Wednesday, September 21, 2011

Behavioral economics - a way to fight Big Food?

Eating that double-fudge brownie or entire bag of chips ultimately comes down to individual choice. However, it is becoming more and more apparent that we are not really free to choose – our choices arise from opportunities or barriers that are structured in large part by the places in which we live, work, play, or go to school. The abundance of ultra-processed, energy –dense, nutrient-poor foods that are readily available, heavily marketed, cheap, and tasty, presents a large barrier to many of us in terms of following a healthy diet. How can we counteract this to make healthier foods like fruits and vegetables the more attractive option? I’ve been thinking about this a lot lately, wondering if the only way is to make these foods just as convenient to consume, such as in healthy prepackaged meals, and somehow find the means to heavily market them in the same way as Big Food.

Behavioral economics may be a simpler way – changing the layout of cafeterias, stores, and restaurants to subtly influence people to make the healthy decision.      

Smarter lunchrooms is an initiative out of the Behavioral Economics and Nutrition Center at Cornell University concerned with doing exactly this. Their philosophy is that draconian school food policies, like banning junk food from cafeterias, don’t work. Often children will skip lunch, bring in their own snacks, or head to a fast food restaurant.  Principal investigators Brian Wansink and David Just think that ‘nudging students toward making better choices on their own, by changing the way their options are presented’ is a better option. I tend to agree.

Although the epidemiologic evidence doesn’t look like it’s strong (most studies appear to be case studies or before-after and I’m not entirely sure of the methodology), I think the results of some of these interventions are worth discussing, especially since most of these are low cost and low effort for the school to implement. Hopefully some larger scale, well designed randomized controlled trials are on the horizon (us epidemiologists can only dream).  Here are a few examples from Wansink & Just, as well as their colleagues (virtually verbatim from their website):

  1. Putting nutritious foods like broccoli at the start of the cafeteria line, rather than in the middle, increased sales by 10-15%      
  2. Switching apples and oranges from a stainless steel pan to a fruit bowl more than doubled fruit sales
  3. Giving healthy food choices more descriptive names like ‘creamy corn’ rather than ‘corn’ increased sales by 27%
  4.  Moving the chocolate milk behind the plain milk led students to buy more plain milk
  5.  Putting the salad bar in front of the check-out register nearly tripled sales of salads
  6. When cafeteria staff asked students if they wanted a salad, salad sales increased by a third
  7.  Requiring that desserts such as cookies be paid for in cash (not with lunch tickets or debit cards) led students to buy 71% more fruit and 55% fewer desserts
  8.  Keeping ice cream in a freezer with a closed, opaque lid significantly reduced ice cream sales
I think that something like this could in some way be translated to other shared dining spaces such as cafeterias in workplaces, hospitals, and universities, to name a few. Google has actually shown us that it is feasible. Now whether its employees are healthier for it, I'm not sure if it has, or will ever be formally evaluated. Too bad..Seems like a waste of a good intervention study.

Just D.R.,, & Wansink B (2009). Smarter Lunchrooms: Using Behavioral Economics to Improve Meal Selection Choices:The Magazine of Food, Farm, and Resource Issues, 24 (3)

1 comment:

  1. Common sense could take us so far towards better health! The interventions you listed are just so obvious yet so rare. Hopefully they do get picked up in lunchrooms around the country.