Understanding the complex systems driving the perceived obesogenic environment among adults in socioeconomically disadvantaged situations: Findings from a participatory Group Model Building process in Flanders.

INTRODUCTION: Persons in socioeconomically disadvantaged situations are disproportionally exposed to obesogenic environments and often have fewer resources to counteract their influence, resulting in poorer dietary outcomes and lower levels of physical activity. This study aimed to map the complex systems within the municipal obesogenic environment driving unhealthy eating behaviors and insufficient walking among adults in socioeconomically disadvantaged situations in Flanders, and to identify potential actions for local policymakers.

METHODS: Participatory group model building (GMB), a qualitative system dynamics method, was used to engage adults in socioeconomically disadvantaged situations (n = 7), local decision makers (n = 7) and local non-government stakeholders (n = 7) in two peri-urban Flemish municipalities. Two GMB sessions over two days were held in each municipality during which a causal loop diagram (CLD) was created and potential actions were identified for local policymakers by considering causal pathways and reinforcing loops in the system.

RESULTS: The CLD represents participants' perceptions of how the local obesogenic environment contributes to unhealthy eating and insufficient walking among adults in socioeconomically disadvantaged situations. Six interconnected subsystems were identified: 1) social context, 2) facilities and activities, 3) mobility options, 4) information, 5) affordability, and 6) marketing and promotions. The perceived obesogenic environment, adverse health effects, and disadvantaged socioeconomic context in which individuals live mutually reinforce each other. Social and physical isolation emerged as important cross-cutting mechanisms, interacting with financial constraints, limited mobility, inadequate facilities, non-inclusive activities and restricted access to information.

CONCLUSION: Participatory GMB and the resulting CLD provide a locally grounded basis for developing actions to promote healthy eating and walking among adults in socioeconomically disadvantaged situations. Actions addressing several subsystems simultaneously, while minimizing the effort required from residents to benefit from them, may be particularly valuable. Further co-design, feasibility assessment and sustained collaboration between residents, local stakeholders and decision-makers are needed to translate these findings into equitable local action.