It’s well understood that the country is facing an obesity epidemic. There are few topics in public health as well covered in recent years. The sugar tax is happening and much debate is underway about the role governments and responsible bodies should have in modifying our irrational and damaging behaviour.
I have a vested interest in the subject from several perspectives: As a concerned citizen, as an endurance runner, as a proud supporter of the UK’s biggest mass exercise movement in parkrun and as a behavioural psychologist working in persuasive consumer design.
My empirical background adds a healthy dose of cynicism when I read today that the Royal Society for Public Health (RSPH) suggest the use of exercise labels for food to replace or augment the nutrition labelling.
The reason this is being suggested is that nutrition labelling isn’t working. The arguments here concern the fact that the detail is too complex for the general public, that it causes an unhealthy focus on calorie content that there is considerable ambiguity on how this information should be used by the consumer and the presentation of portion sizes.
I contend that the solution proposed by RSPH is also doomed to failure because it doesn’t affect the decision at the point of sale and allows our inner defence lawyer to contend and justify the purchase because ‘i’ll deal with the consequences of this bad choice later with some exercise’. It’s the same reason that carbon offsetting is an acceptance that we make the wrong choice with travel. This is what behavioural economists call the default norm, we are not affecting the ingrained status quo of the bad choice. It’s better than nothing, perhaps, but it avoids dealing with the real problem – which is that we don’t promote real nutritious and healthy food anywhere near enough.
The evidence, interrogated
To explain why this was felt to be a worthwhile intervention, some well-meaning commentators and the RSPH have pointed to a study in Baltimore, widely reported in October 2014 [CNN, Washington Post], and published in the American Journal of Public Health. This study placed 20 cm x 28 cm signs in a point of sale (PoS) display in stores that drew attention to the amount of exercise required to ‘burn off’ the carbonated drinks in the adjacent cabinet. It worked, and less drink was sold. However, there are a handful of reasons we cannot extrapolate the findings from this to the RSPH proposition.
- The Baltimore study was a confrontational intervention, it arrested the purchase process with a highly visible sign. Nudges here are just enough to bump people away from their behaviour.
- It isn’t sustainable, even if we accept the execution worked this time, like the note on the fridge to not forget your lunch, you’d ignore it very quickly on repeated presentations.
- This is before the purchase, packaging labels are not universally observed until post-purchase.
- The demographic tested was limited (urban, black, adolescents) and the cultural effects of their consumption and susceptibility for intervention have not been accounted for.
The people that read labels and packaging tend toward higher levels of education and are already motivated by a health goal: fat loss, protein intake etc. so the people making use of labels to change behaviour are already past the trigger point. RSPH cite Dr. Hamlin’s paper about the attention given to front of pack (FOP) labelling but even this paper acknowledges the profound limitations of FOP in the context of the myriad of marketing pressure applied to the persuasion for sale. They also acknowledge [Cowburn, G., Stockley, L., 2005] that the interpretation of labelling is going to be challenged by levels of education and nutritional sophistication. Finally, although the RSPH present research that indicates people would be ‘three times more likely to indicate they would undertake physical activity’, there is no evidence this intent is or would be followed-through.
Distracting us from the task at hand
Solutions may be found by modifying packaging and one could argue that it’s just part of a broad approach to changing perception and behaviour but I contend that it’s actually damaging to press ahead with it. To spend time considering and executing this is to distract from the real solution which is to make healthy food choices the norm. Considerable time and effort must be expended in the persuasive design industry to work with our natural biases and present good food as the obvious, natural and common choice. To dilute the salience of bad food in preference for clean, natural unprocessed alternatives.
I look forward to Public Health sector that recognises that until we confront the universally damaging food we sell in the same way we’ve confronted tobacco (i.e. through demonisation), we’re not going to be able to educate people away from their irrational desire to pursue the forbidden fruit. We cannot go around treating exercise, worthy and valuable as it is, as the cure for a problem we’ve not had the guts to deal with at source. You wouldn’t promote chemotherapy on cigarette packets … would you?
The RSPH paper itself acknowledges that the solution needs to tackle both sides of the obesity equation (ie. “When calories in … exceeds calories out” and “modifying both energy intake and energy expenditure”) but their solution will not change ‘calories in’ and does not have realistic prospect of effecting ‘calories out’.
EDIT: On the 9th May 2016 a piece by Nick Triggle was posted on BBC News which highlights the disparity alluded-to in the final section of this blog: “Some 58% of advertising spend is on confectionery and convenience food, compared to only 3% on fruit, vegetables and pasta” What Yoghurt Tells Us About The Obesity Fight retrieved 09/05/2016.