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Obesity and the Social Network Effect

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[youtube=http://www.youtube.com/watch?v=pJfq-o5nZQ4&list=PLDF49145AFBD42740&index=1&feature=plpp_video]

This video demonstrates an important social phenomena that Entertaining Health believes has significant public health implications. Christiakis and Fowler utilized the Framingham Heart Study to demonstrate the dynamic manner in which individual health characteristics change over time and the influence of an evolving social network of relationships.

The social network analysis looked at  the spread of obesity in the Framingham population from 1971 – 2003.  Three patterns were ascertained:

1.  Friends can cause one to become obese:  An individuals’s chance of becoming obese increased by 57% if he/she had a friend who became obese during a given time interval.
2.  A friends’ friends’ friend can cause one to become obese: An individual’s chance of become obese was increased by relationships with other obese individuals who may be upto three degrees of social separation from oneself.
3.  It matters more how well connected you are than how close you live to your friends.  Social distance (i.e. up to 3 degrees of separation) from other obese individuals is more important in determining the likelihood of one becoming obese than the physical proximity of other obese individuals.

Over time the three phenomenon listed above causes a dynamic change in the pattern of obesity in a population, such that clusters of obese individuals (all connected to one another) emerge.

This analysis clearly reveals the importance of social networks in the development and spread of the obesity epidemic in the US.  It does not however explain the mechanisms of change.  Christiakis interestingly points out that the change may reflect underlying adoption of social norms rather than pure imitation of behaviors of ones friends.  This is evidenced by the fact that there was no correlation between smoking cessation during this period and the spread of obesity.  Since smoking cessation is correlated with weight gain, it may be expected that a spread in smoking cessation would be associated with a spread in obesity.  Such a pattern was not present.  In addition, one would expect that if behavior was the primary determinant, then frequent reinforcement by geographic proximity would enhance the chances of one becoming obese.  This did not occur, rather it was the social distance that determined the potential for becoming obese.  These two factors suggest that underlying social norms are driving the adoption of behaviors resulting in obesity.

The potential of social networks to change behavior in a powerful and dynamic way is of particular interest to Entertaining Health and has significant implications for public health programmatic development.  In order to affect health behaviors in a positive manner at a population level, the effect of an individuals’ connections within their community need to be understood.  Current technological tools allow for unprecedented levels of communications and interactions between individuals enhancing the power of social connectedness, unfettered by geographic distance.

In our collaboration with NYU’s Center For Healthful Behavior Change we are trying to understand some of the mechanisms by which health interventions targeted towards hypertension in a black community are influenced by their social network.  This seminal paper by Christiakis and Fowler provides us with a theoretical framework to understand some of this phenomenon and its public health implications.

N.A. Christakis and J.H. Fowler, “The Spread of Obesity in a Large Social Network Over 32 Years,” New England Journal of Medicine 357(4): 370-379 (July 2007)

The post Obesity and the Social Network Effect appeared first on ENTERTAINING HEALTH.


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