Gareth Leng, Roger A.H. Adan, Michele Belot, Jeffrey M. Brunstrom, Kees de Graaf, Suzanne L Dickson, Todd Hare, Silvia Maier, John Menzies, Hubert Preissl, Lucia A. Reisch, Peter J. Rogers, Paul A.M. Smeets,
Preprint: in press, Proceedings of the Nutrition Society, accepted 18th October 2016
Health nudge interventions to steer people into healthier lifestyles are increasingly applied by governments worldwide. ‘Nudges’ are approaches to law and policy that maintain freedom of choice, but which steer people in certain directions they consist of small yet relevant behavioral stimuli such as simplification of information and choices, framing and priming of messages, feedback to one’s behavior, defaults and reminders and similar behavioral cues. Much of the health burden is caused by modifiable behaviors such as smoking, unhealthy food consumption, and sedentary lifestyles, but neither decades of health information and education, nor attempts at hard regulation (such as fat taxes or sugar taxes), nor voluntary self-regulation of industry have markedly promoted healthier lifestyles or helped to stop the rise of non-communicable diseases. At the same time, there is increasing evidence that the purposeful design of the living and consumption environments – the “choice architecture” – is key to changing nutritional and activity patterns and to maintaining healthier lifestyles. There is mounting evidence for the usefulness of World Health Organization’s motto: “make the healthier choice the easy choice”, through easier access, availability, priming and framing. More than 150 governments now use behavioral science, with an emphasis on nudges. In these countries, “nudging for health” is regarded as an attractive option to make health policies more effective and efficient; a recent poll in six European countries found that health nudges are overwhelmingly “approved” by the people. This is the backcloth against which we set out to test nudging tools that might be useful add-ons to traditional health policies.
However, to produce policy recommendations that are likely to be effective, we need to be able to make valid, non-trivial predictions about the consequences of particular behaviors and interventions. For this, we need a better understanding of the determinants of food choice. These determinants include dietary components (e.g. highly palatable foods and alcohol), but also diverse cultural and social pressures, cognitive-affective factors (perceived stress, health attitude, anxiety and depression), and familial, genetic and epigenetic influences on personality characteristics. Our choices are influenced by how foods are marketed and labelled and by economic factors, and they reflect both habits and goals, moderated, albeit imperfectly, by an individual understanding of what constitutes ‘healthy eating’. In addition, our choices are influenced by physiological mechanisms, including signals to the brain from the gastrointestinal tract and adipose tissue which affect not only our hunger and satiety but also our motivation to eat particular nutrients, and the reward we experience from eating.
To develop the evidence base necessary for effective policies, we need to build bridges across different levels of knowledge and understanding. This requires experimental models that can fill in the gaps in our understanding that are needed to inform policy, translational models that connect mechanistic understanding from laboratory studies to the real life human condition, and formal models that encapsulate scientific knowledge from diverse disciplines, and which embed understanding in a way that enables policy-relevant predictions to be made.
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