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Introduction

The Roundtable on Obesity Solutions, Health and Medicine Division, National Academies of Sciences, Engineering, and Medicine, convened a virtual workshop series to explore sustainable systems-wide changes with the potential to reduce the prevalence of obesity. The series consisted of three workshops held in 2021 (April 8, June 22, and October 28–29). The overall goal of this workshop series was to examine data-driven solutions and innovative approaches that leverage the connections among three foundational drivers of obesity—structural racism, biased mental models and social norms, and health communication—and hold promise for effecting lasting systems change. The workshops explored opportunities for leveraging these connections and their impact on other obesity drivers and solutions across multiple levels and sectors of society, and aimed to identify systems change applications and opportunities for the future (Box 1-1).^1,2

The April workshop provided a level-setting introductory session for the workshop series, covering the intersection of foundational drivers of obesity and potential solutions. Additional sessions addressed the intersection of

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¹ The workshop series agendas, presentations, and other materials are available via https://www.nationalacademies.org/our-work/addressing-structural-racism-bias-and-health-communications-as-foundational-drivers-of-obesity-a-workshop-series (accessed January 10, 2022).

² The planning committee’s role was limited to planning the workshop, and the Proceedings of a Workshop has been prepared by the workshop rapporteur as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants, and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and they should not be construed as reflecting any group consensus.

structural racism and obesity in the context of housing and education, and the intersection of biased mental models, stigma, weight bias, and obesity in the context of workplace and health care settings. The June workshop examined strategies for leveraging health communication and data-informed, innovative approaches for sustainable systems-wide changes to reduce the prevalence of obesity. It explored how health communication might enhance the understanding and use of current modeling and data-driven efforts to advance obesity solutions, as well as innovative data and policy approaches. The October workshop considered means of advancing strategies for sustainable systems-wide changes that leverage the three drivers of obesity, which can inform actionable priorities for individuals, organizations, and policy makers seeking to reduce both the incidence and prevalence of obesity. The October workshop also included a session examining patient–provider communication on obesity treatment and solutions for improving those communications.

INTRODUCTORY REMARKS

Nicolaas (Nico) Pronk, president of HealthPartners Institute, chief science officer at HealthPartners, Inc., affiliate professor of health policy and management at the University of Minnesota School of Public Health, opened each of the three workshops by welcoming participants and providing a

brief overview of the Roundtable on Obesity Solutions, explaining that it engages leaders and voices from diverse sectors and industries (e.g., academia, government, public health and health care, business, finance, media, education, child care, philanthropy, nonprofit) to help solve the nation’s obesity crisis. Through meetings, public workshops, reports, five innovation collaboratives, and other workgroups, he continued, the roundtable provides a venue for ongoing dialogue on critical and emerging issues in obesity prevention, as well as treatment and weight maintenance. It applies a policy, systems, and environmental change lens; focuses on sustainable, equitable strategies for addressing obesity-related disparities; and explores and advances effective solutions.

Pronk explained that the workshop series was designed to build on the roundtable’s previous 2 years of work, during which it examined systems science approaches, health equity, and effective health communication. He summarized the roundtable’s strategic planning efforts, completed in 2020, which he said were intended to inform future efforts in addressing obesity. He highlighted the strategic planning activities that helped the roundtable coalesce around a systems-oriented approach to better understanding barriers to and facilitators for the implementation of obesity solutions, an approach he said has informed its membership of actionable solutions that support their organizational priorities. In this process, the roundtable conducted group model-building exercises; gathered input via member webinars; and disseminated new ideas and systems perspectives and applications through workshops, meetings, and publications. Infused in these efforts were discussions that occurred during activities of the roundtable’s innovation collaboratives and other workgroups.

The roundtable’s strategic planning activities culminated in the development of a causal systems map of obesity drivers and evidence-based solutions, Pronk said, intended to explore data-driven obesity solutions and innovative approaches. This causal systems map illuminated three priority areas for the roundtable to address during the next 3–6 years: structural racism and social justice, biased mental models and social norms, and effective health communication (Figure 1-1).

Pronk explained that the three priority areas were identified by considering the roundtable’s mission and operating principles, along with a framework, based on the work of prominent systems thinking scholar Donella Meadows, illustrating the least and most effective leverage points at which to intervene in a system (Meadows, 1999). The framework depicts increasingly deeper leverage points, which Pronk acknowledged are progressively more difficult to penetrate. Yet the deeper leverage points represent increasing effectiveness in creating systems-wide change, he pointed out, because they represent the power to transcend paradigms out of which systems arise (Figure 1-2).

The three focus areas are representative of the framework’s deeper leverage points, Pronk clarified, adding that it is starting to introduce these areas as opportunities for potential member action and solutions. The conversation will be iterative, he emphasized, as it is fed back through the activities of the full roundtable and its innovation collaboratives and workgroups.

ORGANIZATION OF THIS PROCEEDINGS

This proceedings follows the order of the workshop agendas (Appendix A), chronicling their sessions in individual chapters. Chapter 2 summarizes the introductory session from the April workshop, which laid the foundation for the workshop series in focusing on the intersection of obesity solutions with biased mental models, stigma, weight bias, structural racism, and effective health communication. Chapters 3 through 5 report on the remainder of the April 2021 workshop, which included sessions on the intersections of obesity and structural racism (Chapter 3); obesity and biased mental models, stigma, and weight bias (Chapter 4); and reflections on the workshop (Chapter 5). Chapters 6 through 9 are dedicated to the June 2021 workshop, which included sessions on health communication (Chapter 6); data-driven obesity solutions and innovative approaches in the education and health care contexts (Chapter 7); innovative policy

solutions, challenges, and opportunities (Chapter 8); and reflections on the workshop (Chapter 9). Chapters 10 through 14 recount the October 2021 workshop, which included sessions on leveraging data for systems change (Chapter 10), systems applications to address structural barriers to obesity solutions (Chapter 11), policy solutions for nutrition security and obesity (Chapter 12), multisector perspectives on systems-level changes for obesity solutions (Chapter 13), and patient–provider communication around obesity treatment and solutions (Chapter 14). Appendix B is a list of acronyms used in this proceedings, and Appendix C contains biographical sketches of the workshop series planning committee members and speakers from the three workshops.