Abstract
Many Small Island Developing States of the Caribbean experience a triple burden of malnutrition with high rates of obesity, undernutrition in children, and iron deficiency anemia in women of reproductive age, driven by an inadequate, unhealthy diet. This study aimed to map the complex dynamic systems driving unhealthy eating and to identify potential points for intervention in three dissimilar countries. Stakeholders from across the food system in Jamaica (n = 16), St. Kitts and Nevis (n = 19), and St. Vincent and the Grenadines (n = 6) engaged with researchers in two group model building (GMB) workshops in 2018. Participants described and mapped the system driving unhealthy eating, identified points of intervention, and created a prioritized list of intervention strategies. Stakeholders were also interviewed before and after the workshops to provide their perspectives on the utility of this approach. Stakeholders described similar underlying systems driving unhealthy eating across the three countries, with a series of dominant feedback loops identified at multiple levels. Participants emphasized the importance of the relative availability and price of unhealthy foods, shifting cultural norms on eating, and aggressive advertising from the food industry as dominant drivers. They saw opportunities for governments to better regulate advertising, disincentivize unhealthy food options, and bolster the local agricultural sector to promote food sovereignty. They also identified the need for better coordinated policy making across multiple sectors at national and regional levels to deliver more integrated approaches to improving nutrition. GMB proved to be an effective tool for engaging a highly diverse group of stakeholders in better collective understanding of a complex problem and potential interventions.
Highlights
One in five members of the United Nations are Small Island Developing States (SIDS)
We describe the system driving unhealthy eating in these three Caribbean countries as mapped by stakeholders during the workshops
Most of the studies we reviewed that applied systems methods to obesity prevention and unhealthy eating have called for better coordination of multisector and multilevel policies and interventions
Summary
One in five members of the United Nations are Small Island Developing States (SIDS). These include38 countries, of which 16 are in the Caribbean, with a combined population of around 42 million [1].These countries share some social, economic, and environmental vulnerabilities, especially related to inadequate and unhealthy diets driving high burdens of two or more types of malnutrition [2]. Many of the SIDS of the Caribbean are faced with a triple burden of high and increasing rates of overweight and obesity (typically ≥30%), persistent underweight and stunting in children (≥7%), and micronutrient deficiencies including iron deficiency in women of reproductive age (≥20%) [3]. The drivers of these burdens are complex and interrelated and in the Caribbean include an unhealthy diet characterized by low consumption of fruits, vegetables, nuts, and whole grains [4,5], and high consumption of fats, refined sugars, and salt [3]. The majority of these imports are highly processed, energy-dense, nutrient-poor foods which are partly responsible for the rising obesity epidemic and micronutrient deficiencies [6]
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