Implementation of Clinical Services for Adults with Obesity in Different Health Systems: A Scoping Review and Causal Loop Diagram.

The medical needs of obesity have been underrecognized, though it has posed long-term and enormous challenges to global health. Correspondingly, clinical services for obesity are still uncommon and in their infancy across health systems. It is meaningful to sort out the implementation of such clinical services involving a multiplicity of factors to identify measures for service development, scaling-up and optimization. This study aims to generate a comprehensive understanding of key variables and factors in the utilization and delivery of clinical services for adult patients with obesity and their dynamic patterns and to explore viable options for improved implementation of such services in health systems. We conducted a scoping review of published articles in the database from the lens of system dynamics through causal loop diagramming. Based on the data obtained from the review, we employed the causal loop diagramming as a tool to capture the variables in the implementation of clinical obesity services and their causal relationships. Twenty-one studies were finally included in the review. Based on the evidence consolidated through the review, we developed a causal loop diagram containing 19 causal variables and 38 causal arrows in single directions centered around the service utilization and delivery in the clinical obesity service. The feedback loops revealed potential activation points to intervene to facilitate the service implementation, such as, promotion of obesity as a disease with medical needs and available clinical services, provision of obesity-specific medical education and training opportunities, and prioritization of obesity-specific procedures in clinical protocols. The possible intervention points identified through the causal loop analysis can facilitate the development, implementation, and optimization of clinical obesity services in health systems.