Leveraging social influence to address overweight and obesity using agent-based models: the role of adolescent social networks

The prevalence of adolescent overweight and obesity (hereafter, simply overweight) in the US has increased over the past several decades. Individually-targeted prevention and treatment strategies targeting individuals have been disappointing, leading some to propose leveraging social networks to improve interventions. We hypothesized that social network dynamics (social marginalization; homo-phily on body mass index, BMI) and the strength of peer influence would increase or decrease the proportion of network member (agents) becoming overweight over a simulated year, and that peer influence would operate differently in social networks with greater overweight. We built an agent-based model (ABM) using results from R-SIENA. ABMs allow for the exploration of potential interventions using simulated agents. Initial model specifications were drawn from Wave 1 of the National Longitudinal Study of Adolescent Health (Add Health). We focused on a single saturation school with complete network and BMI data over two waves (n 1?4 624). The model was validated against empirical observations at Wave 2. We focused on overall overweight prevalence after a simulated year. Five experiments were conducted: (1) changing attractiveness of high-BMI agents; (2) changing homophily on BMI; (3) changing the strength of peer influence; (4) shifting the overall BMI distribution; and (5) targeting di- etary interventions to highly connected individuals. Increasing peer influence showed a dramatic decrease in the prevalence of overweight; making peer influence negative (i.e., doing the opposite of friends) increased overweight. However, the effect of peer influence varied based on the underlying distribution of BMI; when BMI was increased overall, stronger peer influence increased proportion of overweight. Other interventions, including targeted dieting, had little impact. Peer influence may be a viable target in overweight interventions, but the distribution of body size in the population needs to be taken into account. In low-obesity populations, strengthening peer influence may be a useful strategy.