Complex problems, such as chronic health conditions like obesity, are problems that persist. They are often intractable, referred to as “wicked”, and require complex solutions. The Foresight project provided proof of this complexity when they used qualitative modelling to explore variables associated with obesity. They developed a systems map (illustrated below) to model the interrelationships among the factors impacting a person’s energy balance. The model is so complex, it has never been implemented. However, the model highlights that a substantial degree of intervention will be required to impact obesity trends, both individually and at a population level.
Figure 1. Systems Map; the interrelationships among the factors impacting a person’s energy balance
The numerous complex causative and maintaining factors for obesity, depicted in the Foresight Obesity Map above, call into question the efficacy of approaches used in outcome research in health management. Outcome research seeks to provide evidence about which specific interventions work best for specific conditions, and under what specific circumstance. Obviously, using reductionist linear models of cause and effect to engage with the non-linear complexity of the obesity problem may explain our poor success in reversing obesity prevalence.
Another issue with outcome research is that it endeavours to lessen therapist or practitioner effects to reduce the likelihood that therapist or practitioner effects are responsible for the outcome. The aim of outcome research is to identify outcome effects due to treatment. However, what this approach is doing is removing half the human element of the therapeutic encounter, minimising the interpersonal nature of the client-practitioner interaction and ignoring the practitioner’s contribution to client improvement.
Based on the findings of the Foresight Project and other research, there is emerging agreement that it is futile to pursue linear, cause and effect approaches or isolated initiatives for chronic health conditions that are regarded as complex and multi-systemic. My PhD research was based around this tenet. The thematic concern underlying my research was predicated on the general ineffectiveness of current (individually focussed and non-surgical) weight loss strategies. I was interested in exploring ways to manage the complexity associated with obesity. When I conducted my research position papers and obesity guidelines were recommending multicomponent multidisciplinary approaches, ostensibly to address the complexity highlighted by the Foresight Project. However, there appeared to be no specific recommendations for such an approach. Subsequently, the focus of my research was to operationalise a multicomponent multidisciplinary approach to obesity management.
Stakeholders providing data for my research affirmed that practitioner factors, as well as client factors, were important considerations in managing obesity. The research redirected attention from a focus on specific treatments, and emphasised the contribution of the practitioner, to the treatment process, and outcomes. This supported the move away from traditional outcome research that endeavours to find the right treatment for the right disorder, and to become more process aware.
Process factors were also identified in my research, as a crucial component of managing complex conditions like obesity. The simple model below depicts the interrelationship among process, practitioner and client factors; the practitioner’s contribution to a client’s well-being, and to treatment outcomes, can be facilitated by applying certain process skills.
Figure 2. The interrelationship among process, practitioner and client factors
Bob Dick (one of my PhD supervisors) and myself, will be teaching process skills and systems thinking, in a two-day workshop in Brisbane on 31 March – 1 April in Brisbane. The workshop will benefit medical (doctors, nurses) and allied health professionals working with chronic health conditions, like obesity. We will present a change model that provides a framework that enables both the practitioner and the client to “co-produce treatment” and respond dynamically to issues in real time. We will also be teaching participants how to develop a systems perspective using a multicomponent multidisciplinary platform. The workshop is titled:
Achieving Better Health & Weight Outcomes: Applying Systems Thinking & Change Processes to a Multicomponent Multidisciplinary Approach
We have posted the event on EventBrite. We are running our first workshop in our hometown of Brisbane, but if we have sufficient interest would run it elsewhere. Prices and other relevant information including registration, can be found on the following link: