Nudging the obese


With obesity levels in the UK now the third highest in Western Europe, political leaders are struggling to find a solution to the nation’s expanding girth. Are nudge policies the way to go?

The latest findings on obesity published in the Lancet| should set off alarm bells worldwide. More than 2 billion people – nearly 30 per cent of the world’s population – are now considered overweight, according to the leading medical journal.

And despite governments scrambling to find ways to reverse the trend of epidemic proportions, experts say that not one country has achieved success in curbing this public health crisis.

A combination of rising wealth in low and middle-income families in the developed world, sedentary lifestyles, more reliance on transport and less on exercise, and aggressive marketing of take-away foods high in sugar and fat are largely to blame.

While the medical fraternity is calling for stricter regulations relating to food advertising and physical exercise in schools, there is a growing realisation that interventions of a more subtle sort are also needed.

Adam Oliver, a behavioural economist in LSE’s Department of Social Policy, says the UK is leading the western world in using ‘nudge policies’ to motivate weight loss.

Favoured by the Conservatives owing to its anti-regulatory nature, ‘nudging’ uses covert incentives to tackle obesity, without resorting to laws or dictating to people how they should live.

In a paper published this month in Health Economics, Policy and Law|, Dr Oliver and his US co-author Dr Peter Ubel from Duke University explain the theory behind nudge policies and why governments support them.

“Politicians looking for cheap, non-regulatory methods to change behaviour have been receptive to nudge policies because they don’t have large financial consequences. They are not like taxes, which are overt,” Dr Oliver says.

Where obesity is concerned, nudges focus on incentives which make healthier lifestyles more enjoyable.

One of the most successful examples of this is LazyTown|, an educational children’s television show from Iceland which promotes healthy lifestyles in a fun and active way.

When it was first aired in 1996, childhood obesity levels in Finland dropped but whether this has been sustained long term is debatable.

Dr Oliver says the initiative meets the ‘nudge’ criteria because it preserves liberty, is not expensive and does not force children to do anything. The aim is to engage children in a fun way with rewards and incentives.

With adults, policy makers take the lead from behavioural economists, who say people care more about what they gain or lose according to what they already have, rather than a projected goal.

“Just paying people to lose weight does not work in the long term,” Dr Oliver says. “It is potentially more effective to get people to pay a deposit before they enrol in a weight loss program, which is retrievable if they meet their target. They may be motivated more by what they will lose rather than gain.”

Visual prompts are also possibly more effective than verbal prompts – hence the age-old suggestion of sticking a ‘before’ photograph on a fridge as a constant reminder to lose weight.

The modern-day equivalent has moved to labelling food stickers as red, amber or green, according to whether they are a high-fat, high-sugar food or a healthy alternative.

And another initiative being considered is for yellow tape to be placed across a section of supermarket trolleys, designating that area for fruit and vegetables.

Dr Oliver says while many nudge policies may prove effective in the short term, it is not known if their effect will be sustained.

“Personally, I think these covert interventions are in some cases arguably manipulative and governments should instead focus more on behavioural economic- informed regulation, potentially bringing harsher penalties and laws into force for food manufacturers.

“It is one thing to use nudge policies with children because they lack agency, but where adults are concerned we need to be more up front.”

One of the stumbling blocks to curbing obesity has been the lack of political will to regulate the food industries, he suggests.

To date, powerful lobby groups have been able to dissuade governments from enforcing regulations which harm food manufacturers. However, the global obesity crisis and its consequences for human health may force their hand.

Additional information

Nudging the obese: a UK-US consideration| is published in the July 2014 issue of Health Economics, Policy and Law.

Dr Adam Oliver is a behavioural economist in the Department of Social Policy at LSE. He teaches a range of health policy and health economic-related topics. His principal research interests focus upon behavioural economics and its applications to public and private policy making.

Posted 7 July 2014