Thinking in circles about obesity: applying systems thinking to weight management

I. Mismanaging the Obesity Threat

1. Like Boiled Frogs

How the Problem Sneaked Up on Us

The Temperature Is Rising

The Heavy Burden of Obesity

For Older Americans, The Future Is Now

The Sociocultural Burden

"Globesity"

A Bucket Half-Empty?

The Leverage (or the Impediment) Is with the People

It Is Not Easy Becoming a Top Gun

States in Mind

Emotions Play a Role

Failure to Learn from Failure

Single-Loop vs. Double-Loop Learning

Barriers to Learning

What is to Be Done?

Metanoia

Synthesis, Not Analysis

What Is Feedback?

Circles, Not Straight Lines

Dynamic, Not Static

Obliterating, Not Automating

Notes

II. How We Changed Our Environment, and Now Our Environment is Changing Us

2. Unbalanced Act

Moving Beyond Individual-Centric Explanations

Evolved Asymmetry of Our Physiology

How Asymmetry Is Achieved by Our Physiology

Asymmetry in Energy Intake

Asymmetry in Energy Expenditure

Asymmetry in Energy Storage

Conclusion

3. Human-Environment Interactions: Not One Way...and Not One-Way

Human Behavior is Not Expressed in a Vacuum

It is Not Just Physical

A Symphony Out of Tune?

4. Tilting the Energy Balance: More Energy In

The Quantity of Food We Eat

The Causes Behind the Cause

How America's Eating Habits Started to Change

The First Mechanism: The Time We Eat

Soft Drinks: The Liquid Snack

The Second Mechanism: Where We Eat

Fast Food: Eat Anywhere, Everywhere

The Qualitative Dimension

The Quantity Dimension

Events Give Birth to Trends, but What Escalates Them Are Self-Reinforcing Processes

Demand-Pull

Supply-Push

Putting It All Together

Hurricane Obesa

5. Tilting the Energy Balance: Less Energy Out

The Water is Boiling!

Work: Engineering Energy Expenditure Out of the Workplace

Moving About: Transport and Urban Design

Play and Leisure

The Burden Is Cumulative

Dr. Jekyll and Mr. Hyde, or Changing the Vicious to Virtuous

6. Individual Differences

Some Are "Squares," and Some Are Not

Deciphering the Code, One Gene at a Time

Genes and Individual Susceptibility to Weight Gain: The Experimental Findings

The Pimas

Genetic × Environmental Interactions: Conclusion

7. Is Ad-Lib Behavior Killing Us?

A (Mis-)Match Made in America

Like Our Genes, Our Mental Models Did Not Change

Turning-Off Automatic Control and Asserting Cognitive Control

It Can Be Done

The Allure of the "Silver Bullet"

Looking Ahead

Notes

III. We Can't Manage What We Don't Understand

8. The Energy Balance Equation: Reigning Intellectual Paradigm or Straitjacket?

The Magic Number

From the Experts' Mouths to the Journalists' Ears to the Public's Mind

We Like to Believe that We Are in Full Control

9. What We Know that Ain't So

Looking Back Versus Looking Forward

The First Trap: Linear Thinking

A Plumbing Analogy

A Second Trap: Energy as a Single Currency

We Need a Better "Map"

10. Closing the Loops on Energy Balance: Energy Output Side

Tip of a Physiological Iceberg!

"Under-the-Surface" Determinants of Energy Expenditure

The System in Action: "Under the Surface" Responses to Energy Imbalance

Implications for Treatment

Failure to Account for Individual Differences

How an Energy Deficit is Induced Also Matters

Seeing Through the Complexity

Revisiting the Bathtub Analogy

Learning to "Squint"

11. Closing the Loops on Energy Balance: Energy Input Side

Body Defenses on the Second Energy Front

Two-Tier System: Short-Term and Long-Term

Short-Term Component

Long-Term Component

Two Asymmetries, Not One

A Homeostatic System with a Difference

12. Beyond Physiology: Closing the Behavior-Physiology Loop

Not Only Do We Eat Food, We Also Think About it

Which Requires More Effort: To Do or Not to Do?

Strength (and Weakness) Model of Human Self-Regulation

A First Course in Managing Stocks and Flows

The Evidence: To Use It Is to Lose It, at Least Temporarily

A Challenge for the Self: How to Accomplish a Lot with a Little

Why Goals Matter, and How More May Be Less

Weight Cycling: Not Once, Not Twice

Understanding How Cycles Happen

Longer-Term Risks

Less is More

13. Looking Back and Looking Forward

Looking Back

Understanding is a First Step, But Far from Sufficient

Looking Forward

Notes

IV. We Can't Manage What We Mis-Predict

14. Learning by Doing

How Hard Can it Be?

Trying Your Hand at Predicting Dynamics

The Bathtub Exercise

The Answer

What Do These Results Tell Us?

Beyond Bathtubs

15. "Give Us the Tools, and We Will Finish the Job"

Sources of Complexity in Systems

The KISS Acronym: "Keep it Simple, Stupid"

Argument for a Calculus

Leveraging Computer Technology

16. A Microworld for Weight and Energy Regulation

Telescopes for the Mind

Simulation Models are Operational Models

Overview of Model Structure

Energy Intake (EI) Subsystem

Energy Expenditure (EE) Subsystem

Energy Metabolism and Regulation Subsystem

Glucose and Free Fatty Acid Metabolism

Protein/Amino Acid Metabolism

Exercise Metabolism

Body Composition Subsystem

Fat Mass (FM)

Fat-Free Mass (FFM)

Taking Off

17. Experiment 1: Assessing Weight Loss-Reality Versus Fiction

The Experiment

Experimental Results

Looking Inside a White Box

It Is Not Academic

18. Experiment 2: Going Ballistic-On a Diet

Chasing a Moving Target

The Experiment

It is No Passive Tool

19. Experiment 3: Understanding Why 250 Pounds Does Not Equal 250 Pounds

Individual Differences: More than Meets the Eye

The Experiment

Phase 1: Overfeeding

Phase 2: Dieting

114 kg ≠ 114 kg ≠ 114 kg!

One Size Does Not Fit All

20. Experiment 4: Trading Treatment Options-Diet Versus Exercise

Energy is Not a Single Currency

Diet Versus Exercise: Do 500 kcal = 500 kcal?

Trading Exercise Intensity for Exercising Time

Manipulating Diet Composition

Don't Trade ... Integrate

21. PhDs for the Masses? (That's Personal Health Decision support)

Notes

V. Prevention and Beyond

22. The Fat Lady...Models

23. The Third Path: Prevention

Can't Unscramble an Egg

The Buck Starts Here

Make Healthy Choices the Easy Choices

Public Works to Level the Playing Field

Energy Input

"Thought for Food"

Economic Incentives

Energy Output

Often Preventable But Rarely Prevented

24. Location, Location, Location: Places to Intervene in Systems

Behavior Change Cannot Be Legislated

Lessons from Managing America's Other Energy Problem

Leverage Points

Leveraging Paradigms...and Succeeding

Back in the United States: A Challenge and an Opportunity

25. It Will Take More Than Food Pyramids

"Educate Them and They Will Change"

Haifa Century of Government Education

It is Not Working

It is Deeper than Just That

Information is Not Enough to Change Mental Models

Learning from Experience: A Bad Second Option

Lessons from Business: Learning About Risky Stuff Without Experiencing the Risk

Transforming Prevention from a Spectator Sport to a Contact Sport

"Virtual to Your Health"

26. Microworlds Us

Child's Play

Learning About Healthy Behavior by Playing, Not by Lecturing

Double-Loop Playing

(Almost) Never Too Young to Think Systematically

At Home, the Real Risk is in Expecting Too Little

Shifting the Burden and Its Risks

Keeping the Burden

Teaching Children to Fish

Balance of Powers and Responsibilities

27. Beyond Prevention

Wellness Does Not Mean Only a Lack of Disease

Beyond Prevention of Disease

Health Potential Programs for People?

The Second Flowering

Advances in Molecular Biology: The Know-How

Computational Modeling of Physiological Processes: The Models

Ubiquitous Computing and Intelligent Sensors: The Personal Specs

The Internet: The Information Infrastructure

Not Automating,... Obliterating

Notes

Subject Index