Systems and Obesity Advances and Innovations for Equitable Health and Well-Being: Proceedings of a Workshop—in Brief (2022) / Chapter Skim
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Proceedings of a Workshop - in Brief
Proceedings of a Workshop - in Brief
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These efforts culminated in the development of a causal systems map of obesity drivers and solutions, he said, to guide the field toward datadriven obesity solutions and innovative approaches.3 Pronk highlighted the map's three priority areas -- structural racism and social justice, biased mental models and social norms, and effective health communication -- and explained that these areas were identified primarily by using a framework developed by Donella Meadows, which depicts potential places to intervene in a system as a taxonomy of 1 See https://www.nationalacademies.org/our-work/addressing-structural-racism-bias-and-health-communications-as-foundationaldrivers-of-obesity-a-workshop-series (accessed January 10, 2022)
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Lee contended, "We have to start somewhere, even if initial efforts provide only partial solutions to the problem; the iterative nature of systems modeling will gradually enable better understanding and in turn, better solutions." The second speaker, Ryan Masters, assistant professor of sociology and faculty associate of the Population Program and the Health and Society Program in the Institute of Behavioral Science at the University of Colorado Boulder, stated that characterizing the relationship between obesity and mortality risk at the individual level is a major challenge, but it can be informed by examining population death rates from cardiometabolic diseases. He shared data indicating that since 1990, trends of decreasing death rates from cardiometabolic diseases among middle-to-older aged adults have begun to flatten,5 presumably driven by prolonged exposure to the rising 4 Meadows, D
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Despite the role of obesity-related mortality in fueling the gap, Masters emphasized the difficulty of empirically demonstrating that BMI classifications of obesity or other individual-level indicators of obesity translate into elevated mortality risk. Related to this challenge, Masters referenced a systematic review and meta-analysis indicating that mortality rates were similar between populations with obesity and populations with low BMI, and also that individual-level mortality risk was lowest among people with BMIs in the overweight category;7 as well as a call for researchers to put forth better metrics than BMI to investigate the individual-level association between obesity and mortality.8 These publications spurred a new era of proposed indices, Masters observed, that use measures of body size, shape, mass, and adiposity distribution to more accurately assess metabolic health and corresponding mortality risk.
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that perpetuate poverty and poor health. This approach to pursuing population health equity, Saha said, builds community assets and resilience and is a more efficient way to address health inequities than focusing solely on individual or even environmental determinants of health.
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The roundtable hosts workshops for ongoing public dialogue among leaders and voices from diverse sectors and industries and develops National Academy of Medicine (NAM) Perspectives that reflect on issues and opportunities for advancing obesity solutions.10 Dietz submitted that the roundtable's current focus on structural racism, bias, mental models, and health communication is sound, but it faces the challenge of inspiring the members to take action.
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Pronk elaborated on this concept of shared value by describing an example of three key sectors -- public health, health care, and business and industry -- organizing around a framework of shared values including equity, harm prevention, ethical principles, science, and practical wisdom as they pursue policy or programmatic initiatives. As an example of a multisector systems change initiative, Pronk mentioned providing health insurance coverage of obesity prevention and treatment options, such as bariatric surgery, in a way that provides benefit for all stakeholders (health plans, employers, and government)
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and other organizations to address systemic racism and obesity through policy changes to improve access to obesity care for people from diverse communities. With regard to biased mental models and norms, he suggested that future roundtable meetings would be helpful to explore a positive reframing of weight bias.
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Multiple challenges to obesity care exist in health care settings, she began, such as incomplete insurance coverage for evidence-based treatments, medically induced causes contributing to obesity or impaired treatment (e.g., medications that promote weight gain) , lack of appropriately sized clinic equipment and devices to accommodate patients of all sizes, lack of clinician time and training to perform obesity care services, and clinicians' biased attitudes toward patients with obesity.
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Sarwer raised the concern that despite bariatric surgery being a highly effective treatment for obesity -- often producing weight losses far greater and more durable than those seen with lifestyle modification and pharmacotherapy -- only about 1 in 100 patients who meet BMI criteria undergo these procedures.14 He said that the underuse of bariatric surgery reflects issues of health insurance coverage and benefits design, weight bias and stigma, and patient– provider communication. Sarwer explained that despite expansion of insurance coverage for bariatric surgery procedures over the past decade, patients' access may be hampered by extensive documentation requirements, precertification criteria such as 3 to 6 months of preoperative medical weight management, and costs of expenses that accumulate during a bariatric surgery experience such as visit copays, transportation or parking fees, and childcare expenditures.
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Sim, National Academies of Sciences, Engineering, and Medicine served as the review coordinator. SPONSORS: This workshop was partially supported by the Academy of Nutrition and Dietetics; Alliance for a Healthier Generation; American Academy of Pediatrics; American Cancer Society; American College of Sports Medicine; American Council on Exercise; American Society for Nutrition; Blue Shield of California Foundation; General Mills, Inc.; Intermountain Healthcare; JPB Foundation; Kresge Foundation; Mars, Inc.; National Recreation and Parks Association; Nemours; Novo Nordisk; Obesity Action Coalition; Partnership for a Healthier America; Reinvestment Fund; Robert Wood Johnson Foundation; SHAPE America; Society of Behavioral Medicine; Stop & Shop Supermarket Company; The Obesity Society; University of Pittsburgh Medical Center; Wake Forest Baptist Medical Center; Walmart; and WW International.
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