Systems Thinking and Obesity: A Public Health Report (South Africa)

This report examines the public health crisis of obesity in South Africa, highlighting its prevalence, especially among women. It explores the application of systems thinking to address this issue, emphasizing the importance of feedback, balancing, and reinforcing processes. The report details the roles of various stakeholders, including public health officials, healthcare providers, and social groups, in obesity prevention. It also identifies significant obstacles to implementing a systems thinking approach, such as limited access to treatment programs, poor health literacy, and cognitive biases. The report recommends utilizing global approaches, interdisciplinary expertise, and systems mapping to improve obesity prevention and management. It suggests enhancing existing healthcare methods and translating research findings into practical applications, concluding that a systems-based approach is crucial for effectively addressing obesity in South Africa. The report includes an executive summary, table of contents, introduction, discussion of the public health issue, stakeholder roles, obstacles, and recommendations, along with a conclusion and references.

Running head: REPORT
Public health
Name of the Student
Name of the University
Author Note

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Executive summary
Obesity is a complex health ailment that encompasses accumulation of excess body fat. The
condition is highly prevalent in South Africa, with an increased incidence amid females,
when compared to their male counterparts. According to systems thinking approach, attention
to feedback, balancing and reinforcing are central components of systems thinking. However,
several barriers are encountered during the implementation of this approach for obesity
prevention. Hence, application of system thinking to implementation, development, and
assessment of obesity management efforts must characterise the cutting edge of community-
based programs.

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Table of Contents
Introduction................................................................................................................................3
Public health issue......................................................................................................................3
Role of stakeholders...................................................................................................................4
Obstacles....................................................................................................................................5
Recommendations......................................................................................................................6
Conclusion..................................................................................................................................6
References..................................................................................................................................7

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Introduction
Obesity refers to a medical condition that is characterised by an excess accumulation
of body fat to an extent that results in adverse health consequences. Individuals are typically
considered obese when the body mass index (BMI) in more than 30 kg/m2. The condition is
triggered by a range of risk factors such as, excess food consumption, absence of physical
activity, and genetic vulnerability (Jaacks et al., 2019). Obesity has also been identified as a
major risk factor for type 2 diabetes, hypertension, cardiovascular complications, and cancer.
This assignment will elaborate on obesity as a major concern in South Africa, and will also
explain the role of stakeholders and health systems.
Public health issue
There were an estimated 1.9 billion adults, aged more than 18 years in 2014, who
were recognised as overweight (WHO, 2019). In addition, of these, more than 600 million
people were obese. According to reports from the Healthy Living Alliance an estimated 39%
males and 70% females are overweight in South Africa, and the nation displays highest rates
of obesity in the Sub-Saharan region (AfricaCheck.Org, 2018). Results from
the Demographic and Health Survey also estimated that 68% of females aged 15 years or
more were obese or overweight. In contrast, merely 31% of males reported obesity.
Furthermore, according to reports from the World Health Organization (2019) there were
approximately 28.3% of adults who were obese in South Africa. This is considered to be the
maximum rate for obesity in sub-Saharan African nations, and was followed by Botswana
that reported 18.9% obesity rate. Further reports from South Africa that focus on the key
health indicators provided evidence for the fact that in 2016, one in five females (20%) were
in obese category, with as much as 3% of males being severely obese (National Department
of Health, 2017). Obesity was more prevalent amid coloured and Black-African females

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(26% vs. 20%). This highlights the fact that obesity is a major public health concern in South
Africa.
Role of stakeholders
There are a plethora of potential partners that significantly contribute to enforcement
and implementation of obesity prevention programs. According to Ganter et al. (2016)
comparable to the role of national and international organisations, non-profit organisations
play an important role in development of health policy, health services, and promotion of
educational and workplace settings that are characterised by increased levels of health and
fitness. Support obtained from social groups encompass assistance from friends and family
that helps people to enrol themselves in different weight-loss programs, and also encourages
them to adhere to lifestyle changes that are effective in reducing BMI (Yoshida et al., 2018).
Public health officials and governmental leadership help in development of obesity
prevention initiative, followed by evaluation of already existing programs, and dissemination
of necessary information. In addition, the officials are also accountable for multi-sectoral
family
support
groups
social
groups
health
education
centres
non-profit
organisatio
ns
elected
officials
health
advocacy
and fitness
groups
healthcare
providers

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initiatives and guiding principles that are essential to prevent obesity. Effective advocacy is
also desirable to create an impact on a range of factors at social, environmental, individual,
and policy levels. Advocacy generally comprises of skill development, education, and
behaviour changes, in order to persuading the wider population for taking necessary action to
reduce their BMI, thereby lowering their risks of mortality and morbidity. Furthermore,
taking into consideration the multifaceted interaction between genetics and the environment,
customised care plans for deterrence and management of obesity must be enforced by a
multidisciplinary healthcare team that preferably embraces the complete
community. Furthermore, healthcare providers also have the duty to give attention to
multigenerational psychosocial history of affected people, concomitant with comprehensive
physical assessment.
Obstacles
Systems thinking is an umbrella term that refers to a holistic approach to examination
that emphases on the method that a system's essential parts interconnect and how the
organisations work within the setting or superior systems. According to this approach, system
behaviour is a direct manifestation of the impacts of balancing and reinforcing processes.
However, major obstacles encountered during implementation of systems thinking approach
(Loosemore & Cheung, 2015). Although surgical programs like bariatric surgery have been
found effective in obesity treatment, access to such programs by people living in South
Africa is limited for several reasons such as, poor socioeconomic status, lack of health
infrastructure, invasive kind of surgery, and long waiting time. Another major challenge is
that poor health literacy among residents of South Africa makes it difficult for the affected
people to show adherence to lifestyle modifications, thus acting as an impediment (Arnold &
Wade, 2015). The structure of the human mind also results in an incapability to routinely
transfer information and refined learning from theory to practice. The human mind needs

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positive progress and the inherent tendency to reach conclusions gets augmented by
“availability error”. This makes it difficult to develop verifications about obesity management
procedures, based on limited health literacy. The natural desire of affected people to observe
immediate progress in their health status is another potential barrier.
Recommendations
A systems thinking approach can be implemented by utilising more global approaches
such as, interconnectivity between different nations through communications, food systems,
manufacturing practices, and socio-behavioural norms. This would increase stakeholder
cooperation and funding for cross-country obesity prevention initiatives. Expertise must be
cultivated from different disciplines. Utilising expertise from disciplines like computer
science and engineering, will also prove beneficial in bringing about significant
methodological approaches and novel perspectives (Lee et al., 2017). Systems mapping will
help in delineating a comprehensive picture of the obesity prevention system existing in the
nation. Collecting stakeholders for group mapping exercise will help in gaining suggestions
related to identification of health components that are vital for obesity prevention and
management. At the time of mapping food system in the nation, urban planners can also
provide description for food supply and connection between retailers, suppliers, and
manufacturers. Systems approach can also be used for enhancing existing healthcare
methods, by shaping the development and design of health policies and interventions for
reducing obesity (Allender et al., 2015). Systems approach can also be used for translating
research findings about obesity prevention programs into real-time settings. Training can also
be provided by systems science experts to decision makers and healthcare professionals for
obesity prevention.

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Conclusion
Thus, it can be concluded that obesity is a global epidemic and has high prevalence in
South Africa. Although there are several interventions and policies for reversing the trends of
obesity, there is a need to implement system based approach for successfully addressing the
problem of obesity in South Africa.

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References
AfricaCheck.Org. (2018). Are some 70% of women, 39% of men in South Africa overweight?
Retrieved from https://africacheck.org/spot-check/are-some-70-of-women-39-of-men-
in-south-africa-overweight/
Allender, S., Owen, B., Kuhlberg, J., Lowe, J., Nagorcka-Smith, P., Whelan, J., & Bell, C.
(2015). A community based systems diagram of obesity causes. PloS one, 10(7),
e0129683. https://doi.org/10.1371/journal.pone.0129683
Arnold, R. D., & Wade, J. P. (2015). A definition of systems thinking: A systems
approach. Procedia Computer Science, 44, 669-678.
https://doi.org/10.1016/j.procs.2015.03.050
Friedrich, M. J. (2017). Global obesity epidemic worsening. Jama, 318(7), 603-603.
doi:10.1001/jama.2017.10693
Ganter, C., Aftosmes-Tobio, A., Chuang, E., Blaine, R. E., Land, T., & Davison, K. K.
(2016). Community stakeholders’ perceptions of major factors influencing childhood
obesity, the feasibility of programs addressing childhood obesity, and persisting
gaps. Journal of community health, 41(2), 305-314. https://doi.org/10.1007/s10900-
015-0097-y
Jaacks, L. M., Vandevijvere, S., Pan, A., McGowan, C. J., Wallace, C., Imamura, F., ... &
Ezzati, M. (2019). The obesity transition: stages of the global epidemic. The Lancet
Diabetes & Endocrinology. https://doi.org/10.1016/S2213-8587(19)30026-9
Lee, B. Y., Bartsch, S. M., Mui, Y., Haidari, L. A., Spiker, M. L., & Gittelsohn, J. (2017). A
systems approach to obesity. Nutrition reviews, 75(suppl_1), 94-106.
https://doi.org/10.1093/nutrit/nuw049

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Loosemore, M., & Cheung, E. (2015). Implementing systems thinking to manage risk in
public private partnership projects. International Journal of Project
Management, 33(6), 1325-1334. https://doi.org/10.1016/j.ijproman.2015.02.005
National Department of Health. (2017). South Africa Demographic and Health Survey 2016.
Retrieved from https://www.statssa.gov.za/publications/Report%2003-00-09/Report
%2003-00-092016.pdf#page=62
World Health Organization. (2019). Obesity- Overview. Retrieved from
https://www.afro.who.int/health-topics/obesity
Yoshida, Y., Broyles, S., Scribner, R., Chen, L., Phillippi, S., Jackson-Thompson, J., ... &
Tseng, T. S. (2018). Social support modifies the negative effects of acculturation on
obesity and central obesity in Mexican men. Ethnicity & health, 1-12.
https://doi.org/10.1080/13557858.2018.1492708