Pragmatic Opposition to Nudging

tongs

In the United Kingdom, great credence has been placed in nudge theory, but apparently a certain amount of disillusionment has already set in. Behavior change brought on by the effects of nudge theory is not by itself enough to make a big dent in obesity and the attendant chronic disease, according to public health leader Professor Mike Kelly.

Kelly even feels that “the jury is still out” on whether nudge theory actually has a useful place in the public health sector. Others are critical because if nudge theory is to make a difference, it will take systemic change and massive work on the built environment including physical architecture, food and transport systems, etc.

Interventions

Mark Egan of Stirling Behavioral Science Center compiled a list of nudgy interventions. He talks about the effects of framing, which is one type of nudge:

When patients are told that 90% of those who have a certain operation are alive after five years, they are more likely to have the operation than when they are told that after five years, 10% of patients are dead.

Good to know. Egan also discusses a paper called “Nudge to nobesity I: Minor changes in accessibility decrease food intake.” This was one of the school-lunch studies, by Hanks et al:

One of two lunch lines was arranged so as to display healthier foods. In the healthier line, sales of healthier food increased by 18% and grams of less healthy food consumed decreased by 28%.

Another study, by Rozin et al, found that the consumption of unhealthy food could be decreased from 8% to 16% by making the unhealthy stuff harder to reach and — get this — by changing the serving utensil from a spoon to a pair of tongs. Tongs!

Egan speaks of another, rather complex study having to do with primary school children, fresh fruits and vegetables, and incentives. The followup move was to assess the kids’ attitudes at intervals afterward. Apparently it was disappointing in some ways, but the big takeaway was that, compared to their more economically privileged age-mates, children from lower income groups emerged from the study with a longer-lasting willingness to try fruits and vegetables.

Nudging has many useful applications. A hotel buffet reduced food waste by 20% merely by changing the signage over the spread. In a full-service restaurant, researchers learned that dishes sold better when their blurbs were printed at the beginning or end of the menu, rather than in the middle.

Another study employed self-refilling bowls. Even though the subjects did not believe they had consumed more, as it turns out, they ate 73% more than the participants who had normal bowls. Astonishingly, the people who ate 73% more did not even feel full.

Egan describes in detail a randomized controlled trial (RCT) using lotteries to encourage weight loss, with noteworthy success. (It is example #7 in the paper.) Item #27 describes a study whose title says it all: “Inviting Consumers To Downsize Fast-Food Portions Significantly Reduces Calorie Consumption.” But what fast-food outlet is going to do that? “Excuse me, ma’am, would you like less food? So that the franchise can make less money and I can lose my job?” Not likely!

Your responses and feedback are welcome!

Source: “A nudge and a think: the architecture of choice and health,” PreventionCentre.org, 05/20/15
Source: “Nudge Database v1.2,” Stir.ac.uk, undated
Photo credit: Rusty Clark – 100K Photos on Visualhunt/CC BY

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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
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Presentations

Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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