Healthier Eating Begins with a Nudge: Application of ABI
Imagine as the clerk scans your grocery items, you look up at an impulse buy section filled with bright, local apples. Nougat-filled candy bars are placed a few inches beyond arms reach. Which are you more likely to select?
The prevalence of unhealthy body weights and individuals categorized as overweight or obese has steadily increased in Canadians, with 20.2% of Canadian adults and nearly a third of youth aged 12 – 17 reporting measures classified as overweight or obese in 2014.
Left unchecked, overweight and obese children and youth are likely to become overweight and obese adults (see also here), and are therefore more at risk for adult health problems such as heart disease, type 2 diabetes, stroke, several types of cancer and osteoarthritis.
The estimated economic burden of excess weight alone in Canada in 2012 was approximately $19 billion in direct ($5.4 billion) and indirect ($13.6 billion) costs. This figure is likely higher as the prevalence of overweight and obese individuals has continued to increase since this time.
The estimated economic burden of excess weight alone in Canada in 2012 was approximately $19 billion in direct ($5.4 billion) and indirect ($13.6 billion) costs
Eating behavior is often affected by your environment and the choices available to you. This can range from the size of your dinner plate and drinking glass through to the positioning of various food products in a grocery store. Going back to the earlier example of the impulse buy section, research has shown that you may be more likely to reach for the apple as opposed to the candy bar because of the way those choices have been presented to you. To address eating behaviours, we need to take a holistic approach that accounts for the multitude of factors that can affect our choices and behaviour.
Diet is a key, modifiable behavior in achieving and maintaining healthy weights. However, single, dietary interventions in the home, or workplace have, to date, not produced impactful, public health outcomes.
A person may make as many as 250 food decisions on an average day, the vast majority are made without conscious thought. If individuals are influenced by subconscious cues to eat, maybe the influences to make better choices are subconscious as well.
While regulatory interventions such as taxation have been suggested to affect healthy eating behaviours, such interventions have seen varied success in other jurisdictions (and here) and may have a disproportionate effect on lower socio-economic status households.
Applied behavioural insights (ABI) leverages a deep understanding of how and why individuals make decisions in order to create conditions under which individuals will make healthier choices. By understanding the decision making processes of individuals, policy makers can affect choice architecture (the ways in which choices can be presented to consumers) to result in positive health outcomes. Done properly, changes in choice architecture are hardly noticeable, and pre-disposes one choice over another, while not limiting the overall options available.
ABI interventions do not limit people’s freedom to choose, rather subconsciously influence decisions. By leveraging psychology and behavioural economics, small changes in the choice architecture can result in significant impacts. ABIs can take on a number of forms such as financial incentives or education. One well-known application of ABI is “nudging”, as popularized by Thaler and Sunstein. A nudge is “any aspect of the choice architecture that alters people’s behavior in a predictable way without forbidding any options or significantly changing their economic incentives”. Everything from the design of a form, to the placement of healthy options on shelves at eyelevel can be used as a nudge.
Policy-makers can use tactics to encourage behaviours that benefit the individual and society. Though ABI-based interventions may only make minute changes to the environment, the sum of many changes to behavior can lead to overall healthier diets.
Like any intervention, ABI interventions have received critical reception, citing cost-effectiveness, ethical controversy, policy paternalism, and difficultly measuring impacts as concerns. However, the smallest interventions can have largest impacts, and used properly with other tools, ABIs can have an impact many times larger than it’s cost. With the weight of unhealthy eating behaviours on our systems, what do we have to lose?
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