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Grappling With Complex Food Systems to Reduce Obesity: A US Public Health Challenge

Published: November 2018
Bibliographic reference: Barnhill A, Palmer A, Weston CM, et al. Grappling With Complex Food Systems to Reduce Obesity: A US Public Health Challenge. Public Health Reports. 2018;133(1_suppl):44S-53S. https://doi:10.1177/0033354918802793

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Our efforts to address obesity can be advanced and improved by the use of systems approaches that consider outcomes of the interconnected global food system, including undernutrition, climate change, the environmental sustainability of agriculture, and other social and economic concerns. By implementing innovative local and state programs, taking new approaches to overcome political obstacles to effect policy, and reconceptualizing research needs, we can improve obesity prevention efforts that target the food systems, maximize positive outcomes, and minimize adverse consequences. We recommend strengthening innovative local policies and programs, particularly those that involve community members in identifying problems and potential solutions and that embrace a broad set of goals beyond making eating patterns healthier. We also recommend undertaking interdisciplinary research projects that go beyond testing targeted interventions in specific populations and aim to build an understanding of the broader social, political, and economic context.

BACKGROUND: Despite 2 decades of effort by the public health community to combat obesity, obesity rates in the United States continue to rise. This lack of progress raises fundamental questions about the adequacy of our current approaches. Although the causes of population-wide obesity are multifactorial, attention to food systems as potential drivers of obesity has been prominent. However, the relationships between broader food systems and obesity are not always well understood.

METHODS: Applying a systems approach to a problem means understanding that the problem is part of a system with many interrelated parts and recognizing that this system may work in surprising ways.

RESULTS: New approaches are needed to reduce the rates of obesity and minimize the unintended consequences of interventions in US food systems. The public health tools needed to do this—policies, local programs, and research—should be reconceptualized to work at multiple levels, including the individual, family, community, and society levels, as well as for localities, nations, and the global community. They should reach beyond public health to other sectors, such as education, planning, and economic development, as well as other government agencies and nongovernmental organizations.

CONCLUSIONS: The authors offer several recommendations for future obesity research and practice. First, interdisciplinary research projects are needed that bring together diverse stakeholders, including community members, policy makers, obesity researchers, food systems researchers, and researchers from other fields, including social scientists with qualitative research skills who can address the broader social, cultural, and political context. A research approach that uses targeted population-specific interventions could be enhanced by focusing on community contexts that can amplify or limit interventions and by implementing changes at multiple levels (ie, a systems approach to intervention delivery). Second, consulting and engaging with a broad array of researchers across the fields of obesity, food systems, and the social sciences is needed. Third, public health should work to strengthen innovative local policies and programs, particularly those that include community members in identifying problems and solutions. Fourth, although interventions should aim to improve healthy eating patterns in the short term and measure the interventions’ success, these interventions should also embrace a broader set of goals and a lengthy time horizon and be evaluated accordingly. Long-term indicators of success will include not only changes in diet and obesity but also indicators of improving community well-being in other ways, building local capacity, building political momentum, and addressing other problems in food systems. Fifth, the field of public health should support interdisciplinary, multistakeholder research teams with broad sets of goals and the ability to study change during long periods, while growing opportunities for training and collaboration for obesity researchers that bring together multiple disciplines and perspectives and teach new skills in systems methods. Finally, funders should create mechanisms to support longer-term commitments to researchers and communities to sustain projects that can be repeated, improved, and, rigorously evaluated.

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