08:07am Monday 23 October 2017

Bigger than the both of us: Obesity is best tackled at a community level

If the obesity crisis continues on its current trajectory, almost half of the world’s adult population will be overweight or obese by 2030. Celebrity chefs and food bloggers are lining up to solve our obesity epidemic, with one in particular calling on world governments to legislate against obesity. But should we expect governments to address our failure to shift the kilos when the key to weight loss – eat less and move more – seems so simple?

The truth is that the challenge is beyond any one player. To put it bleakly, we are trapped in an obesogenic environment of our own making. We have designed a lifestyle that meets our basic biological desires for minimal energy expenditure and constant access to an inexhaustible variety of easily digestible, safe, palatable foods. Our ancient biological programming to conserve energy is at odds with our economy, our political structures, our agricultural systems and our built environment. So it’s not as simple as just deciding to eat healthily and exercise more.

On the surface, government-led action shows potential to solve a problem of this scale. However, there is a growing body of research showing that community-led interventions are the most likely to succeed. The science is clear: it is simply too difficult to break our habits from the very top down, or the very bottom up. Social ecology tells us that small communities can solve problems in ways not possible in large groups or at the individual level.

Modern society is the pinnacle of what scientists call a complex adaptive system, in which complex outcomes emerge from simple connections. Each person has a multitude of simple interactions at different levels of society, which paints a very complicated picture of what is driving obesity. The spaghetti map presented by the UK Foresight Project to chart the network of influences on obesity is so intricate that it has become a favourite of conference presenters pointing out the near hopelessness of effecting change.

Complex systems theory tells us that complex systems are resistant to change. Many disturbances, even major coordinated attempts to shake the system, will have no observable impact. However, if you get the intervention right, complex systems have a brighter side. They can rapidly self-organise into a different, potentially healthier, stable state. Think of tobacco in Australia – it took many decades of interventions at individual, community and government levels to shift the system into a state where it flipped, driven by a contagion of public opinion.

Science also gives us a clue as to how we might create change. Human society evolved around social units numbering in the tens or hundreds – not in the millions. Once groups of people exceed several hundred members, they require governance. If they have fewer than several hundred members, they become self-supporting, self-organising and self-controlling. The village effect prevails. Communities have a voice, will take ownership of issues, and know their own business.

A significant benefit of acting at community level is that it becomes possible to implement multiple interventions at once. The holy grail of an holistic approach to health is within reach because it’s easier to see and act on the big picture.

Take Broken Hill, where the Charles Perkins Centre has opened a regional hub to tackle obesity, diabetes, cardiovascular disease and related conditions: its obesity levels rank among the very worst in the country, and yet it represents an ideal opportunity for intervention. It encompasses the mix of socioeconomic, educational and ethnic diversity that we see on a national level; has a strong sense of itself with longstanding and trusting relationships between community and University of Sydney researchers; and the extent of the community can be defined geographically without merging into larger conurbations.

The community of Brimbank, a resilient, cohesive local government area in the western suburbs of Melbourne, is another example. It is a culturally diverse community in one of the largest industrial areas of Melbourne, and is in the midst of strong residential, industrial and community development. It has higher than average rates of obesity, twice the prevalence of diabetes as in Melbourne and Australia, and lower than average rates of engagement in physical activity. The Brimbank City Council, the Mitchell Institute for Health and Education and Victoria University have launched the Brimbank Collaboration to lift health and education outcomes in the Brimbank community through community-based and supported initiatives.

Community-level, community-led interventions such as these hold the key to breaking our complex systems. If we can improve the health and habits of communities, there is a real chance we could disrupt the larger complex systems that operate around them, sparking a domino effect across the nation.

Professor Stephen Simpson is Academic Director of the Charles Perkins Centre at the University of Sydney. Rosemary Calder is Health Policy Director for the Mitchell Institute for Health and Education Policy at Victoria University.

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