Mobile apps try to affect leverage points related to obesity by designing features that: 1) Provide feedback and notifications to increase awareness of behaviors and lengthen the delay between actions and their consequences. 2) Incorporate social sharing and challenges to strengthen negative feedback loops that discourage overeating and inactivity. 3) Reward positive behaviors like exercise and healthy eating through achievements and points to drive positive feedback loops. However, apps may have limited effectiveness if they don't help users develop new decision-making skills and change underlying mindsets about weight control. A systems thinking approach recognizes weight as involving complex physiological and environmental factors rather than simply calories in versus out.

1. BODIES &
BUILDINGS
NYU ITP LECTURE COURSE SPRING 2013
CLASS 2: FEBRUARY 4, 2013
JEN VAN DER MEER @JENVANDERMEER WWW.JENVANDERMEER.COM

2. LEVERAGE POINTS
Class assignment for 2/4/2013
Mandatory! Read ALL OF Donella Meadows:
Leverage Points: Places to Intervene in a System
Take leverage points 9, 8, 7.
Write a 1 page or 500-6000 word essay on the following topic:
How do mobile apps try to affect leverage points 9, 8, and 7.
9) The length of delays, relative to the rate of system change
8) The strength of negative feedback loops, relative to impacts they are trying
to correct against
7) The gain around driving positive feedback loops
Give one example and explain how the app is or is not designed to affect each
of these leverage points. How effective do you think this app will be at
changing behavior?
You will be asked to present your work, so practice rehearsing your in class
presentation at least two times.
February 4, 2013
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3. PLACES TO INTERVENE IN A SYSTEM:
12. Constants, parameters, numbers (subsidies, taxes, standards)
11. The sizes of buffers and other stabilizing stocks, relative to their flows
10. The structure of material stocks and flows (transport networks, population age structures)
9. Length of delays, relative to the rate of system change
8. The strength of negative feedback loops, relative to the impacts they are trying to correct against
7. The gain around driving positive feedback loops
6. The structure of information flows (who does and does not have access to what kinds of information)
5. The rules of the system (such as incentives, punishments, constraints)
4. The power to add, change, evolve, or self-organize system structure
3. The goals of the system
2. The mindset or paradigm out of which the system – its goals, power structure, rules, its culture-arises
1. The power to transcend paradigms
February 4, 2013
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4. BODIES IN THE NEWS
LabDoor Launches: lets users search for their dietary
supplements and view grades reflecting their clinical efficacy
and ingredient safety.
New HIPAA rules finalized: When a patient is required by a
provider to request records or documents in writing, the request
may be made electronically.
In a video produced for the release of Bill Gates's 2013 Annual
Letter, Swedish academic Hans Rosling explains why common
notions of developing vs. developed countries are no longer
clear-cut.
February 4, 2013
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5. BODIES: THE
OBESEITY EPIDEMIC
BODIES & BUILDINGS
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6. BODIES +
We have made huge strides in life expectancy, but we have
reached limits of growth.
February 4, 2013
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7. NATIONAL OBESITY
CRISIS
February 4, 2013
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8. US OBESITY GROWTH RATE
February 4, 2013
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9. OBESITY TRENDS
Today’s children may well be
the first generation of
Americans whose life
expectancy will be shorter
than that of their parents.
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10. 10

11. 11

12. 12

13. Data from 3,139 counties in the U.S. Quintiles are cohorts of counties ranked by the
percentage of people living with poverty.
Levine J A Diabetes 2011;60:2667-2668
Copyright © 2011 American Diabetes Association, Inc.

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15. DIGITAL DIVIDE + DIABETES
Social disparities in internet
patient portal use in diabetes:
evidence that the digital divide
extends beyond access.
Urmimala Sarkar, Andrew J
Karter, Jennifer Y Liu, et al.
J Am Med Inform Assoc 2011
18: 318-321 originally
published online January 24,
2011.
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16. GLOBAL OBESITY
PANDEMIC
“GLOBESITY”
GLOBAL OBESITY: TRENDS, RISK FACTORS AND POLICY
IMPLICATIONS. VASANTI S. MALIK, WALTER C. WILLETT & FRANK B.
HU. NATURE REVIEWS ENDOCRINOLOGY 9, 13-27 (JANUARY 2013)
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February 4, 2013

17. Figure 1 Global trends in the prevalence of obesity among women and men in
1980 and 2008 from select regions of the world
Malik, V. S. et al. (2012) Global obesity: trends, risk factors and policy implications
Nat. Rev. Endocrinol. doi:10.1038/nrendo.2012.199

18. Women
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19. Men
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20. OBESITY + GLOBALIZATION
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21. THINKING IN
CIRCLES ABOUT
OBESITY
APPLYING SYSTEMS THINKING TO WEIGHT MANAGEMENT.
TAREK K. A. HABI
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22. HOW THE PROBLEM SNEAKED UP ON US
As the upward and outward trend
in the population’s weight and
waistline accelerated in the late
1980s and 1990s, most public
health experts failed to perceive
the escalating threat.
• Unlike communicable diseases,
no immediate symptoms.
• Initially only affected a few
people.
• The science establishing links
between diet, weight and health
were just beginning.
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23. HOW MANY CAUSES
CAN WE COUNT?
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24. BUCKET THEORY OF MIND
• Minds seen as containers – Karl Popper.
• Public understanding is viewed as a function of how much
scientific facts are known.
• How many scientific facts public minds contain.
• Irony: Americans know more about food and nutrition than
in any time in their history, but they are gaining more
weight.
• “Knowledge (in the bucket) without the requisite decision-
making skills will produce little change.
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February 4, 2013

25. THE LEVERAGE (OR THE IMPEDIMENT) IS
WITH THE PEOPLE
• In the US, most obese individuals attempting to lose weight do so
themselves, without seeking professional help.
• Weight has been seen as an individual, personal problem.
• The wellness movement is rooted in the concept of personal control.
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26. WE ASSUME MORE CONTROL THAN
ACTUALLY EXISTS
• Obesity is a complex multi-factorial disease involving
genetics, physiology, and biochemistry, as well as
environmental, psychosocial, and cultural factors.
• In managing our health – and our bodies – we are decision
makers who are managing a truly complex and dynamic
system: the human body.
• Living systems do not come with an operator’s manual. It
requires skills to see through complexity to the underlying
structures generating a complex situation or problematic
behavior.
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27. IT’S SO EASY
CALORIES IN. CALORIES OUT.
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February 4, 2013

28. MORE COMPLEX THAN THAT
• Body’s homeostatic process- adaptive (and defensive)
mechanisms that continuously aim to maintain the body’s
internal stability.
• Weightloss is not linear, but curvilinear.
• Unrealistic optimism causes us to ignore legitimate risks.
• Failure to learn from failure. Learning has not occurred.
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29. PHYSIOLOGICAL ASYMMETRY
• Humans are wired to compensate for caloric dilution but not
the reverse.
• Asymmetry in energy expenditure- basal metabolism.
• Asymmetry in energy storage- when body fat is shed during
weight loss, the size, but not the number, of fat cells
dwindles.
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30. SINGLE LOOP LEARNING
Consequences
Decisions, Feedback
Actions
Single loop
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31. SINGLE LOOP DIETING
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32. SINGLE LOOP LEARNING
• Often we find ways to move closer to our desired state
without changing our mental model.
• Learning to use life’s raw experiences to adjust our
entrenched worldviews is hard and, therefore, uncommon.
• Experience, after all, provides only data, the raw ingredients
for learning, not knowledge.
• Single loop: we learn to tweak our decisions without altering
our mental models or their associated decision rules.
• (A thermostat that sense when it is too hot or cold).
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33. SINGLE LOOP DIETING
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34. WHAT IS TO BE
DONE
CHALLENGE INGRAINED ASSUMPTIONS
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35. DOUBLE LOOP LEARNING
Consequences
Decisions, Feedback
Actions
Single loop
Decision Rules, Mental Models
Strategies Of Real World
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36. DOUBLE LOOP LEARNING
• Learning that occurs when we use the feedback information
to enhance our fundamental understanding of the decision
task.
• Learning is discovery of mental maps and decision rules
that are better aligned with the decision task at hand.
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February 4, 2013

37. SHIFT IN PUBLIC POLICY
• From: stuff buckets with nutritional guidelines/scare into
good health
• To: challenge people’s deeply ingrained assumptions.
Provide them with the conceptual skills to JUMP.
• From: attention on the separate mechanisms of human
weight and energy regulation.
• To: the hole bioenergetics systems as an integrated
operating system.
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February 4, 2013

38. FRAGMENTIC ANALYSIS LENS
• Nutrition out of the context of lifestyle
• Biology out of the context of behavior
• Behavior out of the context of environment
“The performance of any system (whether it is an oil refinery,
an economy, or the human body) obviously depends on the
performance of its parts, but a system’s performance is never
equal to the sum of the actions of its parts taken separately.
Rather it is a function of their interactions.”
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39. SHIFT IN CULTURAL UNDESTANDING
• From: solely individual interventions. A sole focus on the
obese person and how to help them gain control.
• To: Why is society obese. How can we help society.
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40. SHIFT HEALTHCARE PRACTICE
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41. NETWORKED MEDICINE
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42. ASSIGNMENT:
FEBRUARY 11
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43. READING
Read: Networked Medicine: From m Obesity to the “Diseasome”. Editorial
by Albert-László Barabási, Ph.D. NEJM. July 26, 2007.
Optional:
Deeper Reading:
Original Study by Christakis and Fowler:
The Spread of Obesity in a Large Social Network over 32 Years. NEJM. July
26, 2007.
Critique of this study: Lyons.
The Spread of Evidence-Poor Medicine via Flawed Social-Network Analysis.
Statistics, Politics, and Policy: (2011) Vol. 2 : Iss. 1, Article 2. Last revised 5
May 2011
Watch:
Catherine Kerr on Cortical Measures in Mindfulness Meditation at
Quantified Self.
Personal account of Weight Watchers by Laura Beck at Jezebel.
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February 4, 2013

44. ASSIGMENT
When developing ideas and concepts for our student projects,
and future projects, business ideas, and save-the-world ideas, we
often start by designing for ourselves.
For this assignment, research a part of the world at a local level
(city, state, province, county) that has a problem with obesity.
The only requirement: pick somewhere that you have never been.
In a one page essay, describe the social, cultural, technological,
economic, and other conditions of this region that may be
contributing to a growth in the prevalence of obesity. You may
choose to write a non-fiction account or take this as a creative
writing assignment – imagining a first person day-in-the-life
account of what it feels like to live here.
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February 4, 2013

45. LINKS AND PRESENTATION
Today’s class presentation is available
http://jenvandermeer.com/2013/02/bodies-buildings-
class-2-february-4/
And Links from this presentation are available here at
Annotary.
https://annotary.com/collections/9149/bodies-and-
buildings-class-2-nyu-itp
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February 4, 2013