Thinking in Circles About Obesity Applying Systems Thinking to Weight Management 1st Edition by Tarek Hamid ISBN 978-0387094687 0387094687
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ISBN 10: 0387094687
ISBN 13: 978-0387094687
Author: Tarek K. A. Hamid
Today’s c Tarek K. A. Hamidhildren may well become the first generation of Americans whose life expectancy will be shorter than that of their parents. The culprit, public health experts agree, is obesity and its associated health problems. Heretofore, the strategy to slow obesity’s galloping pace has been driven by what the philosopher Karl Popper calls ‘‘the bucket theory of the mind. ’’ When minds are seen as containers and public understanding is viewed as being a function of how many scientific facts are known, the focus is naturally on how many scientific facts public minds contain. But the strategy has not worked. Despite all the diet books, the wide availability of reduced-calorie and reduced-fat foods, and the broad publicity about the obesity problem, America’s waistline continues to expand. It will take more than food pyramid images or a new nutritional guideline to stem obesity’s escalation. Albert Einstein once observed that the significant problems we face cannot be solved at the same level of thinking we were at when we created them, and that we would have to shift to a new level, a deeper level of thinking,tosolvethem. Thisbookarguesfor,andpresents,adifferent perspective for thinking about and addressing the obesity problem: a systems thinking perspective. While already commonplace in engineering and in business, the use of systems thinking in personal health is less widely adopted. Yet this is precisely the setting where complexities are most problematicandwherethestakesarehighest
Table of contents:
I Mismanaging the Obesity Threat
1 Like Boiled Frogs.
How the Problem Sneaked Up on Us.
The Temperature Is Rising
The Heavy Burden of Obesity
For Older Americans, The Future Is Now.
The Sociocultural Burden
“Globesity”.
A Bucket Half-Empty?
The Leverage (or the Impediment) Is with the People.
It Is Not Easy Becoming a Top Gun
States In Mind
Emotions Play a Role
Failure to Learn from Failure
Single-Loop vs. Double-Loop Learning
Barriers to Learning.
What Is to Be Done?.
Metanoia.
Synthesis, Not Analysis
What Is Feedback?.
Circles, Not Straight Lines.
Dynamic, Not Static
Obliterating, Not Automating
Notes…
II How We Changed Our Environment, and Now Our Environment
Is Changing Us
2 Unbalanced Act
Moving Beyond Individual-Centric Explanations
Evolved Asymmetry of Our Physiology
How Asymmetry Is Achieved by Our Physiology
Asymmetry in Energy Intake.
Asymmetry in Energy Expenditure.
Asymmetry in Energy Storage…
Conclusion
3 Human-Environment Interactions: Not One Way and
Not One-Way.
Human Behavior Is Not Expressed in a Vacuum.
It Is Not Just Physical.
A Symphony Out of Tune?.
4 Tilting the Energy Balance: More Energy In
The Quantity of Food We Eat….
The Causes Behind the Cause
How America’s Eating Habits Started to Change.
The First Mechanism: The Time We Eat.
Soft Drinks: The Liquid Snack…
The Second Mechanism: Where We Eat.
Fast Food: Eat Anywhere, Everywhere
The Qualitative Dimension
The Quantity Dimension.
Events Give Birth to Trends, But What Escalates Them
Are Self-Reinforcing Processes
Demand-Pull
.
Supply-Push..
Putting It All Together.
Obese Hurricane.
5 Tilting the Energy Balance: Less Energy Out.
The Water Is Boiling!.
Work: Engineering Energy Expenditure Out
of the Workplace
Moving About: Transport and Urban Design.
Play and Leisure…
The Burden Is Cumulative.
Dr. Jekyll and Mr. Hyde, or Changing the Vicious to Virtuous
6 Individual Differences.
Some Are “Squares,” and Some Are Not.
Deciphering the Code, One Gene at a Time
Genes and Individual Susceptibility to Weight Gain:
The Experimental Findings..
The Pimas.
Genetic x Environmental Interactions: Conclusion.
7 Is Ad-Lib Behavior Killing Us?
A (Mis-)Match Made in America
Like Our Genes, Our Mental Models Did Not Change.
Turning-Off Automatic Control and Asserting Cognitive
Control
It Can Be Done….
The Allure of the “Silver Bullet”
Looking Ahead.
Notes…
III We Can’t Manage What We Don’t Understand
8 The Energy Balance Equation: Reigning Intellectual Paradigm or Straitjacket?..
The Magic Number
From the Experts’ Mouths to the Journalists’ Ears to the
Public’s Mind.
We Like to Believe that We Are in Full Control.
9 What We Know that Ain’t So.
Looking Back Versus Looking Forward
The First Trap: Linear Thinking.
A Plumbing Analogy
A Second Trap: Energy as a Single Currency
We Need a Better “Map”
10 Closing the Loops on Energy Balance: Energy Output Side
Tip of a Physiological Iceberg!
“Under-the-Surface” Determinants of Energy Expenditure.
The System in Action: “Under the Surface” Responses to Energy
Imbalance.
Implications for Treatment…
Failure to Account for Individual Differences
How an Energy Deficit Is Induced Also Matters
Seeing Through the Complexity Revisiting the Bathtub Analogy.
Learning to “Squint”
11 Closing the Loops on Energy Balance: Energy Input Side
Body Defenses on the Second Energy Front.. Two-Tier System: Short-Term and Long-Term
Short-Term Component.
Long-Term Component..
Two Asymmetries, Not One.
A Homeostatic System with a Difference
12 Beyond Physiology: Closing the Behavior-Physiology Loop
Not Only Do We Eat Food, We Also Think About It.
Which Requires More Effort: To Do or Not to Do?.
Strength (and Weakness) Model of Human Self-Regulation.
A First Course in Managing Stocks and Flows…
The Evidence: To Use It Is to Lose It, at Least Temporarily
A Challenge for the Self: How to Accomplish a Lot with a Little…
Why Goals Matter, and How More May Be Less
Weight Cycling: Not Once, Not Twice
Understanding How Cycles Happen.
Longer-Term Risks
Less Is More.
13 Looking Back and Looking Forward
Looking Back
Understanding Is a First Step, But Far from Sufficient
Looking Forward
Notes.
IV We Can’t Manage What We Mis-Predict
14 Learning by Doing.
How Hard Can It Be?
Trying Your Hand at Predicting Dynamics
The Bathtub Exercise.
The Answer…
What Do These Results Tell Us?.
Beyond Bathtubs
15 “Give Us the Tools, and We Will Finish the Job”
Sources of Complexity in Systems
The KISS Acronym: “Keep It Simple, Stupid”
Argument for a Calculus
Leveraging Computer Technology
16 A Microworld for Weight and Energy Regulation
Telescopes for the Mind..
Simulation Models Are Operational Models.
Overview of Model Structure.
Energy Intake (EI) Subsystem.
Energy Expenditure (EE) Subsystem
Energy Metabolism and Regulation Subsystem
Glucose and Free Fatty Acid Metabolism.
Protein/Amino Acid Metabolism
Exercise Metabolism
Body Composition Subsystem..
Fat Mass (FM)
Fat-Free Mass (FFM)
Taking Off…
17 Experiment 1: Assessing Weight Loss-Reality Versus Fiction.
The Experiment.
Experimental Results..
Looking Inside a White Box
It Is Not Academic.
18 Experiment 2: Going Ballistic-On a Diet.
Chasing a Moving Target.
The Experiment.
It Is No Passive Tool
19 Experiment 3: Understanding Why 250 Pounds Does Not Equal 250
Pounds
Individual Differences: More than Meets the Eye
The Experiment.
Phase 1: Overfeeding.
Phase 2: Dieting
114 kg / 114 kg ≠ 114 kg!.
One Size Does Not Fit All
20 Experiment 4: Trading Treatment Options-Diet Versus Exercise.
Energy Is Not a Single Currency
Diet Versus Exercise: Do 500 kcal = 500 kcal?
Trading Exercise Intensity for Exercising Time.
Manipulating Diet Composition
Don’t Trade… Integrate.
21 PhDs for the Masses? (That’s Personal Health Decision support).
Notes…
V Prevention and Beyond
22 The Fat Lady Models
23 The Third Path: Prevention
Can’t Unscramble an Egg.
The Buck Starts Here
Make Healthy Choices the Easy Choices.
Public Works to Level the Playing Field.
Energy Input…
“Thought for Food”
Economic Incentives
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