The World Health Organization (WHO) Global Action Plan on Physical Activity recommends adopting a systems approach to implementing and tailoring actions according to local contexts. We held group ...model-building workshops with key stakeholders in the Caribbean region to develop a causal loop diagram to describe the system driving the increasing physical inactivity in the region and envision the most effective ways of intervening in that system to encourage and promote physical activity. We used the causal loop diagram to inform how the WHO Global Action Plan on Physical Activity might be adapted to a local context. Although the WHO recommendations aligned well with our causal loop diagram, the diagram also illustrates the importance of local context in determining how interventions should be coordinated and implemented. Some interventions included creating safe physical activity spaces for both sexes, tackling negative attitudes to physical activity in certain contexts, including in schools and workplaces, and improving infrastructure for active transport. The causal loop diagram may also help understand how policies may be undermined or supported by key actors or where policies should be coordinated. We demonstrate how, in a region with a high level of physical inactivity and low resources, applying systems thinking with relevant stakeholders can help the targeted adaptation of global recommendations to local contexts.
Background: Adolescents who perceive themselves as overweight are at risk of future weight gain and increased risk of type 2 diabetes, hypertension, and poor mental health. Perceived weight may ...influence weight related behaviors (e.g., physical activity), but less is known about the relationship between adolescents' perceived weight and both perceived health and desire to exercise. We explored the association between perceived weight, perceived health, and desire to exercise in adolescents. Methods: Cross-sectional data from adolescents, ages 12-17 years, were drawn from the Family Life, Activity, Sun, Health, and Eating study (2014). Perceived weight status (1-item; very underweight to very overweight), perceived health status (1-item; poor to excellent), and desire to exercise (1-item; strongly disagree to strongly agree) were self-reported. Ordinal logistic regression models tested associations between perceived weight and both perceived health and desire to exercise controlling for age, sex, race/ethnicity, and food insecurity. Results: Of the sample (n = 1407; mean age = 14; 51% female; 64% White), most adolescents perceived their weight to be just right (61%), and their health to be excellent (42%). Adolescents who perceived themselves as slightly or very overweight, compared to just right, had 4.5 (95% CI 3.5, 5.8) and 37.7 (95% CI 22.5, 63.2) higher odds, respectively, of perceiving themselves in worse health. Adolescents who perceived themselves as slightly or very underweight, compared to just right, had 2.94 (95% CI 0.1, 0.8) and 1.41 (95% CI 0.5, 1.0) lower odds of a greater desire to exercise. Perceptions of being slightly or very overweight were not associated with desire to exercise (p = 0.9 and 0.4, respectively). Conclusions: Current findings highlight that higher perceived weight in adolescents is negatively associated with perceived health, but not necessarily desire to exercise. Future research should explore the relationship between weight perception and other motivators of physical activity.
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