The Obesity Epidemic in Turkey: A System Dynamics and Behavioral Economics Approach in the context of an Obesogenic System

Obesity is an increasing problem across the world, and it has risen dramatically in the last decades. It is a major risk factor for noncommunicable diseases which are the world’s leading cause of death. In Turkey, the obesity epidemic is becoming a growing concern. Policies against obesity have had minimal success thus far. Given this issue, the aim of this study is to analyze the underlying structure of the obesity problem from a system’s perspective since the obesogenic system is a complex adaptive system. Therefore, this study uncovers the dynamic interactions within this system and resulting behavior patterns by developing a system dynamics simulation model. Furthermore, behavioral economics and reinforcement pathology frameworks are integrated into the model to provide policymakers with more robust insights. This thesis employs a system dynamics methodology to analyze aggregated level interactions between system components to understand complex systems. Combining system dynamics with behavioral economics and reinforcement pathology frameworks provides a guide to this complex adaptive system to understand how the obesogenic environment shapes individual decision-making. A theoretical model developed to show how reinforcement pathology occurs within the obesogenic environment, as well as the feedback loop analysis to identify important feedbacks within the system. Thereafter, the theoretical model quantified into a system dynamics simulation model that generates the behavior pattern and trend from endogenous interactions for further analysis of the system. According to the findings, the obesogenic environment is a complex adaptive system where ingestive behavior is shaped by the environment as well as the environment is influenced by the ingestive behavior. It was found that this system is dominated by many uncontrolled powerful reinforcing feedback loops at various levels interacting with each other. In addition, the study found that reinforcement pathology framework integrated to system dynamics methodology shows how environmental factors are making food consumption more valuable, more reinforcing within this adaptive system, hence affecting individual behavior. Additionally, the study also identified several leverage points to intervene obesogenic system namely intervening reinforcement pathology feedback loop by creating substitutes for food, the weak balancing feedback loop that fails to balance the relative reinforcing value of food and lack of rules within the system especially mechanisms that reward individuals with healthier lifestyle. In conclusion, the study showed that without a clear understanding feedback mechanisms working within an obesogenic environment and interventions that aim to address those feedback processes may result in less effective policies. This research sheds some light into understanding the obesity problem as a complex adaptive system and how the system can be leveraged to help reduce obesity rates.Master's Thesis in System DynamicsGEO-SD351INTL-KMDINTL-JUSINTL-MEDINTL-MNMASV-SYSDYINTL-SVINTL-HFINTL-PSY

Understanding the dynamics emerging from the interplay among poor mental wellbeing, energy balance-related behaviors, and obesity prevalence in adolescents: A simulation-based study

Both obesity and poor mental wellbeing have a high prevalence in European youth. Adolescents in six countries identified mental wellbeing factors as main drivers of youth obesity through systems mapping. This study sought to (1) explore the dynamics of the interplay between poor mental wellbeing, energy balance-related behaviors, and adolescent overweight and obesity prevalence and (2) test the effect of intervention point scenarios to reduce adolescent obesity. Drawing on the youth-generated systems maps and a literature synthesis, we built a simulation model that represents the links from major feedback pathways for poor mental wellbeing to changes in dietary, physical activity, and sleep behaviors. The model was calibrated using survey data from Norway, expert input, and literature and shows a good fit between simulated behavior and available statistical data. The simulations indicate that adolescent mental wellbeing is harmed by socio-cultural pressures and stressors, which trigger reinforcing feedback mechanisms related to emotional/binge eating, lack of motivation to engage in physical activity, and sleep difficulty. Targeting a combination of intervention points that support a 25% reduction of pressure on body image and psychosocial stress showed potentially favorable effects on mental wellbeing—doubling on average for boys and girls and decreasing obesity prevalence by over 4%.publishedVersio

Co-creating obesity prevention policies with youth: Policy ideas generated through the CO-CREATE project

Despite growing recognition of the importance of applying a systems lens to action on obesity, there has only been limited analysis of the extent to which this lens has actually been applied. The CO-CREATE project used a youth-led participatory action research approach to generate policy ideas towards the reduction of adolescent overweight and obesity across Europe. In order to assess the extent to which these youth-generated policy ideas take a systems approach, we analyzed them using the Intervention Level Framework (ILF). The ILF ascribes actions to one of five system levels, from Structural Elements, the least engaged with system change, up to Paradigm, which is the system's deepest held beliefs and thus the most difficult level at which to intervene. Of the 106 policy ideas generated by young people during the CO-CREATE project, 91 (86%) were categorized at the level of Structural Elements. This emphasis on operational rather than systems level responses echoes findings from a previous study on obesity strategies. Analyzing the distribution of systems level responses using the ILF has the potential to support more effective action on obesity by allowing identification of opportunities to strengthen systems level responses overall.publishedVersio

The Obesity Epidemic in Turkey: A System Dynamics and Behavioral Economics Approach in the context of an Obesogenic System

Obesity is an increasing problem across the world, and it has risen dramatically in the last decades. It is a major risk factor for noncommunicable diseases which are the world’s leading cause of death. In Turkey, the obesity epidemic is becoming a growing concern. Policies against obesity have had minimal success thus far. Given this issue, the aim of this study is to analyze the underlying structure of the obesity problem from a system’s perspective since the obesogenic system is a complex adaptive system. Therefore, this study uncovers the dynamic interactions within this system and resulting behavior patterns by developing a system dynamics simulation model. Furthermore, behavioral economics and reinforcement pathology frameworks are integrated into the model to provide policymakers with more robust insights. This thesis employs a system dynamics methodology to analyze aggregated level interactions between system components to understand complex systems. Combining system dynamics with behavioral economics and reinforcement pathology frameworks provides a guide to this complex adaptive system to understand how the obesogenic environment shapes individual decision-making. A theoretical model developed to show how reinforcement pathology occurs within the obesogenic environment, as well as the feedback loop analysis to identify important feedbacks within the system. Thereafter, the theoretical model quantified into a system dynamics simulation model that generates the behavior pattern and trend from endogenous interactions for further analysis of the system. According to the findings, the obesogenic environment is a complex adaptive system where ingestive behavior is shaped by the environment as well as the environment is influenced by the ingestive behavior. It was found that this system is dominated by many uncontrolled powerful reinforcing feedback loops at various levels interacting with each other. In addition, the study found that reinforcement pathology framework integrated to system dynamics methodology shows how environmental factors are making food consumption more valuable, more reinforcing within this adaptive system, hence affecting individual behavior. Additionally, the study also identified several leverage points to intervene obesogenic system namely intervening reinforcement pathology feedback loop by creating substitutes for food, the weak balancing feedback loop that fails to balance the relative reinforcing value of food and lack of rules within the system especially mechanisms that reward individuals with healthier lifestyle. In conclusion, the study showed that without a clear understanding feedback mechanisms working within an obesogenic environment and interventions that aim to address those feedback processes may result in less effective policies. This research sheds some light into understanding the obesity problem as a complex adaptive system and how the system can be leveraged to help reduce obesity rates

System dynamics simulation models on overweight and obesity in children and adolescents: A systematic review

It has increasingly been recognized that developing successful obesity prevention policies and interventions requires understanding of the complex mechanisms driving the obesity pandemic and that models could be useful tools for simulating policies. This paper reviews system dynamics simulation models of mechanisms driving childhood overweight and obesity and/or testing of preventive interventions. A systematic literature search was conducted in six databases from inception to January 2023 using terms related to overweight/obesity, children, and system dynamics. Study descriptives, mechanisms, and where to intervene (the leverage points), as well as quality assessments of the simulation models were extracted by two researchers into a predetermined template and narratively synthesized. Seventeen papers describing 15 models were included. Models describing the mechanisms ranged from only intrapersonal factors to models cutting across multiple levels of the ecological model, but mechanisms across levels were lacking. The majority of interventions tested in the simulation models were changes to existing model parameters with less emphasis on models that alter system structure. In conclusion, existing models included mechanisms driving youth obesity at multiple levels of the ecological model. This is useful for developing an integrated simulation model combining mechanisms at multiple levels and allowing for testing fundamental system changes.publishedVersio

Push and Pull Factors of Why Medical Students Want to Leave Türkiye: A Countrywide Multicenter Study

Phenomenon: Physician immigration from other countries is increasing as developed countries continue to be desirable destinations for physicians; however, the determinants of Turkish physicians’ migration decisions are still unclear. Despite its wide coverage in the media and among physicians in Türkiye, and being the subject of much debate, there is insufficient data to justify this attention. With this study, we aimed to investigate the tendency of senior medical students in Türkiye to pursue their professional careers abroad and its related factors. Approach: This cross-sectional study involved 9881 senior medical students from 39 different medical schools in Türkiye in 2022. Besides participants’ migration decision, we evaluated the push and pull factors related to working, social environment and lifestyle in Türkiye and abroad, medical school education inadequacy, and personal insufficiencies, as well as the socioeconomic variables that may affect the decision to migrate abroad. The analyses were carried out with a participation rate of at least 50%. Findings: Of the medical students, 70.7% had emigration intentions. Approximately 60% of those want to stay abroad permanently, and 61.5% of them took initiatives such as learning a foreign language abroad (54.5%) and taking relevant exams (18.9%). Those who wanted to work in the field of Research & Development were 1.37 (95% CI: 1.22–1.54) times more likely to emigrate. The push factor that was related to emigration intention was the “working conditions in the country” (OR: 1.89, 95% CI: 1.56–2.28) whereas the “social environment/lifestyle abroad” was the mere pull factor for the tendency of emigration (OR: 1.73, 95% CI: 1.45–2.06). In addition, the quality problem in medical schools also had a significant impact on students’ decisions (OR: 2.20, 95% CI: 1.83–2.65). Insights: Although the percentage of those who want to emigrate “definitely” was at the same level as in the other developing countries, the tendency to migrate “permanently” was higher in Türkiye. Improving working conditions in the country and increasing the quality of medical faculties seem vital in preventing the migration of physicians