Systems science and obesity policy: a novel framework for analyzing and rethinking population-level planning.

OBJECTIVES: We demonstrate the use of a systems-based framework to assess solutions to complex health problems such as obesity. METHODS: We coded 12 documents published between 2004 and 2013 aimed at influencing obesity planning for complex systems design (9 reports from US and Canadian governmental or health authorities, 1 Cochrane review, and 2 Institute of Medicine reports). We sorted data using the intervention-level framework (ILF), a novel solutions-oriented approach to complex problems. An in-depth comparison of 3 documents provides further insight into complexity and systems design in obesity policy. RESULTS: The majority of strategies focused mainly on changing the determinants of energy imbalance (food intake and physical activity). ILF analysis brings to the surface actions aimed at higher levels of system function and points to a need for more innovative policy design. CONCLUSIONS: Although many policymakers acknowledge obesity as a complex problem, many strategies stem from the paradigm of individual choice and are limited in scope. The ILF provides a template to encourage natural systems thinking and more strategic policy design grounded in complexity science.

Health communication cards as a tool for behaviour change.

Individuals seeking healthcare treatment in the context of obesity often experience difficulty engaging in discussions around their health and face challenges finding consensus with practitioners on care plans that best suit their lives. The complex set of biological, social, and environmental variables that have contributed to the higher prevalence of obesity are well illustrated in the foresight obesity system map. Effectively understanding and addressing key variables for each individual has proven to be difficult, with clinicians facing barriers and limited resources to help address patients' unique needs. However, productive discussions inspired by patient centered care may be particularly effective in promoting behaviour change. Tools based on systems science that facilitate patient centered care and help identify behaviour change priorities have not been developed to help treat adult obesity. This project created and pilot tested a card based clinical communication tool designed to help facilitate conversations with individuals engaged in health behaviour change. The health communication cards were designed to help direct conversation between patients and healthcare providers toward issues relevant to the individual. Use of the cards to facilitate patient driven conversations in clinical care may help to streamline conversations, set realistic care plan goals, and improve long term rates of compliance.

Obesity, Complexity, and the Role of the Health System.

As obesity continues to increase throughout the world, there is still no well-defined solution to the issue. Reducing obesity poses a significant challenge for the health care system because it is a complex problem with numerous interconnections and elements. The complexity of obesity challenges traditional primary care practices that have been structured to address simple or less complicated conditions. Systems thinking provides a way forward for clinicians that are discouraged or overwhelmed by the complexity of obesity. At any given level, individuals matter and system functioning is optimized when our capacity is well matched to the complexity of our tasks. Shifting paradigms around the causes of obesity is essential for creating a health care system that promotes innovative and collaborative practice for healthcare practitioners and individuals dealing with obesity.

Getting from analysis to action: framing obesity research, policy and practice with a solution-oriented complex systems lens.

Public policy aimed at reducing obesity is just one of many avenues that must be pursued to address the still-growing obesity pandemic. The complexity of the problem is illustrated in ecological frameworks and system maps of the determinants. These conceptual maps illustrate the complexity by acknowledging the influence of many different factors such as social norms and values; sectors of influence such as the food and beverage industries, media and transportation; behavioural settings including home and family, school and community; and individual factors such as genetics, psychosocial and other personal elements. But to solve such a complex problem, we need to move from an analysis of the determinants or causes of the problem to a solution orientation; the frameworks used to describe the problem may not be the right ones for building the "best" solutions. Solution-oriented frameworks, like those presented by Hobbs and Seeman, have been based on parameters such as the sector of influence (e.g., public policy) but would benefit from the consideration of complexity and the leverage points for intervention in complex systems, which are a function of parameters such as the structure of relationships and the presence or absence of feedback loops.