Exploring ways to respond to rising obesity and diabetes in the Caribbean using a system dynamics model

Abstract

Diabetes and obesity present a high and increasing burden of disease in the Caribbean that have failed to respond to prevention policies and interventions. These conditions are the result of a complex system of drivers and determinants that can make it difficult to predict the impact of interventions. In partnership with stakeholders, we developed a system dynamics simulation model to map the system driving diabetes and obesity prevalence in the Caribbean using Jamaica as a test case. The study aims to use the model to assess the magnitude changes necessary in physical activity and dietary intake to achieve global targets set by the WHO Global Action plan and to test scenarios for interventions to reduce the burden of diabetes and obesity. Continuing current trends in diet, physical activity, and demographics, the model predicts diabetes in Jamaican adults (20+ years) to rise from 12% in 2018 to 15.4% in 2030 and 20.9% by 2050. For obesity, it predicts prevalence to rise from 28.6% in 2018 to 32.1% by 2030 and 39.2% by 2050. The magnitude change necessary to achieve the global targets set by the World Health Organization is so great as to be unachievable. However, a combination of measures both upstream (including reducing the consumption of sugar sweetened beverages and ultra processed foods, increasing fruit and vegetable intake, and increasing moderate-to-vigorous activity) at the population level, and downstream (targeting people at high risk and with diabetes) can significantly reduce the future burden of diabetes and obesity in the region. No single intervention reduces the prevalence of these conditions as much as a combination of interventions. Thus, the findings of this model strongly support adopting a sustained and coordinated approach across various sectors to synergistically maximise the benefits of interventions.

Fig 1. Summary stock and flow diagram of the core structure of the model for diabetes in the Caribbean.

Fig 2. Comparison of modelled outcomes (diabetes prevalence (A), obesity prevalence (B), and body mass index (C)) and projections to 2050 to survey measured estimates in adults (20+ years with 95%CI) from Jamaica(19–22).

Fig 3. Scenarios for the magnitude of change in physical activity and caloric intake necessary to achieve global targets for diabetes (A) and obesity (B) prevalence (in adults 20+ years).

Fig 4. Effects of scenarios for intervention relevant to the Caribbean on diabetes (A) and obesity (B) prevalence in adults (20+ years).