Aug. 11 2015

World Economic Forum Leadership Fellows Consider Obesity Pandemic

Obesity, once thought of as an American problem, has spread around the world as cities from Sao Paolo to Seoul are clogged with fast food and starved of parks and playgrounds. The global scope of this pandemic made it a fitting subject of study for mid-career professionals of the World Economic Forum's Global Leadership Fellows Program.

For the third year, scholars at Columbia University’s Mailman School of Public Health took a week in July to introduce ideas in public health as the fellows prepare for careers with international reach. Dean Linda P. Fried asked the group to challenge the notion that obesity’s rise—up twofold since 1980—is the product of gluttony and sloth. “Global willpower didn’t decline in the last 30 years,” Fried said. Instead, populations are shaped by the physical and social environment. Demanding schedules create a time famine that privileges fast food, which is also more available and affordable than nutritious options. “Health is everyone’s responsibility and matters for every sector,” said Fried.  

Our culture and our thinking tilt toward obesity. Case in point: at the sports bar, people eat and drink and leave the physical activity to professional athletes on big screen TVs; and more often than not they drive to get there. Andrew Rundle, associate professor of Epidemiology and co-director of the School’s Obesity Prevention Initiative, emphasized the power of the built environment. How healthy is the place you live? Ask yourself if you have to get in a car to go to the grocery store. In general compared with the suburbs, cities with sidewalks, mixed land uses, and public transportation are more walkable and support physical activity as part of every day life. “If you live in an environment where you can walk to pick up some milk or accomplish other tasks of daily living, you are generally going to be more physically active,” said Rundle. “All those steps to the grocery store and subway stop add up, every ride on subway involves climbing four flights of stairs.”

Individual decisions around food often aren’t always rational, said Claire Wang, associate professor of Health Policy and Management and co-director of the School’s Obesity Prevention Initiative. She related an experiment by Cornell researcher Brian Wansink that employed a “bottomless bowl” that surreptitiously refilled itself. The result showed that people continue to eat as long as food is readily available; portion size matters. “People often eat and drink what’s served. We don’t have as much control as we think we do,” said Wang. While some believe that the solution to obesity is a public better informed about diet and exercise, interventions like calorie labeling haven’t been nearly as effective as their authors hoped. In fact, one study found that some young men choose foods with the highest calories to get their money’s worth. It’s more effective if restaurants cut the calories across the board than relying on customers to choose healthy foods. “I don’t want to discount education and knowledge, but more is needed,” Wang said.

Obesity isn’t just called an epidemic for its rapid expansion—research shows that it spreads person to person. A study by Nicholas Christakis at Harvard found that your risk for obesity is 45 percent higher if your friends are obese; if your friends of friends are obese, your risk is elevated another 25 percent. How does this work? Your idea of what a healthy body weight shifts while you may be more likely to get invited to go out to a sports bar and dig in on the buffalo wings.

Armed with facts, the World Economic Forum fellows were challenged to dream up strategies to combat obesity. Mark Vernooij and his team from THNK School of Creative Leadership led the teams through a design thinking process to flesh out ideas targeting specific demographics. One team of fellows discussed a Task Rabbit-style smartphone app to promote physical activity among seniors by connecting them with odds jobs like dog walking. Another, inspired by research by Heather Greenlee, assistant professor of Epidemiology, looked for ways to nudge pregnant women to prepare healthy meals.

Claire Wang left the group with advice inspired by complex systems thinking. Turn the idea of obesity as an infection on its head, she said. Think of solutions from the point of view of a virus. For example, if you’re a public health intervention, you’d do well to “infect” a super-spreader—a social butterfly who travels widely. “Good ideas go viral,” said Wang. “Will your idea excite people? Can it spread and stick? Can it be effortless so that the healthy choice is the easy or automatic choice?