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  • The main goal of this paper is

    2018-11-05

    The main goal of this paper is to develop and use an ABM to evaluate different methods of targeting obesity interventions. Therefore, a model is needed that can, at minimum, incorporate three key factors determining the diffusion of intervention effects throughout a population: personal characteristics of actors, social network ties and social influence, and the role of environmental factors (Andajani-Sutjahjo, Ball, Warren, Inglis, & Crawford, 2004). We assume a fixed funding pool from which a fixed number of persons can be enrolled in a well-validated behavioral intervention. To evaluate population intervention effectiveness, we begin by selecting the state-of-the-art behavioral intervention shown to be efficacious in randomized experiments of two key behavioral pathways: dietary intake and physical activity. For this analysis, we assume an average intervention effect size based on Cochrane Reviews of obesity prevention interventions (Brown, Avenell, Edmunds, Moore, & Whittaker, 2009; Doak, 2002; Mastellos, Gunn, Felix, Car, & Majeed, 2014; McTigue, Harris, Hemphill, Lux, & Sutton, 2003; Prevention & Glickman, 2012). We identified and reviewed randomized trials of adults who represented all weight Mifepristone or overweight and obese. We included only studies that reported behavioral outcomes (change in diet or physical activity) with at least 6 months of follow-up. We prioritized studies that involved intensive non-pharmacological interventions that would be moderate in cost and could be scaled up with sufficient resources. Studies of disease groups (e.g., diabetes) or among only obese adults were excluded. We selected the best studies that also reported pre-post intervention change in diet or PA, where the latter was measured with a pedometer or accelerometer. For each category (diet or PA) we summarized the top and bottom of estimated proportional change. For our final estimate, we chose the midpoint of the range. For dietary change, we used the America on the Move trial for the upper bound estimate (Rodearmel, Wyatt, Stroebele, Smith, & Ogden, 2007; Stroebele, de Castro, Stuht, Catenacci, & Wyatt, 2009) and the Diabetes Prevention Program (DPP) (Group, 2002; Mayer-Davis, Sparks, Hirst, Costacou, & Lovejoy, 2004) for the lower bound. The mid-point estimate is reduction in total kcals of consumption at 6–12 months. For physical activity, we base the upper-bound estimate on the trial by Dinger, Heesch, Cipriani and Qualls (2007) that used pedometers to investigate increased walking after intensive intervention based on the transtheoretical model of behavior change. For a lower bound estimate, we used the Reasonable Eating and Activity to Change Health study (REACH) a randomized trial of 665 overweight men and women ages 40–69 followed for 2 years after an intensive behavioral intervention tailored to the subjects stage of change (Logue, Sutton, Jarjoura, Smucker, & Baughman, 2005). The mid-point estimate for proportional change in physical activity based on these trials is . Existing research show that obesity patterns can be contagious; friends and family can affect an individual\'s behavior (Ali, Amialchuk, Gao, & Heiland, 2012a; Ali, Amialchuk, & Rizzo, 2012b; Baker, Little, & Brownell, 2003; Blanchflower, Landeghem, & Oswald, 2009; Centola, 2011; Christakis & Fowler, 2012, 2007; Crandall, 1988; de la Haye, Robins, Mohr, & Wilson, 2011a, b; Eisenberg, Neumark-Sztainer, Story, & Perry, 2005; El-Sayed et al., 2012; Sentočnik, Atanasijević-Kunc, Drinovec, & Pfeifer, 2014). For instance, an individuals’ chance of becoming obese increases as their friends or family became obese. As Trogdon and Allaire (2014) point out , the burgeoning literature on peer effects on obesity has important policy implications: social multiplier effects imply that interventions to reduce obesogenic behaviors may spill over and translate to increase overall population impact. A key goal of this analysis was to evaluate which targeting strategy leads to larger overall impact via social multiplier effects.