Why we struggle to make progress in obesity prevention and how we might overcome policy inertia: Lessons from the complexity and political sciences.
Luc Louis HagenaarsLaura A SchmidtJoost Oude GroenigerMarleen P M BekkerFleur Ter EllenEvelyne de LeeuwFrank J van LentheKaren M Oude HengelKarien StronksPublished in: Obesity reviews : an official journal of the International Association for the Study of Obesity (2024)
Despite evidence for the effectiveness of policies that target obesogenic environments, their adoption remains deficient. Using methods and concepts from complexity and political science (Stock-and-Flow analysis and Punctuated Equilibrium Theory) and a qualitative literature review, we developed system maps to identify feedback loops that hinder policymaking on mitigating obesogenic environments and feedback loops that could trigger and sustain policy change. We found numerous self-reinforcing feedback loops that buttress the assumption that obesity is an individual problem, strengthening the biomedical and commercial weight-loss sectors' claim to "ownership" over solutions. That is, improvements in therapies for individuals with obesity reinforces policymakers' reluctance to target obesogenic environments. Random events that focus attention on obesity (e.g., celebrities dismissing soda) could disrupt this cycle, when actors from outside the medical and weight-loss sector (e.g., anti-weight stigma activists) successfully reframe obesity as a societal problem, which requires robust and politically relevant engagement with affected communities prior to such events taking place. Sustained prioritization of policies targeting obesogenic environments requires shared problem ownership of affected communities and nonhealth government sectors, by emphasizing cobenefits of policies that target obesogenic environments (e.g., ultraprocessed food taxation for raising revenue) and solutions that are meaningful for affected communities.
Keyphrases
- weight loss
- bariatric surgery
- public health
- insulin resistance
- roux en y gastric bypass
- weight gain
- metabolic syndrome
- gastric bypass
- high fat diet induced
- healthcare
- mental health
- type diabetes
- systematic review
- randomized controlled trial
- adipose tissue
- body mass index
- glycemic control
- case report
- obese patients
- hiv aids
- social media
- social support
- human immunodeficiency virus
- hiv infected
- antiretroviral therapy
- risk assessment
- molecular dynamics simulations
- body weight