1

Introduction

A series of three virtual workshops, Translating Knowledge of Foundational Drivers of Obesity into Practice, was held April 19, July 25, and October 25, 2022, by the Roundtable on Obesity Solutions, Health and Medicine Division, National Academies of Sciences, Engineering, and Medicine. The goals of the workshop series were to explore (1) gaps in knowledge regarding the foundational drivers of obesity (health communication, structural racism, and biased mental models and social norms [described in detail below]), (2) future research in evidence-based obesity solutions, and (3) potential strategies for translating current evidence into action. Workshop presentations explored possible avenues for addressing evidence gaps, potential agents of change and solutions-oriented actions, and strategies for assessing progress toward implementing obesity solutions; the statement of task for the workshop series is presented in Box 1-1.¹

The April workshop examined connections between obesity and health communication, structural racism, and biased mental models and social norms, as well as their interactions with academic and workforce structures, to uncover practical strategies for intervention. The July workshop focused on community engagement, with special attention to the relevance and impact of power within communities for implementing obesity solutions. In exploring barriers to and opportunities for solutions at the community level, it highlighted examples of community initiatives emphasizing

___________________

¹ The workshop series agendas, presentations, and other materials are available at https://www.nationalacademies.org/our-work/translating-knowledge-of-foundational-drivers-of-obesity-into-practice-a-workshop-series.

the intersection of obesity with health communication, structural racism, and bias and stigma. The October workshop focused on methods for assessing progress toward addressing structural drivers of obesity. Presentations explored innovative approaches and performance indicators that could be used to gauge progress in obesity solutions, as well as strategies for holding leaders and decision makers accountable.

INTRODUCTORY REMARKS

Nicolaas (Nico) Pronk, president of HealthPartners Institute; chief science officer at HealthPartners, Inc.; and professor of social and behavioral science at the Harvard T.H. Chan School of Public Health, opened the April workshop by welcoming participants and providing a brief overview of the roundtable.² He explained that the roundtable engages leaders and voices from diverse sectors and industries (e.g., academia, government, public health and health care, business, finance, media, education, child care, philanthropy, nonprofit) to help solve the nation’s obesity crisis. Through meetings, public workshops, reports, five innovation collaboratives, and other workgroups, he continued, the roundtable provides a venue for ongoing dialogue on critical and emerging issues in obesity prevention, treatment, and management. It applies a policy, systems, and environmental change lens; focuses on sustainable, equitable strategies for addressing obesity-related disparities; and explores and advances effective solutions.

___________________

² Pronk and roundtable vice chair Christina Economos opened the April workshop, while roundtable vice chair Ihuoma Eneli opened the July and October workshops. Similar background and contextual information was provided at the beginning of each workshop.

Pronk then introduced Christina Economos, dean ad interim, professor, and New Balance chair in childhood nutrition at the Friedman School of Nutrition Science and Policy at Tufts University and co-chair of the workshop series planning committee, to provide background and context for the workshop series. Economos explained that the workshop series was designed to build on a strategic planning process initiated by the roundtable in 2020. That process entailed using a systems-oriented approach to identify priority areas for obesity solutions and potential areas of exploration for the roundtable’s workshops and activities, she recounted, which culminated in a causal systems map depicting both the drivers of and evidence-based solutions for obesity. This map was used to determine cross-cutting priority topics—health communication, structural racism, and biased mental models and social norms—topics that the roundtable has since pursued. Economos characterized these topics as deep leverage points that could bring about lasting, systems-wide change. The systems map includes additional deep leverage points, she added, including social determinants of health—such as poverty, housing, employment, stress, and environments—that do not support health-promoting lifestyle behaviors.

Economos further described the process used to develop the roundtable’s causal systems map of obesity drivers and solutions (Figure 1-1). The effort began with group model-building exercises, which she explained were designed to engage group members in a participatory, iterative process that drew on the members’ knowledge and expertise, facilitated a shared understanding of the problem, and resulted in a map reflecting the drivers of obesity’s incidence and prevalence, as well as their interdependencies and interrelationships.

The group also decided to identify and map potential obesity solutions, Economos said, which added another layer to the systems map. Solutions were prioritized using the Meadows framework, developed by scholar Donella Meadows to rank solutions to a given problem based on leverage points—intervention points in a system at which meaningful change can be made (Meadows, 1999; see Figure 1-2). Recognizing the importance of identifying the right leverage points, Economos explained, the roundtable ultimately decided to focus on those deepest in the system, which were believed to hold the greatest potential for effecting systems-wide change. Those leverage points, she reiterated, were health communication, structural racism, and biased mental models and social norms. Few interventions exist that address those leverage points, Economos pointed out, but she expressed hope that the roundtable’s work on exploring potential solutions and innovative approaches could help fill that gap.

Economos went on to explain that the roundtable has worked to disseminate the new paradigm of applying a systems approach to the prevention and treatment of obesity through a series of public workshops.

She recounted that in 2020, three workshops provided an introduction to systems science and approaches, such as modeling, that could be applied to the development of obesity solutions. Three workshops held in 2021, she continued, took a deeper dive into the three priority areas of health communication, structural racism, and biased mental models and social norms. The goal of the 2021 series, she elaborated, was to explore data-driven solutions and innovative approaches leveraging the relationships among these three priority areas as foundational drivers of obesity, as well as to identify systems change applications and actions for the future. The goal of the 2022 workshop series, she concluded, was to explore how to fill evidence gaps in these three areas and translate that knowledge into actionable solutions.

ORGANIZATION OF THIS PROCEEDINGS

This proceedings follows the order of the workshop agendas (Appendix A). The April 2022 workshop, “Shifting the Paradigm: Targeting Structures, Communications, and Beliefs to Advance Practical Strategies for Obesity Solutions,” is summarized in Chapters 2 through 5. That workshop began with an introductory session focused on shifting the paradigm (Chapter 2) and included sessions on academic and workforce structures that dismantle systemic racism while building an evidence base (Chapter 3),

the effect of communications on perceptions and understanding of obesity (Chapter 4), and strategies for changing the conversation around representation in media and body image (Chapter 5).

The July 2022 workshop, “Engaging Communities in Addressing Structural Drivers of Obesity,” is chronicled in Chapters 6 through 9. That workshop’s introductory session reviewed causes of and contributors to obesity and how community systems change can effect obesity solutions (Chapter 6). This was followed by sessions on power dynamics and community as complex systems in relation to obesity (Chapter 7), the role of community dynamics in power and engagement (Chapter 8), and promising initiatives for building community power and improving health (Chapter 9).

The October 2022 workshop, “Defining Progress in Obesity Solutions through Structural Changes,” is covered in Chapters 10 through 13. That workshop began with a stage-setting presentation on the science, strengths, and limitations of body mass index as a measure (Chapter 10), which was followed by sessions on progress in obesity solutions in political, economic, environmental (Chapter 11), health care (Chapter 12), and sociocultural (Chapter 13) systems.

Appendix A provides agendas for the three workshops, Appendix B is a list of acronyms used in this proceedings, and Appendix C contains biographical sketches of the workshop series planning committee members and speakers at the three workshops.