Thinking in Circles About Obesity
By Vicky Schubert
Regardless of what kind of legislation results from the torrid healthcare battle being waged on Capitol Hill, one notable outcome of the process has been a shift in our awareness of the obesity epidemic that has engulfed the U.S. in the last two decades.
Whether heightened awareness translates into behavio
r change sufficient to reverse the trend will depend on our ability to understand the complex causal relationships driving this shared crisis. Our chances of achieving that kind of behavior-changing understanding got a little better last month with the publication of Thinking in Circles About Obesity, by system dynamicist Tarek Hamid of the Naval Postgraduate School.
Engaging and thorough, Hamid suggests that the solutions to the obesity epidemic need to be as nuanced as the problem, entailing "a whole lot more than food-pyramid images or a new nutritional guideline." The systems thinking perspective he offers highlights the fatal flaws in our commonly held assumptions about energy balance--the dynamic equation between the calories we consume and the energy we expend--and provides practical leverage points for breaking the vicious cycles that are fueling the crisis.
There is no shortage of data documenting the dimensions of the problem. According to the Centers for Disease Control and Prevention (CDC), over a 20-year period, obesity in American adults has increased by 60%, and obesity in children has tripled. With two-thirds of U.S. adults officially overweight (measured in body mass index, or BMI)--and 30% of those obese--rampant weight gain has emerged as the major healthcare crisis of the day, contributing to many lethal conditions including cardiovascular disease, certain types of cancer, and type 2 diabetes. In a study published earlier this year in the journal Health Affairs, it was estimated that over the last 10 years, the annual medical costs associated with obesity in this country have ballooned from about $78 billion a year to around $147 billion.
As Hamid documents in Thinking in Circles, the environmental, physiological, and behavioral causes that have spiraled out of control in such a short time are many and complex. Some obvious factors often cited in the popular media, such as decreased activity levels and increased consumption of high-fructose corn syrup, offer a variety of possible intervention points. But the highest leverage actions will be focused at the structural level, on prevention rather than remediation, as reflected in the CDC's recommendations for policy-level prevention strategies.
This is where Hamid's work is most insightful, emphasizing the importance of underlying mental models and informed choice in managing our health before problems arise--especially in the formulation of childhood nutrition practices. Pointing to studies that show encouraging results from early intervention, Hamid notes, "targeting children allows us to intervene before obesity-promoting behaviors have become well ingrained."
In his discussion of prevention measures, Hamid suggests that we can bolster children's natural propensity for systems thinking and equip them to manage their own nutritional health through play. Using computer games and other experiential learning methods, children are capable of profoundly changing the way they think about themselves in relation to energy and food.
And even without the aid of simulations, children are more able to regulate their own food intake than we might believe. Hamid helps us see how, as parents and caregivers, we tend to fall prey to the "Shifting the Burden" systems archetype, making what we think are healthy choices on our children's behalf. By mistakenly assuming that children are incapable of choosing wisely, we shift the burden of nutritional responsibility to ourselves and rob them of developing the fundamental cognitive skills they'll need to manage their health in our absence.
Also known as the "Addiction" archetype, this pattern lies at the root of many other situations in which people turn to "quick-fix" solutions to solve deep-seated issues--substance abuse, gambling, workaholism, just to name a few. One clear lesson from this book is that our job is not to impose better choices on our children, but to model healthy behavior and support their ability to make good decisions. That's the kind of systems thinking that will have far-reaching implications not just for our healthcare policies and insurance costs, but for our society as a whole.
Vicky Schubert is marketing director at Pegasus Communications.