS AND MODERATORS

D GLOSSARY

Boxes and Figures

BOXES

1-1 Workshop Statement of Task

2-1 Quotes About the Roles of Qualitative Maps and Group Models

3-1 Eight Strategies of Sport for All, Play for Life: A Cross-Sector Framework for Action for Youth (aged 12 and younger)

4-1 Additional Systems Science Resources

4-2 Potential Future Directions for Systems Modeling Efforts

FIGURES

2-1 Comparison of characteristics of three simulations approaches to systems science modeling

2-2 The “possibility frontier” of reliable modeling

2-3 Work in progress for ReThink Health

3-1 Lifetime benefits of physical activity

3-2 Benefits to residents of active communities

3-3 U.S. costs averted annually by increasing levels of children’s participation in physical activity

3-4 Comparing the impact of key model variables on change in obesity prevalence in Baltimore City

3-5 Example of a causal loop diagram developed by participants in a policy stakeholder workshop in Latin America

3-6 Causal loop diagram created during the TransMiCable group model-building workshop and updated based on stakeholder interviews following the workshop

4-1 The complex context of health disparities and obesity: health as a continuum of biological and social factors across the lifespan