Incorporating Systems Science Principles into the Development of Obesity Prevention Interventions: Principles, Benefits, and Challenges

Abstract

Systems modeling represents an innovative approach for addressing the obesity epidemic at the community level. We developed an agent-based model of the Baltimore City food environment that permits us to assess the relative impact of different programs and policies, alone and in combination, and potential unexpected consequences. Based on this experience, and a review of literature, we have identified a set of principles, potential benefits, and challenges. Some of the key principles include the importance of early and multilevel engagement with the community prior to initiating model development and continued engagement and testing with community stakeholders. Important benefits include improving community stakeholder understanding of the system, testing of interventions before implementation, and identification of unexpected consequences. Challenges in these models include deciding on the most important, yet parsimonious factors to consider, how to model food source and food selection behavior in a realistic yet transferable manner, and identifying the appropriate outcomes and limitations of the model.

Multi-Level, Multi-Component Approaches to Community Based Interventions for Healthy Living—A Three Case Comparison

“…The community engagement process in the case of B’More Healthy Communities for Kids was conducted through policy working groups, sequential workshops, and multiple trainings of community implementers (e.g., small store owners, youth leaders, etc.) that were designed to provide adaptation and sustainability of the intervention components [13]. …”

“…Significant effort has gone into interventions in key community institutions, such as schools [2,3,4], pre-schools [5,6], worksites [7,8] and food stores [9,10], with some tangible results. Studies using “the settings approach” as defined in the Ottawa charter [11] have been able to show effects on food acquisition and consumption [12,13], as well as on physical activity [14]. However, interventions in single settings/institutions tend to rely on intensive short-term activities, and may have limited sustainability.…”

A systems approach to obesity

“…70 The GOPC's Baltimore Project (B'More Healthy Communities for Kids 71,72 ) has taken a systems approach to try to stem rising rates of obesity among early adolescents in some of Baltimore's low-income neighborhoods. The interest in this age group emerged from the finding that early adolescence (between the ages of 10 and 14 years) is 1 of the 3 developmental periods during which youth are likely to experience rapid weight gain.…”

“…In Baltimore, GOPC Members developed the Baltimore Low Income Food Environment (BLIFE) model, 72 an ABM representing low-income inner-city neighborhoods that have been designated as food deserts (i.e., locations with relatively low access to healthy foods and beverages) and their early adolescent inhabitants. For example, the GOPC team developed the BLIFE model to aid Baltimore City policy makers and stakeholders in exploring the factors leading to obesity among schoolage children.…”

Translating research into prevention of high-risk behaviors in the presence of complex systems: definitions and systems frameworks

“…Another approach, organizational network analysis, has already proven highly relevant to T4 translation and can improve our understanding of the adoption and implementation of evidence-based interventions [74]. Similar to system dynamics, agent-based modeling can be used to test combinations of efficacious intervention strategies in silico, improving our understanding of potential effectiveness prior to costly real-world implementation [75][76][77]. A National Institutes of Health (NIH) collaborative, the Initiative on the Study and Implementation of Systems, funded to understand tobacco control as a system and assess the value of systems methods concluded: BIntegration and synthesis of systems approaches are key to a systems thinking environment for tobacco control, moving toward a more adaptive system that changes public health outcomes.…”