How do you help a class of undergraduate students learn that obesity is a complex problem that cannot be solved with the simple message of “eat less, move more”? Previously I blogged about a class experiment I used to illustrate the effects of health halos on our perceptions about the caloric value of a meal. While students left class with a greater understanding of the complexity of our food environment, the next challenge was for me to help them apply this knowledge. How did this experiment change students’ approaches to developing solutions that will work within a complex system?
In our next class, I asked students to brainstorm interventions centered on the “Food Consumption” cluster of the Foresight Obesity Map that would improve health and reduce obesity. Students previously received introductory lectures on complex systems (similar to the recent public lecture given by my supervisor Dr. Diane Finegood, the 2010/2011 recipient of the E.W. Crampton Award). We equipped them with a five level intervention framework (Figure 1) developed by our research group(1) that is based on Donella Meadows’ 12 places to intervene in a complex system.(2)
At the highest level, a paradigm shift (e.g. a widespread shift away from blaming personal choices as the cause of obesity) will have the greatest impact on the system. However, it is difficult to change the underlying deeply held beliefs that direct the behaviours of the players within the system. It is easier to implement changes in the structural elements of the system (e.g. limit trans fat in food, create segregated cycling lanes), but these actions may have limited effects on the system as a whole. Students were also provided with a background on developing solutions to complex problems: the importance of supporting individuals, helping match capacity to complexity, setting functional goals, distributing decisions, actions, and authority, establishing networks and teams, fostering competition and creating feedback loops.(3, 4)
Armed with these tools, what solutions did students propose? A theme common to many of the ideas was education: on nutrition, portion sizes, label reading, and cooking skills. Other suggestions included subsidizing healthier food options and using scare tactics. As a class, we looked at each suggestion in the context of the strategies for solving complex problems described above.
The strength of education is that it has the potential to improve an individual’s capacity. The suggestion to include nutrition programming each year in elementary and high school curriculae would teach children the skills to navigate confusing food labels and assess appropriate portion sizes. A key limitation to this approach is that the food environment remains complex, and too often, although we “know better”, we fall prey to its challenges (such as health halos).
One group of students proposed an interesting twist – turn the challenge of making healthy choices into a game based in the classroom. Throughout the week, reward healthy choices (e.g. eating a serving of vegetables, walking to school, etc…) with a sticker or star and tally up at the end of the week for a larger reward. Instead of just working individually, children would work in teams within the class, and the team as a whole would receive a reward. This would foster both competition, between the children as individuals, and cooperation, as children in each team would support and encourage each other. Additionally, focussing on behaviours not outcomes, follows the guidelines for setting functional goals. Keeping track of the behaviours also creates a new feedback loop to help children be more aware of their habits. Expanding the game to include family members or through social networks could have the potential to engage whole communities.
While the results of our brainstorming session are unlikely to “solve obesity”, each student left class not only with strategies useful for solving complex problems, but more importantly, a shift in their own perceptions about obesity, its causes and solutions. Many of these students plan to persue careers as health care providers (physicians, physical and occupational therapists, kinesiologists, etc…) and I hope that these perspectives will guide their future interactions with patients and clients.
Malhi, L., Karanfil, O., Merth, T., Acheson, M., Palmer, A., & Finegood, D. (2009). Places to Intervene to Make Complex Food Systems More Healthy, Green, Fair, and Affordable Journal of Hunger & Environmental Nutrition, 4 (3), 466-476 DOI: 10.1080/19320240903346448
2. Meadows, D. (1999). Leverage Points – Places to Intervene in a System. The Sustainability Institute http://www.sustainabilityinstitute.org/pubs/Leverage_Points.pdf
3. Bar-Yam, Y. (2004). Making Things Work: Solving Complex Problems in a Complex World. United States of America: NECSI – Knowledge Press. http://necsi.edu/publications/mtw/
4. Finegood, D.T., T.D.N. Merth, & H. Rutter. (2010). Implications of the Foresight Obesity System Map for Solutions to Childhood Obesity. Obesity 18 (Suppl 1): S13-S16. doi:10.1038/oby.2009.426