Consulting, Research and Speaking on Health and Media Issues

Change the defaults

The other day, I heard an NPR health iStock5241132_toddler-yogurt-300x199podcast titled “Bad Habits Die Hard–Will We Die With Them?” It includes an interview with Charlotte Schoenborn, a CDC statistician, who notes ruefully that after years of health education campaigns, there’s relatively little to show for these efforts: “It’s amazing how hard it is to change these personal health behaviors.”

One problem is disagreement about what should be changed. For example, the NPR report noted with disapproval that more educated people are more likely to drink alcohol, with the unstated assumption that all drinking is bad. A slew of health reports suggest that for most adults over 30, the benefits of a drink a day may outweigh the risks. There is also concern about New York City’s campaign to reduce salt intake across the board, which some view as tantamount to an uncontrolled experiment with the public’s health.

One area of agreement is that children’s eating habits are decidedly subpar. Experts talk of an epidemic of high blood pressure, Type 2 diabetes, sleep apnea and even knee problems in increasingly heavy kids and teens. To cut these risks, the NPR podcast mentioned the idea of an “in your face” campaign to reduce obesity, akin to past antismoking campaigns.

Wait a minute. I’ve done work in both smoking prevention/cessation and weight loss, and I worry that this attitude and approach could do more harm than good.

First, there’s zero evidence that shaming fat people helps them lose weight, whereas there’s lots of evidence that stress promotes weight gain (even without overeating), and that accepting obesity as shameful legitimizes weight discrimination – which appears to harm health as well as undermine access to good medical care.

Second, you can quit smoking, but you can’t quit eating. Sure, smoking is a complex and multifaceted behavior (involving environmental cues, genetic factors, pricing, etc.), but it’s nothing compared to eating.

I’m a fan of starting with low-risk, low-hassle, pretty-good-payoff interventions. On the issue of healthy eating, we can take a lesson from financial psychology. We know that employees save more with opt-out company retirement plans–ones that automatically set aside part of your monthly paycheck, unless you actively stop it. Economists sing the praises of setting up smart default options, then letting inertia work on the side of the angels.

There are already efforts underway to put healthy food choices in front of kids’ faces at school. We can also work to change the defaults in our kitchens at home. Leave healthy snacks (but only things your kids like, such as bananas) right up front on the counter. Position those little cups of fruit in juice, or some not-overly-sugary yogurt, so it hits your child’s eye first when she opens the fridge. Make inertia your friend.

For a contrarian perspective on food, read my article on stress and sugar cravings on the Brainlink website.