Citerank: (10) 352797Definitive evidence is often difficult to obtain"When dealing with complex systems it is rarely possible to obtain the sort of evidence that would be required in science, engineering or clinical trials. As things stand, the overall evidence base on how to tackle obesity is limited, and what evidence there is on effective approaches is skewed towards short ‘visible’ interventions at an individual and consumer level." [1]118FF4888, 352798Relational complexity of problems makes them hard to grasp as a wholeObesity is a complex, systemic issue with no single or simple solution. Within complex systems it is normal for there to exist a complex network of causes that frequently feeds back on itself. The systems that have been modelled mathematically indicate that the overall behaviour of the system is determined by the structure of these interactions (in particular feedback loops and delays) rather than the values of any particular variables or parameters. [1]118FF4888, 352799Need to appreciate and incorporate multiple perspectivesA second dimension of complexity requires an appreciation of the different perspectives used by agents and agencies within the system (pluralism). Most of the population, including many experts and scientists, are not able to dis-identify from their own perspective sufficiently to be able to appreciate other people's perspectives fully. Until all the key perspectives are incorporated into a study then any analysis will be partial and any intervention likely to fail. [1]118FF4888, 352800Desire for solutions undervalues real improvementsWhen dealing with complex human systems it is necessary to focus on improvements, not solutions. Sustainable change takes place slowly and as the result of co-operative action by large numbers of agents and agencies within the system. [1]118FF4888, 352802Institutional inertiaIn most human activity systems a change in the functioning of the whole system requires a significant number of people within the system to change; they may have to change some or all of their habits, behaviour and values. [1]118FF4888, 399558Changes required across many different policy areasObesity has to be seen as not just a technical, food, physical activity or healthcare problem but a challenge for what sort of society is being built. Small, incremental, publicity-driven (i.e. social market-based) changes might suit the existing balance of policy interests, but a more extensive, co-ordinated, cross-sectoral action would be more effective.1198CE71, 400056Institutional inertiaIn most human activity systems a change in the functioning of the whole system requires a significant number of people within the system to change; they may have to change some or all of their habits, behaviour and values. 118FF4888, 400077Definitive evidence is often difficult to obtainWhen dealing with complex systems it is rarely possible to obtain the sort of evidence that would be required in science, engineering or clinical trials. As things stand, the overall evidence base on how to tackle obesity is limited, and what evidence there is on effective approaches is skewed towards short ‘visible’ interventions at an individual and consumer level.118FF4888, 400079Need to appreciate and incorporate multiple perspectivesA second dimension of complexity requires an appreciation of the different perspectives used by agents and agencies within the system (pluralism). Most of the population, including many experts and scientists, are not able to dis-identify from their own perspective sufficiently to be able to appreciate other people?s perspectives fully. Until all the key perspectives are incorporated into a study then any analysis will be partial and any intervention likely to fail.118FF4888, 400080Desire for solutions undervalues real improvementsWhen dealing with complex human systems it is necessary to focus on improvements, not solutions. Sustainable change takes place slowly and as the result of co-operative action by large numbers of agents and agencies within the system.118FF4888

My evidence is presented as a result of my experience of teaching systems thinking, carrying out a number of projects using systemic approaches and working with senior civil servants on 3-day “system challenges” organised as part of the Prime Minister‟s Top Management Programme (TMP). I anticipate that my contribution may assist in developing the principles of adopting a “whole systems approach”, complementing those with content expertise.

Original source: http://hbr.org/2005/04...

Citerank: (16) 340964Tackling obesity in the UKWith concern growing that the Foresight analysis—that 50% of the UK population could be obese by 2050, at an annual cost to the nation of around £50 billion per year [2]—substantially underestimates the scale of the unfolding obesity crisis, the College of Contemporary Health is working with the wider policy community to develop a whole systems map of the obesity crisis and the potential responses.7F1CEB7, 348688Impacts of obesityObesity presents a significant threat to the health of the UK population and a significant drain on the nation's financial resources. 24.9% of adults in England are obese—with a body mass index of over 30—62% of adults are either overweight or obese (with a BMI of over 25), and 32% of 10–11-year-olds are overweight or obese. The annual cost of obesity to the UK is estimated to be £27bn–£46bn [1], [2]; although international comparisons suggest that the true cost could be significantly higher.57DE7179, 348776A profound impact on the health of the populationObesity is responsible for more than 9,000 premature deaths each year in England, reduces life expectancy on average by nine years, and is a major risk factor in wide range of serious health problems including Type 2 diabetes (5 x), cancer (3 x the risk of colon cancer), and heart disease (2.5 x).57DE7179, 348780Causes of obesityUnderstanding the causes of obesity is critical to the success of prevention and treatment strategies. However, while (simply put) obesity occurs when energy intake from food and drink consumption is greater than energy expenditure through the body’s metabolism and physical activity over a prolonged period (resulting in the accumulation of excess body fat), in reality many complex behavioural and societal factors contribute systemically to the current crisis and no single influence dominates.555CD992, 348780Causes of obesityUnderstanding the causes of obesity is critical to the success of prevention and treatment strategies. However, while (simply put) obesity occurs when energy intake from food and drink consumption is greater than energy expenditure through the body’s metabolism and physical activity over a prolonged period (resulting in the accumulation of excess body fat), in reality many complex behavioural and societal factors contribute systemically to the current crisis and no single influence dominates.555CD992, 351719Actions – Local Authorities2794CAE1, 352311Lost productivityObesity has as a serious impact on UK economic development –  constraining economic productivity and increasing business costs – affecting individuals’ ability to get and hold down work, their self-esteem and their underlying mental health.57DE7179, 352312Target interventions across the whole course of lifeTackling obesity effectively requires the adoption of a life course approach – from pre-conception through pregnancy, infancy, early years, childhood, adolescence and teenage years, and through to adulthood and preparing for older age. There are specific opportunities and challenges at each stage of the life course and action is needed at all ages to avert the short- and long-term consequences of excess weight and to ensure that health inequalities are addressed. 565CA4D9, 352314Actions – Central Government2794CAE1, 399558Changes required across many different policy areasObesity has to be seen as not just a technical, food, physical activity or healthcare problem but a challenge for what sort of society is being built. Small, incremental, publicity-driven (i.e. social market-based) changes might suit the existing balance of policy interests, but a more extensive, co-ordinated, cross-sectoral action would be more effective.1198CE71, 399559Target interventions across the whole course of lifeTackling obesity effectively requires the adoption of a life course approach – from pre-conception through pregnancy, infancy, early years, childhood, adolescence and teenage years, and through to adulthood and preparing for older age. There are specific opportunities and challenges at each stage of the life course and action is needed at all ages to avert the short- and long-term consequences of excess weight and to ensure that health inequalities are addressed. 565CA4D9, 399887Causes of obesityUnderstanding the causes of obesity is critical to the success of prevention and treatment strategies. However, while (simply put) obesity occurs when energy intake from food and drink consumption is greater than energy expenditure through the body’s metabolism and physical activity over a prolonged period (resulting in the accumulation of excess body fat), in reality many complex behavioural and societal factors contribute systemically to the current crisis and no single influence dominates.555CD992, 399887Causes of obesityUnderstanding the causes of obesity is critical to the success of prevention and treatment strategies. However, while (simply put) obesity occurs when energy intake from food and drink consumption is greater than energy expenditure through the body’s metabolism and physical activity over a prolonged period (resulting in the accumulation of excess body fat), in reality many complex behavioural and societal factors contribute systemically to the current crisis and no single influence dominates.555CD992, 399972Impacts of obesityObesity presents a significant threat to the health of the UK population and a significant drain on the nation's financial resources. 23% of adults are obese—with a body mass index of over 30—61% of adults are either overweight or obese (with a BMI of over 25), and 33% of 10–11-year-olds are overweight or obese. The annual cost of obesity to the UK economy has been estimated to be £27bn–£46bn [1], [2]; although international comparisons suggest that the true cost could be significantly higher.57DE7179, 399974A profound impact on the health of the populationObesity is responsible for more than 9,000 premature deaths each year in England, reduces life expectancy on average by nine years, and is a major risk factor in wide range of serious health problems including Type 2 diabetes (5 x), cancer (3 x the risk of colon cancer), and heart disease (2.5 x).57DE7179, 400018Lost productivityObesity has as a serious impact on UK economic development –  constraining economic productivity and increasing business costs – affecting individuals’ ability to get and hold down work, their self-esteem and their underlying mental health.57DE7179

This document sets out how the new approach to public health will enable effective action on obesity and encourages a wide range of partners to play their part.

Citerank: (21) 348675Adopt a whole systems approach to obesityTackling obesity effectively—accomplishing a population wide-shift—requires a comprehensive and integrated whole systems approach, involving a range of measures focusing on individuals, social and other systems, including at the local and community level, and on the interrelated physical, physiological, social and cognitive factors that determine health outcomes.565CA4D9, 348693Stakeholders – Groups & ActionsExplore the map via the different stakeholder groups and the measures each group can take to help tackle the obesity crisis.58D3ABAB, 348702Individuals and FamiliesThe actions and choices of individuals and families are fundamental to the challenge of tackling obesity. 84E4A378, 348703Actions – Industry2794CAE1, 348780Causes of obesityUnderstanding the causes of obesity is critical to the success of prevention and treatment strategies. However, while (simply put) obesity occurs when energy intake from food and drink consumption is greater than energy expenditure through the body’s metabolism and physical activity over a prolonged period (resulting in the accumulation of excess body fat), in reality many complex behavioural and societal factors contribute systemically to the current crisis and no single influence dominates.555CD992, 352314Actions – Central Government2794CAE1, 352387Previous physical activities replaced by industrially generated energyIndustrial development allows many different aspects of life that previously involved daily physical activity to be accomplished through industrially generated energy instead; for example, the substitution of motorised transport for walking and cycling, a shift from manual and agricultural work towards office work, and a multitude of labour saving devices at work and in the home.555CD992, 352388Advertising and marketing reinforce new eating patterns Marketing and advertising instil and reinforce new cultural norms about what (e.g. fast food) and how to eat (e.g. snacking), and how much (e.g. larger portions) to eat.555CD992, 352389Reluctance to talk about and address implications of own weightThe weight of the population continues to rise despite media imagery of thin models encouraging a slim ideal that is far out of reach for most of the public. In this context, “Fat” remains an emotive and stigmatic subject – and often perceived as an insult – which makes it harder for people to acknowledge, confront and address their own obesity (and harder for others including health professionals to encourage them to do so too).555CD992, 352391Industrial development changes what and how people eatEconomic and industrial development has tended to be accompanied by a historic shift in patterns of food consumption from diets high in cereal and fibre to diets high in sugars, fat, animal-source food and highly-processed foods – creating a socio-cultural environment in which obesity is more likely to emerge in the population.555CD992, 352399Successive governments have made counterproductive policy choicesThe growing prevalence of obesity in the UK is partly the result of well-intentioned but counterproductive policy choices made by successive governments over several decades.555CD992, 352400Many individuals are consuming more energy than they are expendingPublic Health England estimates that the average man in England is consuming around 300 calories a day more than they would need were they a healthy body weight.555CD992, 399547Adopt a whole systems approach to obesityTackling obesity effectively—accomplishing a population wide-shift—requires a comprehensive and integrated whole systems approach, involving a range of measures focusing on individuals, social and other systems, including at the local and community level, and on the interrelated physical, physiological, social and cognitive factors that determine health outcomes.565CA4D9, 399558Changes required across many different policy areasObesity has to be seen as not just a technical, food, physical activity or healthcare problem but a challenge for what sort of society is being built. Small, incremental, publicity-driven (i.e. social market-based) changes might suit the existing balance of policy interests, but a more extensive, co-ordinated, cross-sectoral action would be more effective.1198CE71, 399887Causes of obesityUnderstanding the causes of obesity is critical to the success of prevention and treatment strategies. However, while (simply put) obesity occurs when energy intake from food and drink consumption is greater than energy expenditure through the body’s metabolism and physical activity over a prolonged period (resulting in the accumulation of excess body fat), in reality many complex behavioural and societal factors contribute systemically to the current crisis and no single influence dominates.555CD992, 399890Successive governments have made counterproductive policy choicesThe growing prevalence of obesity in the UK is partly the result of well-intentioned but counterproductive policy choices made by successive governments over several decades.555CD992, 399891Many individuals are consuming more energy than they are expendingPublic Health England estimates that the average man in England is consuming around 300 calories a day more than they would need were they a healthy body weight.555CD992, 399896Industrial development changes what and how people eatEconomic and industrial development has tended to be accompanied by a historic shift in patterns of food consumption from diets high in cereal and fibre to diets high in sugars, fat, animal-source food and highly-processed foods – creating a socio-cultural environment in which obesity is more likely to emerge in the population.555CD992, 399907Reluctance to talk about and address implications of own weightThe weight of the population continues to rise despite media imagery of thin models encouraging a slim ideal that is far out of reach for most of the public. In this context, “Fat” remains an emotive and stigmatic subject – and often perceived as an insult – which makes it harder for people to acknowledge, confront and address their own obesity (and harder for others including health professionals to encourage them to do so too).555CD992, 399917Advertising and marketing reinforce new eating patterns Marketing and advertising instil and reinforce new cultural norms about what (e.g. fast food) and how to eat (e.g. snacking), and how much (e.g. larger portions) to eat.555CD992, 399923Previous physical activities replaced by industrially generated energyIndustrial development allows many different aspects of life that previously involved daily physical activity to be accomplished through industrially generated energy instead; for example, the substitution of motorised transport for walking and cycling, a shift from manual and agricultural work towards office work, and a multitude of labour saving devices at work and in the home.555CD992

There are many competing diagnoses of what ‘really’ matters in obesity generation. Different analyses and policy solutions have been developed and proffered, each clamouring for support, funding and adoption. The increasing sophistication of different positions actually adds to the complexity of the policy challenge. For policymakers, now worried about the cost of obesity (and the spectrum of ailments linked to it, such as diabetes), there is a situation we describe as policy cacophony – noise drowning out symphony of effort. This cacophony is not helpful because policymakers need coherent directions on which they feel they can deliver. Obesity policy is already weighed down by complexity, accentuated by the multi-level (global, European, national, regional and local) nature of modern systems of governance. It is also shrouded by ideological fears such as interventions being interpreted as ‘nanny-ish’ or restricting ‘personal’ choices in food and lifestyle.

Compounding this policy cacophony are two other difficulties which this review sets out to address. The first is time frame. Obesity is a problem that has taken decades to develop. Bar sudden external shocks to society, such as a massive oil shortage or price rises that make walking a necessity, it is likely to take many years to bring it under control. Yet, the political timetable demands quick results. Second, there is a difficulty about evidence. No country has managed to reverse obesity trends, or at least not so far. To some extent, part of the obesity policy problem is the evidence, or lack of it. Yet, the rise of obesity is literally visible and the explanation and ways forward are hard to pinpoint. This does not mean we favour disregarding evidence, but rather that we see obesity as a test case for policy changes in advance of perfect evidence. Faint hearts privately muse that obesity is too complex. But we see obesity as akin to that of climate change – complex, yes – and demanding firm action, however hard that might be.

Priorities for Food 2030

1. Enabling and encouraging people to eat a healthy, sustainable diet

2. Ensuring a resilient, profitable and competitive food system

3. Increasing food production sustainably

4. Reducing the food system’s greenhouse gas emissions

5. Reducing, reusing and reprocessing waste

6. Increasing the impact of skills, knowledge, research and technology