Review and special article
Revisiting Kurt Lewin: How to Gain Insight into Environmental Correlates of Obesogenic Behaviors

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Abstract

Overweight and obesity are important determinants of population health. Prevention of weight gain is dependent on the successful balancing of eating and physical activity behaviors. Planned promotion of healthful behavior requires insights into important and changeable determinants and correlates of behavior change. The modest effects of health education have induced a shift in focus from personal to environmental correlates of eating and physical activity behaviors.

Six systematic reviews were conducted in 2005 of observational studies of environmental correlates and environmental interventions for weight-related eating behaviors and physical activity for children, adolescents, and adults. The reviews of 297 observational studies showed that few investigations of environmental associations have been replicated, and that most studies used weak research designs and nonvalidated self-report measures, were restricted to micro-environmental factors, and failed to apply multilevel analyses. There is, therefore, very little evidence for an association between environmental factors and weight-related behaviors. However, the reviews of 112 intervention studies indicated much stronger evidence for positive effects of micro-physical and sociocultural environmental changes on eating and physical activity behaviors.

Inspired by quotes from Kurt Lewin, we argue that before large-scale environmental change interventions are launched, better-designed and -conducted research on the true importance of environmental factors, including macrolevel factors, for obesogenic behavioral change is needed. Such research should (1) develop better measures of environmental exposure, (2) attempt to integrate personal and environmental correlates of obesogenic behaviors, (3) take a solution-oriented, rather then a problem-oriented approach, and (4) identify access points for inducing behavior change instead of finding explanations for existing behavioral patterns.

Introduction

Energy intake and energy expenditure behaviors underlie today’s obesity epidemic. The underlying determinants of obesogenic behaviors are, however, less clear. Kurt Lewin’s renowned “field theory”1 posits that human behavior is the function of both the person and the environment. For many years, behavioral determinant research focused mostly on personal correlates of behavior. However, especially since Egger and Swinburn2 introduced their ecologic paradigm for understanding obesity, and argued that the present day “obesogenic environment” induces obesogenic behavior,3 more and more research tries to explore if and how environmental factors are associated with obesity-related behaviors. To summarize the available scientific evidence, recently a series of systematic reviews was conducted of studies on environmental factors and obesity-related behaviors.4 In this paper, the rationale, main results, and conclusions from this review project are briefly described, and it is discussed how we should proceed to further dissect the obesogenic environment.

Section snippets

Personal and Environmental Correlates of Obesogenic Behaviors

In order to develop interventions to promote obesity-prevention behaviors, insight into the behavioral determinants is necessary.5 Each of the aforementioned obesogenic behaviors may have different determinants; people’s “reasons” for not eating enough fruits and vegetables may be very different from their reasons for spending too much time watching television.6

Health education has been the primary tool to encourage the general public to adopt health-promoting lifestyles. Health education has

What Is “The Environment”?

The Analysis Grid for Environments Linked to Obesity (ANGELO)3 was developed for the investigation of obesogenic environments. ANGELO is a grid with two axes. On one axis two “sizes” of environment (micro and macro) are distinguished. Micro-environments are defined as environmental settings where groups of people meet and gather, geographically distinct, with room for direct mutual influence between individuals and the environment. Examples of micro-environments are homes, schools, workplaces,

Discussion

Our systematic reviews indicate that the notion of an environment that promotes obesogenic behaviors currently lacks a sound base of scientific evidence. These shortcomings in the evidence may especially be due to a lack of studies with strong study designs and measures. How should we proceed to better study and dissect the environmental determinants of nutrition and physical activity behaviors? Three famous quotes from Kurt Lewin guided us.

There is nothing so practical as a good theory.1

The

Conclusion

It is clear that our environment has changed over the past decades. It now offers almost constant opportunities to eat palatable energy-dense foods and enables almost total avoidance of physical activity.20, 21, 22 This may make it extremely difficult for people to act on their positive intentions to prevent weight gain.23 However, our systematic attempt to further dissect the presumed obesogenic environment did not provide much convincing evidence. Most likely, more insight can be gained from

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