Abstract for: Dynamics of Obesity Interventions inside Organizations

In the US, obesity has been recognized as a major public health challenge for over two decades. A large number of obesity interventions, from upstream (policy) to downstream (individual level), have been put forward to curb the obesity trend; however, not all those interventions have been successful. Overall effectiveness of obesity interventions relies not only on the average efficacy of a generic intervention, but also on the successful Adoption, Implementation, and Maintenance (AIM) of that intervention. In this study, we aim to understand how effectiveness of organizational level obesity interventions depends on dynamics of AIM. We focus on an obesity intervention, implemented in food carry-outs in low-income urban areas of Baltimore city, which aims to improve dietary behavior for adults through better food access and point of purchase prompts. Building on data from interviews and literature, we first develop a contextualized map of causal relationships integral to dynamics of AIM, and then quantify those mechanisms using a system dynamics simulation model. The objective is to enhance our understanding of organizational dynamics that impact the effectiveness of chronic disease preventive interventions. We show how as a result of several reinforcing loops that span stakeholder motivation, communications, and implementation quality and costs, little changes in the process of AIM can make the difference between success and failure. [Word count: 4,610]