Previous studies have identified postprandial systolic blood pressure reductions in old, frail institutionalized subjects, which do not occur in healthy, young subjects, after a morning meal. To evaluate the relative contributions of state of health and time of day to this potentially dangerous abnormality in cardiovascular homeostasis, we measured sitting systolic blood pressure and heart rate before and at intervals after a noon meal, and in identical fashion without a meal, in 21 healthy, community-dwelling elderly subjects (73 +/- 6 years of age) attending a nutrition program. Systolic blood pressure changed a maximum of -11 +/- 9 (SD) mmHg (P = .006, analysis of variance) by 60 minutes after the meal, in contrast to 1 +/- 7 mmHg (NS) by 60 minutes, when no meal was given (P less than .0001, meal versus control studies). There was a highly significant inverse correlation between postprandial and basal sitting systolic blood pressure changes (R = -0.60, P = .004). Healthy community-dwelling elderly demonstrate postprandial reductions in systolic blood pressure which correlate with basal sitting systolic blood pressure. This is consistent with age- and hypertension-related impairment in baroreflex compensation for the hypotensive stress of eating.

Shape Up Under 5 (SUU5) was a two-year early childhood obesity prevention pilot study in Somerville, Massachusetts (2015–2017) designed to test a novel conceptual framework called Stakeholder-driven Community Diffusion. For whole-of-community interventions, this framework posits that diffusion of stakeholders’ knowledge about and engagement with childhood obesity prevention efforts through their social networks will improve the implementation of health-promoting policy and practice changes intended to reduce obesity risk. SUU5 used systems science methods (agent-based modeling, group model building, social network analysis) to design, facilitate, and evaluate the work of 16 multisector stakeholders (‘the Committee’). In this paper, we describe the design and methods of SUU5 using the conceptual framework: the approach to data collection, and methods and rationale for study inputs, activities and evaluation, which together may further our understanding of the hypothesized processes within Stakeholder-driven Community Diffusion. We also present a generalizable conceptual framework for addressing childhood obesity and similar complex public health issues through whole-of-community interventions.

Objective: To describe our process of using group model building (GMB) with the Shape Up Under 5 Committee; measure the effects on Committee members; and describe the community-wide health messaging campaign that resulted from the process. Design: Pilot study. Setting: Somerville, Massachusetts. Participants: Members of the Shape Up Under 5 Committee, a multisector group of professionals. Intervention: Research team convened the Committee and facilitated GMB from October 2015 to June 2017. Main Outcome Measures: Boundary objects produced during GMB activities; committee members' perspectives on early childhood obesity in their community; and Committee members' knowledge, engagement, and trust at the conclusion of each meeting. Results: Working together using GMB activities and with support from the research team, the Committee created a community-wide campaign that provided evidence-based messages to reach an entire city that emphasized diversity and reaching immigrants and community members who spoke languages other than English. More than 80% of Committee members reported changes in their perspectives related to early childhood obesity at the conclusion of the pilot test. Six perspective shift themes emerged from interviews and open-ended survey items: exposure to new perspectives about challenges community members face; increased awareness of others working on similar issues; increased knowledge about early childhood obesity; seeing value in creating a space to work across sectors; appreciating complexity and linkages between early childhood obesity prevention and other community issues; and how participation in committee influences members' priorities in their own work. Knowledge of and engagement with early childhood obesity prevention varied at the conclusion of each meeting, as did increases in trust among Committee members. Conclusion: Group model building is a promising approach to support multisector groups working to address early childhood obesity in their community. Meeting activities may have had differential impacts on members' knowledge of and engagement with early childhood obesity.