“The opposite of a good idea can also be a good idea.”
- Rory Sutherland
Jen* presented to the clinic for the same reason almost all of our patients did. She wanted to lose weight. The first time I saw her for her new patient appointment, she told me her story. She’d tried intermittent fasting and Whole30. Years ago, she’d done WeightWatchers. With each new diet, she always lost weight initially, but eventually she gained it all back plus more.
As a physician assistant, I delved into my role and began treating Jen, and other patients like her, according to my supervising physician’s protocol. Meanwhile, I realized there are two distinct mental models that frame the way people think about overweight** and obesity: the individual model and the systemic model. Understanding both of these mental models is crucial because they significantly impact how we identify problems, generate solutions, and evaluate outcomes.
The individual model is ubiquitous. This model focuses on the personal and genetic factors that can contribute to weight gain. It emphasizes one’s own personal behavior — namely diet and physical activity. Even though the individual model recognizes there are environmental and societal factors that can play a role, it maintains that individuals’ choices related to diet, exercise, and lifestyle are paramount.
The systemic model, on the other hand, focuses on the broader, interconnected factors that contribute to overweight and obesity. This includes the conditions in the environments where people live, work, and play, also known as social determinants of health. Lobbyists representing large food and beverage companies influence public policy and regulations in ways that prioritizes corporate interests over public health. This leads to the promotion of unhealthy food and beverage options through aggressive marketing and the availability of low-cost, high-calorie products. Therefore, the systemic model advocates for comprehensive strategies that target the need for reform in food policies and practices in order to address the root causes of obesity.
In many ways, the individual and systemic models are opposites. The individual model implies that individuals are primarily responsible for overweight and obesity, whereas the systemic model suggests that corporations and the government are largely responsible.
Yet despite these opposite perspectives, to illustrate Rory Sutherland’s point, both models have their benefits. They can both be good ideas. The individual model emphasizes personal responsibility, which can empower people to make healthier decisions. The systemic model has the benefit of reducing stigma, and systemic interventions are more likely to lead to sustainable change.
By being aware of which mental model we’re using, and by being open to incorporating different perspectives, we can greatly enhance our problem-solving capabilities.