Translating systems thinking into practice for community action on childhood obesity.

We report on the first 18 months of two communities' efforts using methods inspired by community-based participatory system dynamics for the development, implementation, and evaluation of whole of community efforts to improve the health of children. We apply Foster-Fishman's theoretical framework for characterizing systems change to describe the initiatives. Bounding the system began with defining leaders more broadly than standard health interventions to be those who had the ability to change environments to improve health, including food retailers, government, and business, and using high-quality childhood monitoring data to define the problem. Widespread access to junk food, barriers to physical activity, and efforts to promote health predominantly through programmatic approaches were identified as potential root causes. System interactions existed in the form of relationships between stakeholder groups and organizations. The approach described built new relationships and strengthened existing relationships. Willingness in taking risks, changing existing practice, and redesigning health promotion work to have a community development focus, were levers for change. This approach has resulted in hundreds of community-led actions focused on changing norms and environments. Insights from this approach may be useful to support other communities in translating systems theory into systems practice. Further empirical research is recommended to explore the observations in this paper.