Bodies and the global obesity epidemic. Why were we so surprised? Systems Thinking - Single and Double Loop learning.

1. BODIES &
BUILDINGS
NYU ITP LECTURE COURSE FALL 2014
CLASS 2: SEPTEMBER 15, 2014
JEN VAN DER MEER @JENVANDERMEER WWW.JENVANDERMEER.COM

2. LEVERAGE POINTS
Class assignment for 9/15/2015
Mandatory! Read ALL OF Donella Meadows:
Leverage Points: Places to Intervene in a System
Take leverage points 9, 8, 7.
Write a 1 page or 500-6000 word essay on the following topic:
How do mobile apps try to affect leverage points 9, 8, and 7.
9) The length of delays, relative to the rate of system change
8) The strength of negative feedback loops, relative to impacts they are
trying to correct against
7) The gain around driving positive feedback loops
Give one example and explain how the app is or is not designed to affect
each of these leverage points. How effective do you think this app will be at
changing behavior?
You will be asked to present your work, so practice rehearsing your in class
presentation at least two times.
2

3. THIS WEEK
Leverage Points: Places to Intervene in a System
Take leverage points 9, 8, 7.
Write a 1 page or 500-600 word essay on the following topic:
How do mobile apps try to affect leverage points 9, 8, and 7.
9) The length of delays, relative to the rate of system change
8) The strength of negative feedback loops, relative to impacts
they are trying to correct against
7) The gain around driving positive feedback loops
Give one example and explain how the app is or is not designed
to affect each of these leverage points. How effective do you
think this app will be at changing behavior?
You will be asked to present your work, so practice rehearsing
your in class presentation at least two times.
3

4. PLACES TO INTERVENE IN A SYSTEM:
12. Constants, parameters, numbers (subsidies, taxes, standards)
11. The sizes of buffers and other stabilizing stocks, relative to their flows
10. The structure of material stocks and flows (transport networks, population age structures)
9. Length of delays, relative to the rate of system change
8. The strength of negative feedback loops, relative to the impacts they are trying to correct against
7. The gain around driving positive feedback loops
6. The structure of information flows (who does and does not have access to what kinds of
information)
5. The rules of the system (such as incentives, punishments, constraints)
4. The power to add, change, evolve, or self-organize system structure
3. The goals of the system
2. The mindset or paradigm out of which the system – its goals, power structure, rules, its culture-arises
1. The power to transcend paradigms
4

5. BODIES IN THE NEWS
Apple Watch and Healthkit launch – a Major Platform for Innovation
Ebola Virus – no mHealth efficacy. Mobile Health Apps Have Role In
Ebola Crisis
5

6. FIRST: HISTORY OF
SYSTEMS THINKING
BODIES & BUILDINGS
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7. 7

8. 8

9. 9
SYSTEMS THINKING QUESTION
WHY DO WE COLLECTIVELY CREATE RESULTS THAT
NOBODY WANTS

10. 10
SYSTEMS THINKING IDEAS
Mental model: an explanation of someone's thought process
about how something works in the real world.
“We cannot solve problems with the same kind
of thinking that created them.” Albert Einstein
Modeling systems: we are limited in our capacity to form and
reform mental models. Systems modeling allows us to move
from “what” to “what if” - to see our thinking.

11. 11
STOCKS, FLOWS, LOOPS
Stocks: foundation of a system. You can see, feel, count, and measure.
Flows: Stocks change over time through the actions of a flow.
Loops: A feedback loop is formed when changes in stock affect the
flows.
• Balancing: feedback loops are stability seeking and try to keep a stock at
a certain level. Balancing process intends to reduce a gap between a
current state and a desired state. The balancing (negative) feedback
adjusts a present state to a desirable target regardless whether the trend
is descending or ascending.
• Reinforcing: feedback loops occur when a system element has the ability
to reproduce itself. If the trend is ascending, the reinforcing (positive)
feedback will accelerate the growth. If the trend is descending, it will
accelerate the decline.

12. 12
A TEST
http://youtu.be/1D07neiB7HI
https://www.youtube.com/watch?v=KmkVWuP_sO0

13. POPULATION GROWTH
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14. MORALE
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15. 15
SYSTEMS ARCHETYPE, DELAYS
Systems archetype: patterns of behavior in a systems
expressed by circles of causality.
Delays: time between when an action is taking and the
current state changes.
http://www.systems-thinking.org/theWay/sbd/bd.htm

16. 16
FEEDBACK LOOPS
“In our current complex global systems, decision-makers
often affect large groups of people with their actions but
never see, feel, or become aware of their actions’
consquences. Without feedback, or with delayed feedback,
there is no learning.”
_Otto Scharmer, Leading from the Emerging Future

17. BODIES: THE
OBESETY EPIDEMIC
BODIES & BUILDINGS
17

18. BODIES +
We have made huge strides in life expectancy, but we have
reached limits of growth.
18

19. NATIONAL OBESITY
CRISIS
19

20. US OBESITY GROWTH RATE
20

21. Today’s children may well be
the first generation of
Americans whose life
expectancy will be shorter
than that of their parents.
21
OBESITY TRENDS

22. 22

23. 23

24. 24

25. Data from 3,139 counties in the U.S. Quintiles are cohorts of counties ranked by the
percentage of people living with poverty.
Levine J A Diabetes 2011;60:2667-2668
Copyright © 2011 American Diabetes Association, Inc.

26. 26

27. DIGITAL DIVIDE + DIABETES
Social disparities in internet
patient portal use in diabetes:
evidence that the digital divide
extends beyond access.
Urmimala Sarkar, Andrew J
Karter, Jennifer Y Liu, et al.
J Am Med Inform Assoc 2011
18: 318-321 originally
published online January 24,
2011.
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28. GLOBAL OBESITY
PANDEMIC
“GLOBESITY”
28
GLOBAL OBESITY: TRENDS, RISK FACTORS AND POLICY
IMPLICATIONS. VASANTI S. MALIK, WALTER C. WILLETT & FRANK B.
HU. NATURE REVIEWS ENDOCRINOLOGY 9, 13-27 (JANUARY 2013)

29. Figure 1 Global trends in the prevalence of obesity among women and men in
1980 and 2008 from select regions of the world
Malik, V. S. et al. (2012) Global obesity: trends, risk factors and policy implications
Nat. Rev. Endocrinol. doi:10.1038/nrendo.2012.199

30. 30
Women

31. September 16, 2014
31
Men

32. 32

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35. OBESITY + GLOBALIZATION
35

36. THINKING IN
CIRCLES ABOUT
OBESITY
APPLYING SYSTEMS THINKING TO WEIGHT MANAGEMENT.
TAREK K. A. HABI
36

37. HOW THE PROBLEM SNEAKED UP ON US
As the upward and outward trend
in the population’s weight and
waistline accelerated in the late
1980s and 1990s, most public
health experts failed to perceive
the escalating threat.
• Unlike communicable diseases,
no immediate symptoms.
• Initially only affected a few
people.
• The science establishing links
between diet, weight and health
were just beginning.
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38. HOW MANY CAUSES
CAN WE COUNT?
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39. BUCKET THEORY OF MIND
• Minds seen as containers – Karl Popper.
• Public understanding is viewed as a function of how much
scientific facts are known.
• How many scientific facts public minds contain.
• Irony: Americans know more about food and nutrition than
in any time in their history, but they are gaining more
weight.
• “Knowledge (in the bucket) without the requisite decision-making
skills will produce little change.
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40. THE LEVERAGE (OR THE IMPEDIMENT) IS
WITH THE PEOPLE
• In the US, most obese individuals attempting to lose weight do so
themselves, without seeking professional help.
• Weight has been seen as an individual, personal problem.
• The wellness movement is rooted in the concept of personal control.
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41. WE ASSUME MORE CONTROL THAN
ACTUALLY EXISTS
• Obesity is a complex multi-factorial disease involving
genetics, physiology, and biochemistry, as well as
environmental, psychosocial, and cultural factors.
• In managing our health – and our bodies – we are decision
makers who are managing a truly complex and dynamic
system: the human body.
• Living systems do not come with an operator’s manual. It
requires skills to see through complexity to the underlying
structures generating a complex situation or problematic
behavior.
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42. IT’S SO EASY
CALORIES IN. CALORIES OUT.
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43. MORE COMPLEX THAN THAT
• Body’s homeostatic process- adaptive (and defensive)
mechanisms that continuously aim to maintain the body’s
internal stability.
• Weightloss is not linear, but curvilinear.
• Unrealistic optimism causes us to ignore legitimate risks.
• Failure to learn from failure. Learning has not occurred.
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44. PHYSIOLOGICAL ASYMMETRY
• Humans are wired to compensate for caloric dilution but not
the reverse.
• Asymmetry in energy expenditure- basal metabolism.
• Asymmetry in energy storage- when body fat is shed during
weight loss, the size, but not the number, of fat cells
dwindles.
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45. SINGLE LOOP LEARNING
45
Consequences
Decisions, Feedback
Actions
Single loop

46. SINGLE LOOP DIETING
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47. SINGLE LOOP LEARNING
• Often we find ways to move closer to our desired state
without changing our mental model.
• Learning to use life’s raw experiences to adjust our
entrenched worldviews is hard and, therefore, uncommon.
• Experience, after all, provides only data, the raw ingredients
for learning, not knowledge.
• Single loop: we learn to tweak our decisions without
altering our mental models or their associated decision
rules.
• (A thermostat that senses when it is too hot or cold).
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48. SINGLE LOOP DIETING
48

49. WHAT IS TO BE
DONE
CHALLENGE INGRAINED ASSUMPTIONS
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50. DOUBLE LOOP LEARNING
50
Consequences
Feedback
Mental Models
Of Real World
Decisions,
Actions
Decision Rules,
Strategies
Single loop

51. DOUBLE LOOP LEARNING
• Learning that occurs when we use the feedback information
to enhance our fundamental understanding of the decision
task.
• Learning is discovery of mental maps and decision rules
that are better aligned with the decision task at hand.
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52. SHIFT IN PUBLIC POLICY
• From: stuff buckets with nutritional guidelines/scare into
good health
• To: challenge people’s deeply ingrained assumptions.
Provide them with the conceptual skills to JUMP.
• From: attention on the separate mechanisms of human
weight and energy regulation.
• To: the hole bioenergetics systems as an integrated
operating system.
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53. FRAGMENTIC ANALYSIS LENS
• Nutrition out of the context of lifestyle
• Biology out of the context of behavior
• Behavior out of the context of environment
“The performance of any system (whether it is an oil refinery,
an economy, or the human body) obviously depends on the
performance of its parts, but a system’s performance is never
equal to the sum of the actions of its parts taken separately.
Rather it is a function of their interactions.”
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54. SHIFT IN CULTURAL UNDESTANDING
• From: solely individual interventions. A sole focus on the
obese person and how to help them gain control.
• To: Why is society obese. How can we help society.
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55. SHIFT HEALTHCARE PRACTICE
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56. NETWORKED MEDICINE
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57. ASSIGNMENT:
SEPTEMBER 22
57
September 16, 2014

58. DEFINITELY READ/WATCH
Required Reading:
Video: Global Obesity at an All Time High With Billions Overweight
Newsy
Network Medicine — From Obesity to the “Diseasome” NEJM.
By Albert-László Barabási, Ph.D.
The epidemic of pre-diabetes: the medicine and the politics The BMJ by
John S Yudkin, Emeritus Professor of Medicine, University College
London, UK and Victor M Montori, Mayo Clinic, USA
September 16, 2014
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59. EXTRA
Video: Technology, Diet and Obesity Related Disease: From Children to Adults
Endocrine Society, David S Ludwig, MD,PHD Boston Children's Hospital, Boston, MA
The Spread of Obesity in a Large Social Network over 32 Years NEJM, by Nicholas A.
Christakis, M.D., Ph.D., M.P.H., and James H. Fowler, Ph.D.
Catching Obesity From Friends May Not Be So Easy, NY Times, by Gina Kolata,
August 8, 2011.
We Are Our Bacteria NYTimes, by Jane Brody July 14, 2014
The Weight of the Nation: Part 1 - Consequences (HBO Docs) 2012 (and keep going –
HBO has the entire series on YouTube).
Catherine Kerr on Cortical Measures in Mindfulness Meditation at Quantified Self.
September 16, 2014
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60. ASSIGMENT
When developing ideas and concepts for our student projects,
and future projects, business ideas, and save-the-world ideas,
we often start by designing for ourselves.
For this assignment, research a part of the world at a local level
(city, state, province, county) that has a problem with obesity.
In a one page essay, describe the social, cultural, technological,
economic, and other conditions of this region that may be
contributing to a growth in the prevalence of obesity. Map the
system of obesity in this country. What is the one
recommendation you would make to government, business, or
the citizens of this country to slow the growth of obesity?
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