Whole systems approach to obesity

在英国，三分之二的成年人、四分之一的2-10岁儿童和三分之一的11-15岁儿童超重或肥胖。肥胖的有害影响不仅是个人感受到的，通过恶化的健康风险，还会给更广泛的经济带来经济上的影响。我们的生活方式对我们的健康有重大影响，然而，越来越多的人认识到，生活环境也影响我们的健康--它影响我们必须做出健康选择的机会。虽然个人行为确实很重要，但现实情况是，我们的健康受到行为、社会、经济和环境因素的影响。对肥胖及其原因进行的最全面的调查[展望]将肥胖描述为一个复杂的问题，需要个人和社会在多个领域采取行动。由于这种范式的转变，现在人们通过社会视角(而不是医学视角)来看待肥胖，人们普遍认为，生活方式(即个人)、环境、经济和社会因素导致了肥胖的后果。然而，在《展望》出版近10年后，为这场正在进行的政策辩论提供信息的大多数研究都没有考虑到这些领域之间的相互作用。有洞察力的分析孤立地考虑了这些因素；这项建议将通过联合考虑肥胖的环境、行为、经济和社会决定因素来扩大现有证据和理解的实用性。有效的体重管理计划的必要性--鼓励参与者强烈参与并证明积极的健康相关改善--是至关重要的。然而，参与者辍学和随之而来的方案自然减员挑战了方案的有效性，例如，在儿童体重管理方面，自然减员从8%到83%不等。与出席率较低或辍学的人相比，出席率较高的参与者与更多的体重减轻和与健康相关的福利相关。政策制定者和方案专员(为方案提供资金的人)担心，辍学和自然减员会损害工作管理方案的经济效果。政策制定者一直认为，个人、社会、经济和环境因素都会导致肥胖。然而，几乎所有评估体重管理干预措施的研究都没有考虑到这种相互作用，而是专注于单个因素。此外，英国公共卫生已经承认有必要了解导致肥胖的所有因素，并承诺“支持地方当局提供一套完整的系统方法来解决肥胖问题”。这一博士学位的目标与这一承诺相一致，因为关键成果将是一种量化的整体系统方法，以建模公共卫生措施，以确定哪些因素与肥胖有关，以及它们在地方和个人层面上如何相互联系。研究目的：-为了创造关于肥胖的驱动因素和参与体重管理计划的新知识和理解，需要在一个综合框架内将这些因素结合在一起：本博士学位的主要目标是使用基于代理的建模来模拟肥胖的环境、行为、经济和社会决定因素，以及在地方一级参与体重管理计划。-方法论方法(基于代理人的建模)将使政策从整个系统的角度影响变化。了解导致肥胖环境的复杂和相互作用的系统是必要的开始，有望导致在地方一级采用完整的系统方法来解决肥胖问题。这将是第一项以英国为基础的研究，将量化关系作为一个更广泛的“系统”的一部分进行调查，整个系统的方法推动着它的发展。

In the UK two thirds of adults, a quarter of 2-10-year olds and third of 11-15-year olds are overweight or obese. The harmful effects of obesity are not only felt by individuals, through worsened health risks, but also financially to the wider economy. The way we live of lives has a major impact on our health, however, there is increasing recognition that the circumstances in which live also impacts on our health - it impacts on the opportunities we must make healthy choices. While individual behaviour does matter, the reality is that our health is impacted by behavioural, social, economic and environmental factors. The most comprehensive investigation into obesity and its causes [Foresight] described obesity as a complex problem that requires action from individuals and society across multiple sectors. Because of this paradigm shift, obesity is now viewed through a social lens (oppose to a medical one), and it is generally accepted that lifestyle (i.e. individual), environmental, economic and social factors contribute to the consequences of obesity. However, with almost 10 years since the publication of Foresight, most of the research informing this ongoing policy debate fails to consider the interplay between these domains. Insightful analyses have considered these factors in isolation; this proposal will extend the utility of current evidence and understanding by jointly considering environmental, behavioural, economic and social determinants of obesity.The need for effective weight management programmes - which encourage strong participant engagement and demonstrate positive health-related improvement is critical. However, participant dropout, and consequent programme attrition, challenges programme effectiveness, in child weight management, for example, attrition ranges from 8-83 %. Higher participant attendance is associated with greater weight loss and health-related benefits in contrast to those with lower attendance or those who dropout. Of concern to policy makers and programme commissioners (those funding the programmes), dropout and attrition compromise the economic effectiveness of WM programmes. Policy makers have engaged with the idea that individual, social, economic and environmental factors contribute to obesity. However, almost all the research evaluating weight management interventions fails to consider this interplay and focus on individual factors.In addition, Public Health England have acknowledged the need to understand all the factors that contribute to obesity and have committed to 'support local authorities to deliver a whole systems approach to tackle obesity'. The objectives of this PhD align to this commitment, as the key outcome will be a quantitative whole systems approach to modelling public health measures to determine what factors are associated with obesity, and how they inter-relate at the local and individual levels. Research Aims:- To create new knowledge and understanding about the drivers of obesity and engagement in weight management programmes, these factors need to be brought together within an integrated framework: the primary objective of this PhD is to use agent-based modelling to simulate environmental, behavioural, economic and social determinants of obesity and engagement in weight management programmes, at the local level. - The methodological approach (agent based modelling) will inform policies to affect change from a whole systems perspective. Understanding the complex and interacting systems that result in an obesogenic environment is the necessary start, hopefully leading to the adoption of a whole system approach to address obesity at the local level. This will be the first UK based study to investigate the quantitative relationships as part of a wider 'system', with a whole system approach driving its development.