Tweaking our environment to tackle obesity

Obesity is a very big problem in the UK – a 2020 survey in England found that almost 1 in 3 adults are obese, with around 2 thirds overweight. And according to the latest NHS statistics, there were over 1 million hospital admissions where obesity was a key factor in just one year of recording. But how do we go about tackling this? Taxing unhealthy foods and beverages is being tried and banning certain items altogether is also being talked about, but in a free society these sorts of restrictions are not, shall we say, very palatable. What about, though, if we could address the problem without most of us even realising? What, Cameron Voisey is wondering, if it’s our environment that’s at fault, rather than us?

Cameron - Picture this: you’re tired, hungry and want some quick food. What do you go for? Some fruit perhaps or maybe a chocolate bar instead? Faced with these choices, opting for the healthier one can be hard. But what if our environment was changed, just a little bit, to make healthier choices easier? Could this make a difference?

James - One of the main factors that’s causing this sudden rise in obesity and overweight rates are the unhealthy food environments that surround us

Cameron - That’s James Reynolds from Aston University, whose new research studied minor modifications to 19 workplace canteens. They found that swapping out a few high calorie options with lower calorie alternatives - say a beef burger with a chicken burger - and slightly reducing the portion sizes of the more calorific products, resulted in a 12% decrease in the workers’ calorie intake while at work. Importantly, these weren’t sweeping changes across the whole canteen - only some of the items were altered - but combining small changes can make a big difference

James - This project evaluated two different interventions and we found evidence that adding one to another was much more effective than an intervention in isolation. And there’s every reason to believe that this would continue to be the case with other interventions that are combined to it

Cameron - Similar changes, or ‘nudges’, have also been looked at in supermarkets. Research from the University of Southampton and Deakin University found that a set of simple modifications - like placing fresh fruit and veg by store entrances and removing confectionery from near checkouts - could have a big impact, resulting in around 10,000 extra portions of fruit and veg and 1,500 fewer portions of confectionery being sold per week per store. The same products were there, just in different places. Helen Brown from the Behavioural Insights Team, who was not involved in the study, explained why these findings are so important

Helen - First, it shows the incredible potential of supermarkets to support consumers and make healthy choices really easy, at almost no cost to their bottom line, which is obviously critical for retailers and manufacturers. I think what’s most exciting though is that these interventions were trialled in discount supermarkets, located in economically deprived neighbourhoods. Now, this is really important as we know that obesity and poor diet is socio-economically patterned, and so research in areas of lower income is much, much needed. And I think that’s really what is very exciting about this work

Cameron - But from a behavioural point of view, where does all this come from? Are we really just victims of our environments? James again

James - There is an old view in Psychology that a lot of human behaviour is entirely intention-based, that people do exactly what they intend to do all the time and that merely by changing people’s intentions to, say, eat fewer calories, that might be sufficient to help people lose weight or intend to do whatever else their goals are

Cameron - But, as James told me, these ideas are quickly becoming outdated, as a growing body of evidence suggests that there are so many more factors that play a role in our decision-making – our environment being a prime example, as Helen explained

Helen - So according to dual-process models in behavioural sciences, there are two systems which drive human behaviour. The first is the reflective system, and this system is all about our rational and analytical processes. So for example, if we take lunch time – if we were using our reflective system, we would stop and think carefully about the pros and cons of all the different food options available to us. Now, obviously, using this reflective system is effortful and requires lots of cognitive resources, and so in reality, much of our behaviours are driven by the other system: our automatic system. And our automatic reactions to external cues from the physical and social environments in which we live, work and play therefore become really critical and sometimes lead us to make unhealthy choices. Now what’s really tricky is that our reliance on this automatic system is heightened when we are tired, busy, hungry, distracted, and that’s why it’s so critical that our environment makes it incredibly easy, if not the default, to make the healthy choice

Cameron - But there is hope for the future

Helen - There is a whole suite of interventions we can use to really shape the environment in which we are shopping, both online and in store, to ensure that the healthy option is absolutely the easiest, the quickest and really supports us in making good choices

Well the easy option sounds pretty good to me. That was Cameron Voisey. He was speaking to James Reynolds and also Helen Brown, and both of the papers that they were talking about have just been published in the journal PLOS Medicine.