Abstract
Research evidence indicates that obesity has spread through social networks, but lever points for interventions based on overlapping networks are not well studied. The objective of our research was to construct and parameterize a system dynamics model of the social transmission of behaviors through adult and youth influence in order to explore hypotheses and identify plausible lever points for future childhood obesity intervention research. Our objectives were: (1) to assess the sensitivity of childhood overweight and obesity prevalence to peer and adult social transmission rates, and (2) to test the effect of combinations of prevention and treatment interventions on the prevalence of childhood overweight and obesity. To address the first objective, we conducted two-way sensitivity analyses of adult-to-child and child-to-child social transmission in relation to childhood overweight and obesity prevalence. For the second objective, alternative combinations of prevention and treatment interventions were tested by varying model parameters of social transmission and weight loss behavior rates. Our results indicated child overweight and obesity prevalence might be slightly more sensitive to the same relative change in the adult-to-child compared to the child-to-child social transmission rate. In our simulations, alternatives with treatment alone, compared to prevention alone, reduced the prevalence of childhood overweight and obesity more after 10 years (1.2–1.8% and 0.2–1.0% greater reduction when targeted at children and adults respectively). Also, as the impact of adult interventions on children was increased, the rank of six alternatives that included adults became better (i.e., resulting in lower 10 year childhood overweight and obesity prevalence) than alternatives that only involved children. The findings imply that social transmission dynamics should be considered when designing both prevention and treatment intervention approaches. Finally, targeting adults may be more efficient, and research should strengthen and expand adult-focused interventions that have a high residual impact on children.
Highlights
The worldwide growth in overweight and obesity has created negative health, social and economic consequences for children, adults, and society as a whole [1,2,3]
Holding the converse rate constant, reducing the adult-to-child social transmission rate from .0019 to .0011 resulted in a 1.8% lower childhood overweight and obesity prevalence than the same reduction in the child-to-child social transmission rate
Childhood obesity prevalence may be more sensitive to changes in adult-to-child social transmission rates compared to child-to-child rates
Summary
The worldwide growth in overweight and obesity has created negative health, social and economic consequences for children, adults, and society as a whole [1,2,3]. Some research indicates increases in US childhood overweight and obesity rates may be slowing [5], but we still need strategies to accelerate a downward trend in order to abate forthcoming obesity-related health and economic consequences [6]. Research that improves our understanding of the complex dynamics of social spread of obesity among children via both peer and adult influences may help identify key leverage points, and guide resource allocation to the most impactful combination of intervention strategies. The immediate cause of overweight and obesity is energy imbalance, but complex interactions of multi-level factors including individual human biology, behavior, and environment give rise to the current worldwide epidemic [7]. Social ties may transfer obesity and obesity-related behaviors through pathways of social norms, capital (i.e., resources, information and people accessible through a social network), and stress [9]
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