April 2, 2015

The Easier Way to Attack Obesity

I frequently give speeches to audiences in which I talk about using Dossia to improve the health of the populations we serve.  Inevitably, I get a question about the challenge of addressing the obesity crisis, since more Americans are overweight than ever.  The questioner usually refers to a weight reduction initiative that has completely failed to make a dent in this problem.

Fortunately, there are scientifically proven ways to get a population to eat and drink less, and to do so quite painlessly.  Scientific studies have found that Americans have much of their food and beverage consumption that depends on convenience, price, or just plain habit.   We are not irreversibly addicted to overeating, and we would eat less, if we were in a supportive environment.

Why is this so important?

Altering American eating habits is far easier than might first appear.  People get overweight by consistently ingesting marginally more calories than they burn off through physical activity.  The battle against obesity can be won with  adjustments of a few hundred calories a day and a few hundred calories a day more of physical activity.   That has guided me when I have successfully controlled my weight.

Why does this work?  Brian Wansink of Cornell University, one of the most strategic thinkers in nutrition management concluded in his most recent book Slim by Design:  It is far easier to change the environment in which most Americans make decisions relative to food and beverages than to change their deeply imbedded habits. Changing the environment can be extremely effective and it will change habits without the population being all that aware of what is happening.

What are the key “silent” levers of environmental change?

Reduce portion sizes gradually

We are relatively insensitive to small differences in weight and mass, especially if portion sizes are reduced a little at a time.  In fact, I recall the Chicago Consumer Affairs Commissioner Jane Byrne attacking a pizza restaurant because it had 15-ounce, instead of 16-ounce pizzas.  But for the sophisticated weighing equipment the City employed, no one would have noticed, even though the number of calories consumed was 6.3% lower.  I also do not believe that a steakhouse that offered an 8-ounce, instead of a 10-ounce, filet would lose business.

How many of us know the size of a dessert before we order it, or, for that matter, the size of a roll, doughnut, bagel or pastry?  Almost no one notices small size differences.

Reduce the caloric ingredient volumes

My first job was in a bakery between my junior and senior years of high school.  The owner of this family-owned business used to tell one of my co-workers not to put too much lemon filling in eclairs.  He was right!  No one cared how completely the eclairs were filled.

When we get Ceasar salads, we do not count the volume of croutons, salad dressing, or Parmesan cheese, the ingredients that add calories.  When I went to a steakhouse in New York City, I was shocked to see that, because of the calories in croutons, salad dressing, and Parmesan cheese, the Ceasar salad had twice as many calories as a 10-ounce filet mignon.

In cafeterias, make the unhealthy foods a little more difficult to access and the healthy foods easier to access.

Every grocery retailer receives “slotting fees.”  Packaged goods vendors pay them to the retailers to get their products on the shelves and aisles that have the greatest revenue potential.

The best shelves are between waist and eye level for an average-sizes adult shopper. The best aisles are the most heavily trafficked, and/or where the shopper is most likely to make an impulse purchase. Getting a product in checkout lane shelves is particularly attractive because shoppers spend more time there.

Applying these theories to cafeterias, we put the healthiest foods and beverages on the most attractive shelves and aisles, and it worked.  We did not eliminate unhealthy foods completely, because no one likes to have someone else take away their freedom of choice.

Change the pricing to provide incentives for healthier foods

Employers reward many food service providers for keeping their food and beverage subsidy costs down.  They achieve this result by providing more inexpensive foods with more calories per dollar or ounce. They should be altering pricing to make eating better more affordable.  Water should cost far less than soda.

Do not market “healthy foods and beverages” as being better for health.  Make them attractive and tasty.

This is counterintuitive.  Because “healthy” foods used to be more bland, labeling a food as “healthy” carries a stigma  that survives today.

Therefore, marketers need to find another reason to get people to consume healthy foods by presenting them more attractively and enhancing the smell and taste through more intelligent use of ingredients or toppings.  How something looks and smells is extremely important.

Get people to stand up and walk more.

The one thing I did not do well enough at Pitney Bowes was to reduce the frequency and duration of big meetings and to get people who were in jobs in which they sat for long periods of time to get up and walk around more.  If I knew then what I know now, no meeting would last more than an hour, and fewer people would attend the meetings.

I am always amazed by conferences on “prevention and wellness” in which the conference organizers schedule presentations that cause people to sit for 2-3 hours, and provide unhealthy food during the breaks and at breakfast and lunch.  No pun is intended, but advocates for health and wellness need to “walk the talk.”

What I have presented is a significant improvement over how organizations function today, and would relatively painlessly improve health!  The harder-to-accomplish programs like those used by health and wellness coaches are desirable, but they are much harder to implement.

Let’s focus on making doing the healthy thing as easy as possible!