Article Title Page

A Dynamic Systems Approach to Weight Related Health Problems

Author Details
Author 1 Name: Yahia Zare Mehrjerdi
Department: Industrial Engineering
University/Institution: Yazd University
Town/City: Yazd
State (US only): Yazd
Country: Iran

Corresponding author: Yahia Zare Mehrjerdi

Corresponding Authors Email: yazm2000@yahoo.com
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Acknowledgments (if applicable):

Biographical Details (if applicable):

Yahia Zare Mehrjerdi, PhD, is associate professor at Yazd University, department of industrial engineering
where he teaches at the graduate and undergraduate levels. His research areas are: dynamic systems, multi
criteria decision making, Health economics, and supply chain management with RFID technology
integration. Yahia enjoys teaching theory of decision making, dynamic systems, simulation-optimization, and
advanced engineering economics at the graduate levels. He is the author of six books in Farsi and one
unpublished book in English. He has published in scientific journals of: European Journal of Operational
Research, Applied Soft Computing, International Journal of Assembly Automation, International Journal of
Quality and Reliability Management, The Electronic Library, journal of Performance Measurement and
Metrics to mention a few. He has presented many articles at the national and international conference levels.

Type header information here

Structured Abstract:

Purpose of this paper: the purpose of this article is to present a system dynamic model for studying
the interconnections between human being weight and the health problems causing various problems
all over the life. To do so, this author has reviewed key points about the system thinking, its theories,
and the system dynamics. Next, models in the form of causal loops presenting the interconnections
between weight factor and health problems are developed and discussed. Thereafter, a flow model of
the problem is constructed and the heart attack deaths are studied under two situations of regular and
taught cases.

Design/methodology/approach: Identifies key health problems related to weight by using causal

loops that demonstrate the whole picture of the situation.
Findings: With the aid of systems thinking and dynamic modeling researchers can study the impacts
of weights on the generation of various health problems as such as heart disease, high blood pressure,
blood sugar, knee problem and more. This study shows that teaching people about their health will
have a significant impact on the number of deaths related to heart attack.

Practical implications (if applicable): With the model proposed here various studies can be
carried on that relates weight to health issues. A sample situation is presented where deaths related to
heart attack is simulated.
What is original/value of paper: This article makes a significant contribution to the health study
issues due to the fact that it shows how a factor such as weight can have impacts on hearth attack,
blood pressure, and blood sugar, to mention a few. Since, to the best of this author's knowledge, this is
the first study that relates weight to health problems using systems thinking concepts and system
dynamic it make a significant contribution to the health literature.

Keywords:

Systems Thinking, System Dynamics, Complex systems, health issues, hearth attack, and

Weights.
Article Classification: Research paper

For internal production use only

Running Heads: the dynamics of weight related health problems

Type footer information here

A Dynamic Systems Approach to

Weight Related Health Problems

Purpose of this paper: the purpose of this article is to present a new system dynamic model for
studying the interconnections between human being weight and the health problems causing various
problems all over the life. To do so, this author has studies key points about the system thinking, its
theories, and the system dynamics. Next, models in the form of causal loops presenting the
interconnections between weight factor and health problems are developed and discussed. Thereafter,
a flow model of the problem is constructed and the heart attack deaths are studied under two situations
of regular and taught cases.

Design/methodology/approach: Identifies key health problems related to weight by using

causal loops that demonstrate the whole picture of the situation.
Findings: With the aid of this new systems thinking and dynamic modeling researchers can study
the impacts of weights on the generation of various health problems as such as heart disease, high
blood pressure, blood sugar, knee problem and more. This study shows that teaching people about
their health will have a significant impact on the number of deaths related to heart attack.

Practical implications (if applicable): With the model proposed here various studies can be
carried on that relates weight to health issues. A sample situation is presented where deaths related to
heart attack is simulated.
What is original/value of paper: This article makes a significant contribution to the health
study issues due to the fact that it shows how a factor such as weight can have impacts on heart attack,
blood pressure, and blood sugar, to mention a few. Since, to the best of this author's knowledge, this is
the first study that relates weight to health problems using systems thinking concepts and system
dynamic it make a significant contribution to the health literature.

Key Words: Systems Thinking, System Dynamics, Complex systems, health issues, heart attack,
and Weights.

1. Introduction
The health care system is large and complex, one that does not naturally lend itself to
easy analysis, design, or even understanding. The complexity and critical nature of the
system beg for the development and use of good, representative models (Keolling and
Schwandt, 2005). For middle aged people and up, health related issues are of highly
important. Due to the fact that as people gets aged their immune system as well as
their muscular body structure starts to weaken more if sport and movement is not
apart of their daily program for living. Those who work in the office and have about
minimal exercise per day are of highly potential group that gets sick sooner rather
than later. The complexity of the health system is obvious to every one these days.
This is why modeling health systems with newly developed techniques or the ones
capable of taking many key variables into consideration for modeling, quantifying,
and analysis are of very high concern.
Keolling and Schwandt (2005) in their article entitled "Health Systems: A dynamic
system-benefits from system dynamics" have classified general health systems
framework into: Health Systems, Systems, Clinical, Delivery, Prevention, and
Epidemiology. The very best way for representing the health system architectures is
through the use of causal loop diagrams that are considered a powerful way for
representation of complex systems, in general. For example Hirsch et al. (2005)
explore the health system from the perspective of population health. The authors
expand the basic model to consider the effects of things such as high tech medicine,
fragmentation of services, cost containment, living conditions, and patient
involvement. Their proposed model integrates all of these effects rather than
considering them individually, demonstrating a strength of SD modeling.
Grossman (1972a) developed a dynamic model for health and then a solution for the
dynamic optimization problem that leads to the optimal life-cycle health paths, gross
investment in each period, consumption of medical care (which is seen as a derived
demand) and time inputs in the gross investment function in each period. Using the
original study and US data, Grossman found positive effects of education and wages
on the demand for health. It also was shown that age had a positive effect on health
demand and a negative effect on medical care (Grossman, 1972a, 1972b, 2000, and
Jones et al., 2003).
Health care is complex system because of the great number of interconnections within
and among small care systems (Institute of Medicine, 2001). A health care system can
be defined as a set of connected or interdependent parts or agents including
caregivers and patientsbound by a common purpose and acting on their knowledge.
Research has proven both the general potential of systems thinking (Plsek and
Greenhalgh, 2001) and applications in specific areas. While health care systems are
complex and include many interconnected elements, the rules and heuristics
generating managerial decisions are too simplistic to cope with the complexity
involved in such systems. The result is that the well-intentioned decisions, which aim
to improve the performance of these systems, lead generally to completely opposite
results, a syndrome known as policy resistance (Lebcir, R.M., 2006). Systems
thinking combine an array of methods and techniques drawn from various fields such
as engineering, computing, cybernetics, and cognitive psychology. It allows managers
to overcome the feeling of helplessness and having necessary tools to analyze,
understand, and influence the functioning of the systems they are trying to improve
2

The rest of this paper is organized as follows: section 2 described the methodology
that this researcher has followed to conduct this research. Section 3 describes systems
thinking while systems thinking diagram is discussed in section 4. Dynamic thinking
diagram is discussed in section 5. Systems thinking patterns of the sample situation is
elaborated in section 6. A dynamic study of heart attack related deaths is the topic of
section 7. Future Research and work extensions are discussed in section 8. The topic
of section 9 is about the limitations and the scope of this research for future working
on. Our discussion and conclusion is given in section 10.

2.Methodology
The purpose of this article is two folds: (1) to show how systems thinking can be used
for the study of basic health problems and the way of tackling some health models for
discussion purposes; and (2) how a stock and flow can be employed to develop a
dynamic model for calculating the heart attack related death patterns over time. In
addition to that, author demonstrates the use of systems thinking and dynamic systems
in the area of health care management for better analysis of the systems and
productivity enhancements. Such a research is needed to determine the capability of
these tools in complex model building and analysis. A brief description of the systems
thinking and dynamic systems are provided for introducing the topic to a group of
new readers, however. More specifically, we can identify the following list of
objectives for achieving the overall goal of this study:
1. Identifying system variables within the human-being-body-system taking the
principles of Cybernetics into consideration.
2. Generating the causal loop diagram for the human-being-body-system using
the identified variables from 1.
3. Flow diagrams construction.
4. Developing the mathematical formulation of the problem.
5. Model simulation using the predefined values.
6. Conclusion and propositions.

3. Systems Thinking
We all are familiar with the systems in such a way that we mindfully and without
realizing it regularly attribute and credit events to all kinds of systems. That usually is
done without paying attention to the type of the system that it is a real one or an
imagined one. System thinking studies the whole as a result of the connections
between its parts. System thinking is the opposite of reductionism, the idea that
something is simply the sum of its parts (OConnor and McDermott, 1997). Most
systems are comprised of smaller systems that we call them the subsystems. The
definition of system must hold for any subsystems of a system as well. Systems
thinking allow consideration of the whole rather than individual elements and
representation of time related behavior of systems rather than static snapshots
(Senge 1990). Some of the topics associated with systems thinking are: causal
feedback (Richardson, 1991); stockflow structures and open and closed systems
(Sterman, 2000); nonlinear systems and chaos (Strogatz, 1994); cybernetics (Francois,
2004); and system dynamics (Forrester, 1961, 1994, 2003, and Richardson, 1996).
System thinking is a conceptual framework for problem-solving that considers
problems in their entirety. Problem-solving in this way involves pattern finding to
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enhance understanding of, and responsiveness to, the problem. Outcomes from
systems thinking depend heavily on how a system is defined because systems thinking
examine relationships between the various parts of the system. Boundaries must be set
to distinguish what parts of the world are contained inside the system and what parts
are considered the environment of the system. The environment of the system will
influence problem-solving because it influences the system, but it is not part of the
system. The concept of system thinking is derived from a computer simulation model,
created in 1956 by Forrester of MIT to deal with management problems in enterprises.
Then, Senge and Lannon (1990) applied this concept to organization research, and
advocated that for effective application of system thinking, researchers have to pay
attention to the four tiers/levels in the system: event, behavior pattern, structure and
mental pattern.
System thinking is important because the society is full of dynamic complexity. The
term dynamic complexity was coined by Senge and Lannon (1990) to indicate that the
real world we live-in are actually composed of numerous causes and effects. People
often concentrate on individual events and forget to consider the entire environment,
and thus confine themselves to thinking in parts rather than whole. Therefore, to solve
dynamic complexity, we need the assistance of system thinking to clearly see the
relation between all problems and prevent the phenomenon that a change in one part
affects the whole. The operation of an enterprise is just like a small society. We start
system thinking by realizing a simple concept, feedback, which explains how
actions intensify or offset each other, and whose ultimate aim is to clearly see the
simple structure behind the complicated events so as to simplify social problems.

4. Systems Thinking Diagrams

In systems thinking diagrams we use two components of elements and influences. An
influence also has a direction, indicated by an arrow, and an indicator as to whether
the influenced element is changed in the same (with a + sign) or opposite (with a sign) direction as the influencing element. A simplest diagram (Figure 1) is comprised
of two elements of Pain and Medicine can be constructed as follow:

Pain

Medicine

Figure 1: Pain and Medicine relationship

From this diagram there are only a couple things which are implied:

Pain and Medicine are elements of the model.

Pain influences Medicine in the same (+) direction as Pain. This means that as
Pain increases the use of Medication by the patient also increases.

Due to the fact that reinforcing and balancing loops build the foundation for other
loops, in the sections that followed first the reinforcing loop and then balancing loop
are discussed briefly.

4.1 Reinforcing feedbacks are the engines of growth. Whenever you are in a
situation where things are growing, you can be sure that reinforcing feedback is at
work. Reinforcing feedback can also generate accelerating decline a pattern of
decline where small drops amplify themselves into larger and larger drops, such as
the decline in bank assets when there is a financial panic. Figure 2 depicts a typical
reinforcing feedback or loop. In this loop, when physician pays attention to patient
the result is satisfied patients who would have positive view of MD and hence the
positive word of mouths. That would cause having more patients for the MD and the
MD would care even more for the patients.
Physician (MD)
+
Reinforcing Loop
+
Satisfied Patient
Positive word of
mouth

Figure 2: A reinforcing feedback

4.2 Balancing feedback operates whenever there is a goal-oriented behaviour. If

the goal is to be not moving, then balancing feedback will act the way the brakes in a
car do. If the goal is to be moving at hundred kilometres per hour, then balancing
feedback will cause you to accelerate to hundred but no faster. What makes balancing
processes so difficult in management is that the goals are often implicit, and no one
recognizes that the balancing process exists at all. And often this has something to do
with corporate culture. But identifying these balancing processes is crucial for system
dynamics modelling. Figure 3a shows a balancing feedback loop with a goal set as
"Patient Health" or (Goal) representing the ultimate "Patient's Health". Between the
"current level of patient's health" and the "the real health of patient" is a gap shown
by variable "Gap". This "Gap" level gives the physician a good reason for taking
action in order to increase the dosage of the medication, if necessary, to improve the
health of his/her patient. The behavior of balancing feedback loop is shown by Figure
3b.
Many feedback processes contain delays, interruptions in the flow of influence
which make the consequences of actions occur gradually. Delays are interruptions
between actions and their consequences. Delays can make you badly overshoot your
mark, or they can have a positive effect if you recognize them and work with them.
Delays exist everywhere in business systems. According to system dynamics,
researchers can model a complete dynamic system by combining these different
elements, like reinforcing feedbacks, balancing feedbacks, and delays. For example a
model could be built to analyze a business system with limits to growth.

Patient's Health
(Goal)

+
Action (Increase level
of Medication)

Balancing Loop

Gap
-

Current level of
Health

Figure 3(a): A balancing feedback loop and goal seeking

Figure 3(b): A balancing feedback loop and goal seeking

5. Dynamic Thinking Diagrams

Systems archetype is composed of many circulations formed as a result of all kinds of
problems that affect one another in society. Senge and Lannon (1990) classified these
circulations into nine major systems archetypes: (1) Delayed balancing process; (2)
Limitation to goals; (3) Shifting the burden; (4) Temporary solution; (5) Escalation;
(6) Success; (7) Common tragedy; (8) Failure; (9) Growth and underachievement;
Fixes that Fail; and (11) Accidental Adversaries.
Systems Dynamic (SD) modeling offers a unique opportunity to improve decisionmakers understanding of the sources of their systems under-performance as it allows
both qualitative and quantitative analysis, which lead more easily to consensus
building, improved shared understanding, and enhanced organizational learning
(Wolstenholme 1993). With regard to a model proposed, once the researcher is able to

identify the qualitative structure describing the problem situation, which are being
used in the Causal Loop Diagrams (CLDs), the next step is to build a computer-based
behavioral model reflecting the qualitative structure. The stocks (variables subject to
accumulation and depletion processes over time) and the flows (which determine the
time related movement of units from one stock to the others) are determined and the
relationships between them defined. In this phase, a link is established between the
variables and their dynamic behavior. The quantitative nature of this phase makes it
the most important one in terms of generating insights about the situation. It is
important to notice here that many specialist software programs have been written for
SD modeling (Richmond 1987, Richardson and Pugh 1981) to make the process easy
and accessible to people even without strong computational background.
In his pioneering book on the subject, Forrester (1961) presented the dynamic analysis
of a business problem through a model of a production-distribution system that shows
oscillatory behavior. Policies to improve system performance were discussed, and
numerous policy experiments were demonstrated. Since then, system dynamic
modeling approach has become a powerful tool for analyzing complex systems.
Lyneis (2000) highlight three important advantages of system dynamic modeling
approach:
1. System dynamics models can provide more reliable forecasts than statistical
(non-structural) models;
2. System dynamics models provide a means of understanding the causes of
industry behavior; and
3. System dynamics models allow the determination of reasonable scenarios as
inputs to decisions and policies.
System dynamic is typically used for models that represent relationships between
system variables, rates of change over time, and explicit feedback. Rather than
focusing on individual transactions in the system, the models focus more on the levels
of variable stocks and the flows between variable states. As a result, SD models are
more often associated with higher level types of problems, especially consideration of
the impact of policy and strategy decisions.
Dynamic Systems Diagrams are composed of four different components: Levels,
Rates, Auxiliary variables, and Connectors. The labels may vary slightly in different
arenas. In relation to Dynamic Systems diagrams, the following points are correct:

Rates influence Levels (state variables)

Levels can influence rates or auxiliary variables
Auxiliary variables can influence Flows or other Converters
Auxiliaries cannot influence Levels
levels cannot influence other Levels

A diagram containing all of these elements is shown by Figure 4:

Rates

Levels

+
Aux variables
Figure 4: a general flow diagram
Systems Dynamic modeling has been applied, in specific health care management
issues such as health care work-force planning and emergency health care provision
(Royston et al 1999, Lane et al 2000), effect of joint health care provision by different
sectors (Wolstenholme 1999), and the effect of a shift from the free-to- service to selfpaying service (Hirsch and Immediato 1999). These models demonstrate the rich
variety of areas in which SD may play a significant role in health policy design.

6. Systems Thinking Patterns of the Sample Situations

On the basis of our observations as well as many opinions gathered by the field
specialists and people in general, this study focuses on how human-being body
operates, and some parts perform and interact with the other parts of the body. Figures
5through 9 discuss various health related problems and then figure 10 concentrates on
the flow diagram for the dynamic study of the heart attack problem.
6.1 Reciprocal effect between loop 1 and loop 2
In Figure 5, the left loop is an indication of that as pain decreases and happiness get in
its place the body will act in the way that the soul and the body come to a start of
healthy situation. As a result of that, persons can have higher levels of movements
that would cause to have stronger muscles and bones and hence lesser pains and
therefore to be happier. Loop 1 and 2 are of reinforcing and balancing loops,
respectively. As the theorem of "Limits to Growth" indicates the growth would not
lasts forever and we know that loop 2 tries to bring that into balancing situation. So,
"no pain" and "happiness" would not last forever because loop 2 has the "movement"
of the person under the control.

Knee Swelling
Soul and Body
Health

+
Movement

+ Watering
Knee
+

Happiness

Loop 1
Reinforcing

Muscle
strenthening

Loop 2
Balancing
Bone Building
Knee
+

Pain

Pressure on
Knee

Correct cell
reconstruction
Figure 5: Movement, Knee problems and health
Knee Robbing -

6.2 Movement, weight, and knee problems

Figure 6 is comprised of four loops which are named loops 3, 4, 5, and 6 and with the
polar natures of +, +, +, and signs, respectively. Loop 3 relates weight and
movement where weight is under the influence of outside factors such as "unhealthy
food" and "good eating planning" and "bad eating habit". Loop 4 studies the impacts
of weight on the knee pain and person's movement. Loops 5 and 6 are both under the
influence of movement which is under the impact of weight. Loop 6 points to this fact
that weight is not the only factor that bring human being movement to a stationary
stage that could be its least knee problems as well as knee pain can have a big impact
on the movement. The lesser the movement the lesser is the happiness, and the higher
the weight the lesser is the movement.
Bad eating habit
Good eating plan
+
-

Knee Pain

Weight Loop 3
-Movement

++
Loop 6

Loop 4
+

bone Robbing

Muscles

Knee robbing
+

Loop 5

Pressure on Knee

Figure 6: Movement, Weight, and Knee problems

6.3 Weight, Movement, Knee and Vascular problems

According to the Centers for Disease Control, heart disease is the leading cause of
death in the United States and is a major cause of disability. In 2002, almost 700,000
people died of heart disease, just over half of which were women. These statistics
mean that nearly 30% all U.S. deaths were due to heart disease. According to the
American Heart Association, heart disease has been the leading killer of adult females

since 1908. Overweight is considered a major risk factor for both coronary heart
disease and heart attack. Being 20% overweight or more significantly increases
person risk for developing heart disease, especially if that person has a lot of
abdominal fat. The American Heart Association has found that even if a person has no
other related health conditions, obesity itself increases risk of heart disease (Plsek and
Greenhalgh, 2001).
A healthy diet is also an important part of lowering the risk of heart disease. The
American Heart Association recommends a diet that contains no more than 30% of
daily calories from fat. For example, if one eats a diet of 2,000 calories per day, no
more than 600 calories should come from fat. The American Heart Association
recommends a diet rich in fruits, vegetables, healthful fatty acids and limited saturated
fat (Walker and Reamy, 2009). The American heart Association
(http://www.heart.org) has identified the health diet goals claims that: heart disease is
the No. 1 killer of Americans. We can reduce heart disease by promoting a healthy
diet and lifestyle. Getting information from credible sources can help us make smart
choices that will benefit your long-term heart health. In a study conducted by
Johannes A.N. Dorresteijn, et al. (2012) it is stated that high blood pressure has since
long been recognized as a strong and modifiable risk factor for cardiovascular disease
and mortality.
Figure 7 is comprised of two balancing loops and one reinforcing loop. Loops 8 and 9
that are balancing and reinforcing, respectively, look into the impacts of weight on
heart problem as well as the bones and pains associated with that. This group of three
loops also have a deep look at the weight and the negative impacts that it can have on
the heart and movement. Although, loop 9 points to this fact that as a result of high
weight and less movement pain can be high and increase over time but in loop 8 as a
result of fighting with heart problem and its related impacts on body performance
some improvement will be done which result in bringing the weight down to an
acceptable level.
Bad eating habit
Good eating habit
Movement
-

Loop 7 Weight
+
(Balancing) Proactive actions
+

Pain
+
Body Fat

Loop 9
(Reinforcing)

+
Robbing
+

Death related to
heart problems

+
Muscle Laziness

Loop 8
(Balancing)

Vascular Problesm
+

+Pressure on Bones

Heart Muscle
Laziness

Heart Operation
disorder

Figure 7: Weight, Movement, Knee and Vascular problems

10

6.4 Weight, exercise and total health (About Loop 4)

Figure 8 is comprised of two reinforcing loops of 10 and 11. Loop 10 relates weight,
exercise, movement, and health with the good eating while loop 11 takes all these
elements and see their impacts on the health of soul. This is the reason why a large
number of people not happy with their extra weight. So, taking figures 6 and 7 and 8
into consideration, we can notice the impact of extra weight on the movement, heart
problem, joint problem, and now on the health of the soul.

Healthy eating
+

Weight

Total health
Loop 10

Body health
+
Loop 11

Excercise
+
Movement

Soul health

Figure 8: Weight, exercise and total health

6. 5 Weight, health, diabetic, blood pressure, and over eating (Obesity)

problems
Julia Steinberger and Stephen R. Daniels (2003) claim that obesity increases the risk
of cardiovascular disease in adults and has been strongly associated with insulin
resistance in normoglycemic persons and in individuals with type II diabetes. An
association between obesity and insulin resistance has been reported in the young, as
has the link between insulin resistance, hypertension, and abnormal lipid profile.
There is an increasing amount of data showing that being overweight during
childhood and adolescence is significantly associated with insulin resistance,
dyslipidemia, and elevated blood pressure in young adulthood. Weight loss by obese
youngsters results in a decrease in insulin concentration and improvement in insulin
sensitivity.
Figure 9 is comprised of 8 loops. Loops 12, 13, 14, and 15 are sharing the weight as
the main cause. We see that also bad eating habit and less movement and exercise can
cause the extra weights the weight by itself can be the source of another problem of
diabetics. Loop 13 which is a balancing loop relates weight with blood sugar,
diabetics and action to control the diet and eating habit. This all together would cause
the weight lost. However, loop 14 relates bad eating habit to extra eating and many
times eating and then the body laziness with the less movement and hence the extra
weight. Loop 15 sees the impacts of blood sugar on diabetic problem, on eye sight

11

and hence on the eye problem as such as blindness. Loop 12 through 15 sees extra
weight and bad eating habit as the main cause of problem.
Loops 17, 18, and 19 share extra eating as the main source of problem and the only
cause for appearing problems as such as blood pressure, blood cholesterol, and
stomach discomfort and reflux problem. These loops all requires some sort of action
(probably a serious one) for dealing with the extra eating.
Loop 16
Weight +
- Movement
Loop 12
-

Bad eating

Blood Sugure

Loop 13

Lozziness
+

Proactive
preventive actions +

Diebetic

Preventive actions

+
+
Bad habit eating

Loop 14

Over eating +

Loop 19
+

Stomach Problems

Loop 15
Sight Problems
+

Consecutive eating
Blood pressure

+
Death due to heart
attack

Cholestrole

Vein Closing
+

Sight

Loop 17

+
+

Loop 18
Heart Attack
+

Hearth Disease

Figure 9: Weight, health, diabetic, blood pressure, and over eating problems

7. A Dynamic Study of Heart Attach related Deaths

The model proposed in figure 9 is being simplified and shown by flow diagram in
Figure 10. By finding the values of heart attack death rate factor of R1 and action
related impact factor of R2 we can determine the pattern of heart attack death
occurring over the time. For comparison purposes, the model is broken into two cases
where in the first case only heart attack death pattern is determined (without
considering the action impact- learning) while in the second case the action impact
(learning) is included.

7.1 Mathematical Model 1 (With no learning impact factor)

To perform a study of the situation, we need to convert the flow diagram model 14
into mathematical model suitable for simulation purposes. In order to quantitatively
simulate the dynamic behaviors of a system, modelers need to write a set of equations
to describe each relationship, and then operate them (Chen, et al., 2004). Causal loop
diagrams help to qualitatively realize the fundamental structure of the system under
study. In order to further describe all relationships among system elements in detail,
VENSIM PLE provides modelers a series of convenient tools to construct a stockflow diagram.

12

7.2 Model Verification

Vensim PLE software has capability for verification purposes. For this purpose, the
structure check which includes formulas check and units check, is used to find
whether there are formulas or units errors in the model of the problem. After
successful completion of checking the formulas and units loaded into the software the
model of choice is simulated.
7.3 Model Validation
Vensim PLE allows model validation using the reality check, the option that the
system provides. One can use that for comparing simulation results with perceived
reality. The smaller difference between them can guide us that model is adequately
addressing the problem to which it is being applied. In this study, we first execute the
model using the regular data without considering the learning rates that would impact
the system to reduce weight, to control blood pressure, to control the amount of sugar
and salt that would, as a result, reduce their chance of suffering heart attack. Then the
system was run using the data with its learning impact.

7.4 Level and Rate

Dynamic systems deal with two types of variables known as level and rate. The
Level refers to a given element within a specific time interval. In dynamic systems,
level type variable is the one that accumulation occurs in that. Meanwhile, the rate
variable causes the increase or decrease in the accumulation, the level variable (Zare
Mehrjerdi, 2012). The level is calculated from the difference between a rate variable
that increases the level and a rate variable that reduces the level. Specifically
speaking, the level deals with rates related to input and output. Therefore, the value of
level can be identified easily. Determination of rate is not a simple task and requires a
great deal of effort in almost all the cases for about every problem. Most of the time a
rate is calculated by finding the average value of the accumulated level over the total
time taken to get that (Zare Mehrjerdi, 2012). In some cases rates are defined
according to following formula:
Rate (t) = Const * Level (t-1)
Const= A predetermined value
Using the Formula for the rate given above one can determine the Level variable at
time t as a function of the Level variable at time (t-1) as shown below:
Level (t) = Level (t-1) + dt * Rate
The above formula can also be written as follow:
d(Level) / dt = Rate
In above formulas dt stands for a time period that we are looking into the changes.
This time period is defined by the researcher as a minute, day, week, month, year, or
others.

7.5 Simulation and Analysis

13

After the models evaluation, we ran it to simulate the dynamic behaviors of

Total_HA_Death, and rate changes over a period of 60 month. Simulation parameters
were defined as follows:
Total_HA_Death (t+1) = Total_HA_Death (t) + DT * RT (t, t+1)
RT (t, t+1) = Const * Total_HA_Death (t)
Const = a pre determined amount
DT = 1 month
Where, the variables used are:
Total_HA_Death = total number of deaths from heart attack situation.
RT (t, t+1) = the rate of occurring heart attack in the time space between t and t+1.
DT= time distance that is considered to be equal to 1time period.
Const=a pre determined amount
t= period t

Action related
impact factor =R2

Total Death (heart attack

related)
Heart Attack Death
rate factor =R1

Population

Death rate

Figure 10: A flow diagram for total heart attack death counts and population

7.6 Model 2 (With learning impact factor)

Now the mathematics used in the first model can be presented as below:
Total_HA_Death (t+1) = Total_HA_Death (t) + DT * [RT1 (t, t+1) RT2 (t, t+1)]
RT1 (t, t+1) = Const * Total_HA_Death (t)
RT2 (t, t+1) = Rand (.) * Total_HA_Death (t)
Const = a pre determined amount
DT = 1

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Rand (.) = Represents the random rate produced as a result of teaching people to
exercise, to reduce weight, to control blood pressure, to control the amount of sugar
and salt that would, as a result, reduce their chance of suffering the heart attack.

Figure 11: Heart Attack Deaths Related before Learning

Figure 11 shows the heart attack deaths by periods without learning factors applied.
On the other hand, figure 12 shows the random learning rates that could obtain as a
result of teaching people about their heart functioning, heart attack, heart problems,
eating habits, blood pressure, sugar blood, and what their impacts are on the heart.
Using the proposed model we were able to determine the heart attack death right after
the learning that has been occurred, with the random learning rates given. As can be
seen from figure 14, the new heart attack related deaths are lower as well as its related
overall deaths.
Figure 13 shows the overall death reduction as a result of the learning that happened.
Since death rates are considered to be random variables related death counts are
showing reduction in death amounts which also behaves as random variable. The new
heart related deaths as well as the total deaths are shown by figure 14.

15

Figure 12: Random learning rates

Figure 13: Death reduction as a results of learning rates

Figure 14: New heart attack deaths

16

8.Future Research and extensions

Currently, one of the central issues of health systems and health providers is to
research on the problems that can be used for showing the insured that taking care of
their personal body is a good business for them. This, in turn, would be very good for
insurance companies too. So it seems a harmonious way with insurance companies to
use SD in health problems and related system modeling. With this taught in mind, this
author proposes the following areas of concern for future researches:

Proposition 1: Obesity, blood pressure and heart attack are closely related causes.
Proposition 2: Obesity, blood pressure, blood sugar, and heart problem are closely
related causes.
Proposition 3: Exercise and heart problem are closely related causes.
Proposition 4: Weight, diabetes, and heart attack are closely related causes.
As can be seen from loops 12 and 13 one can study the impacts that bad eating habit
can have on the weight gain and on the blood sugar, and then identify a pattern for the
type of the food eaten, and that snacks are not good for the kids as parents often tell
them.

9.Limitations and scope for future research

As it is stated by Sterman (2000) All models are wrong, so no models are valid or
verifiable in the sense of establishing their truth. The question facing client and model
builder is never whether a model is true but whether it is a useful one. We can only
say dynamic system is a good tool for studying complex systems. Specially, for a
system as such as human being body with all the complexities that it has. To do a
deep study on that, we are in need of trustful data. Having good data for data analysis
is a big limitation of the proposed model.

10. Discussion and Conclusion

In this article, author has discussed the fundamentals on systems thinking, and system
dynamics. In addition to that five health related models are developed that are highly
beneficial for studying the impacts of weight on different health problems such as
movement (knee problems), blood pressure, blood sugar, heart disease, and heart
attack. To study heart attack problem and its related causes and the death counts a
flow diagram with two models are proposed. The first model just takes in the rates for
heart attack problem while the second model takes in the action related impacts factor
relating to the teaching of people, causing to reduce death due to heart attack. Figure
14 shows the action related impact factors that are generated randomly, assuming that
this factor is not a fixed number and changes over time due to learning more and
implementing that. The pattern shown by figure 14 are the through representation of
the fact that heart attack deaths will reduce once people are taught well and they do
implement that knowledge accordingly.
The main message of this research is that for every human being regardless of their
sex, race, age, and the country that he/she is living in, it is the weight that we carry on
a daily basis. There are some factors that contribute to body mass accumulation as we
get older. We have noticed that bad eating habits and less movements and exercises
17

can cause the extra weights where weight by itself is the main source of problem for
the known diabetic disease. This study showed that there is a balancing loop that
relates weight with blood sugar, diabetics and action to control the diet and eating
habit. However, bad eating habit may be the cause of extra eating or many times
eating and hence laziness and less movement. This study also points to the impacts of
blood sugar on diabetic problem, on eye sight, and hence on the eye problem as such
as blindness.
American Heart Association (http://www.heart.org) has defined what it means to have
ideal cardiovascular health, identifying seven health and behavior factors that impact
health and quality of life. We know that even simple, small changes can make a big
difference in living a better life. Known as Lifes Simple 7, these steps can help add
years to your life: (1) dont smoke; (2) maintain a healthy weight; (3) engage in
regular physical activity; (4) eat a healthy diet; (5) manage blood pressure; (6) take
charge of cholesterol; and (7) keep blood sugar, or glucose, at healthy levels.
The results of this problem also clearly shows that our random learning on heart
disease and its related problems can contribute to lower the overall death which is a
good news for all. This article makes a significant contribution to the health study
issues due to the fact that it shows how a factor such as weight can have impacts on
heart attack, blood pressure, and blood sugar, to mention a few. Since, to the best of
this author's knowledge, this is the first study that relates weight to health problems
using systems thinking concepts and system dynamic it make a significant
contribution to the health literature.

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