Pennsylvania: Strategies aimed at reducing childhood obesity should acknowledge
individuals’ rational taste preferences and apply insights from
behavioral economics to design choice architecture that increases their
likelihood of success, say two physician-scientists.
Noting that “almost one-third of children in the United States are
overweight or obese, a level that has not improved over the past
decade,” the editorial authors outline three strategies for using
behavioral economics (which recognizes that individuals behave
irrationally when making decisions, but often in predictable manners)
and choice architecture (which applies insights from behavioral
economics to real-life scenarios) to change behaviors related to food
choice. The editorial, co-written by Mitesh S. Patel, MD, MBA, MS, assistant professor, and Kevin G. Volpp, MD, PhD,
professor, both of Medicine and Health Care Management at Penn,
accompanies an article on a study using a clinical trial to test
interventions to change students’ food choices at school.
“The results of this study highlight that the design of food choices
can significantly influence behavior,” said Patel. “Lessons from this
intervention in school cafeterias could be applied more broadly in
settings that impact both children and adults.”
First, school leaders and dieticians should recognize the fact that
children (and adults) are behaving rationally when they choose foods
that taste better. Accepting this reality, the authors point to efforts
to make school-based meals more palatable — but still healthy —
through collaborations with professional chefs, such as First Lady
Michelle Obama’s Chefs Move to Schools program. They note research
findings showing that chef involvement increases the consumption of
healthier foods by children.
Next, default (or “opt out”) options should be used to steer
children to healthier food choices and portion sizes. For example, in a
cafeteria self-service food line, placing fruit and vegetables at the
front of the line when plates are relatively empty was found to
increase consumption of these foods. (It is a marketing truism that
placing certain “guilty pleasure” items near the cashier increases
impulse buying, but this usually involves cases of immediate
gratification, such as candy, and less so foods that lead to
longer-term health benefits.)
Third, making food information more appealingly and health benefits
more understandable to children may lead to healthier food choices.
The authors suggest that “nutritional value might better be displayed
using a color-coded scheme that is easily relatable, such as that of a
traffic light,” to help children easily choose which foods to eat and
which to avoid. The authors also cite previous research indicating that
rewards of as little as 25 cents per day have led to a doubling in
consumption of fruits and vegetables, even after the intervention period
ended.
“Lessons from behavioral economics could be used to develop
interventions that help build better eating habits,” said Volpp.
“Default options, information framing and incentives are a few areas
that show promise and should continue to be evaluated in future
studies.”
The Penn-authored JAMA Pediatrics editorial is in
reference to “Effects of choice architecture and chef-enhanced meals
on the selection and consumption of healthier school foods: a
randomized clinical trial” by Cohen et al, also published in the current
issue of JAMA Pediatrics.