Trenton G. Smith

Smart food policies for obesity prevention

Prevention of obesity requires policies that work. In this Series paper, we propose a new way to understand how food policies could be made to work more effectively for obesity prevention. Our approach draws on evidence from a range of disciplines (psychology, economics, and public health nutrition) to develop a theory of change to understand how food policies work. We focus on one of the key determinants of obesity: diet. The evidence we review suggests that the interaction between human food preferences and the environment in which those preferences are learned, expressed, and reassessed has a central role. We identify four mechanisms through which food policies can affect diet: providing an enabling environment for learning of healthy preferences, overcoming barriers to the expression of healthy preferences, encouraging people to reassess existing unhealthy preferences at the point-of-purchase, and stimulating a food-systems response. We explore how actions in three specific policy areas (school settings, economic instruments, and nutrition labelling) work through these mechanisms, and draw implications for more effective policy design. We find that effective food-policy actions are those that lead to positive changes to food, social, and information environments and the systems that underpin them. Effective food-policy actions are tailored to the preference, behavioural, socioeconomic, and demographic characteristics of the people they seek to support, are designed to work through the mechanisms through which they have greatest effect, and are implemented as part of a combination of mutually reinforcing actions. Moving forward, priorities should include comprehensive policy actions that create an enabling environment for infants and children to learn healthy food preferences and targeted actions that enable disadvantaged populations to overcome barriers to meeting healthy preferences. Policy assessments should be carefully designed on the basis of a theory of change, using indicators of progress along the various pathways towards the long-term goal of reducing obesity rates.

Why the Poor Get Fat: Weight Gain and Economic Insecurity

Something about being poor makes people fat. Though there are many possible explanations for the income-body weight gradient, we investigate a promising but little-studied hypothesis: that changes in body weight canat least in partbe explained as an optimal response to economic insecurity. We use data on working-age men from the 1979 National Longitudinal Survey of Youth (NLSY79) to identify the effects of various measures of economic insecurity on weight gain. We find in particular that over the 12-year period between 1988 and 2000, the average man gained about 21 pounds. A one percentage point (0.01) increase in the probability of becoming unemployed causes weight gain over this period to increase by about 0.6 pounds, and each realized 50% drop in annual income results in an increase of about 5 pounds. The mechanism also appears to work in reverse, with health insurance and intrafamily transfers protecting against weight gain.

The McDonald's Equilibrium: Advertising, Empty Calories, and the Endogenous Determination of Dietary Preferences

Abstract.A comparison of accepted nutritional advice with actual American dietary practice suggests that many people fail to eat well in spite of well-documented health consequences. Popular culture often labels the worst offenders as lacking in “self-control,” and many blame the aggressive advertising campaigns of the fast-food and snack-food industries for manipulating consumers into poor diets, but these conclusions are not easily reconciled with a neoclassical approach to economic decision theory. This essay considers the consumer’s “diet problem” in light of emerging evidence from the medical and behavioral sciences. In particular, it is argued that human evolution in the distant past resulted in an elegant solution to this problem (of search for a suitable diet in an uncertain environment), which any neoclassical economist would recognize. In modern environments, however, the signals that formerly provided information in the consumer’s search problem are subject to manipulation by food-producing firms. Confirmation by molecular biologists that many human responses to these signals are firmly encoded in our genes suggests a need to re-evaluate the welfare economics of the food industry.

Reconciling psychology with economics: Obesity, behavioral biology, and rational overeating

The modern phenomenon of obesity is an archetypal example of a behavior whose explanation simultaneously falls within the purview of psychology, economics, and the biological sciences. While psychologists and advocates of public health have long viewed overeating as a weakness or disease in need of treatment, economists have pointed out that—like any other consumer behavior—choices about diet and exercise can be viewed from the perspective of rational decision theory, subject to the influence of variation in prices and income but not necessarily as a problem in need of a solution. Recent advances in our understanding of the physiological mechanisms by which genes influence behavior in modern socioeconomic environments have begun to point the way to a resolution to this debate. Drawing inspiration from the scientific literature on the neuroendocrinology of energy homeostasis, this paper reviews the empirical determinants of obesity in light of the biologist’s notion that humans and other animals evolved the ability to store body fat as an optimal response to the presence of starvation risk. This approach yields a powerful theoretical foundation, capturing such features of obesity as dynamic inconsistency, genetic variation, susceptibility to pharmaceutical intervention, and variation by season, socioeconomic status, and degree of financial security. It also provides a framework for reconciling the conflict between behavioral and neoclassical economics.

Effects of household composition and income security on body weight in working-age men

Many recent studies have provided evidence suggesting that increases in body weight may spread via social networks. The mechanism(s) by which this might occur have become the subject of much speculation, but to date little direct evidence has been available. Building on evidence from economics, anthropology, and behavioral biology, within‐household peers might influence body weight via implicit provision of income security was hypothesized.

The Economics of Information, Deep Capture, and the Obesity Debate

The economic theory of regulatory capture predicts that industry groups will attempt to influence their regulators (for example, by lobbying for rules that exclude competition). It has been suggested that the same logic applies to any powerful institution with the ability to affect industry profits. When the aim of industry is to alter the publics perception of its product (for example, by disseminating favorable messages to the news media or via an advertising campaign, or by funding industry-friendly scientific research), the end result has been dubbed deep capture. We develop a formal model of deep capture, in which consumers have imperfect information about product quality, and a dominant producer is able to increase his profits by altering the parameters of the consumers search problem. We demonstrate the empirical relevance of the phenomenon with a discussion of the food industry response to the obesity epidemic.

Why (and When) are Preferences Convex? Threshold Effects and Uncertain Quality

It is often assumed (for analytical convenience, but also in accordance with common intuition) that consumer preferences are convex. In this paper, we consider circumstances under which such preferences are (or are not) optimal. In particular, we investigate a setting in which goods possess some hidden quality with known distribution, and the consumer chooses a bundle of goods that maximizes the probability that he receives some threshold level of this quality. We show that if the threshold is small relative to consumption levels, preferences will tend to be convex; whereas the opposite holds if the threshold is large. Our theory helps explain a broad spectrum of economic behavior (including, in particular, certain common commercial advertising strategies), suggesting that sensitivity to information about thresholds is deeply rooted in human psychology.

Quality Uncertainty as Resolution of the Bertrand Paradox

We show that in a homogeneous-good duopoly market with quality uncertainty and constant unit costs, the Bertrand paradox (i.e., marginal cost pricing) can be avoided.

Economic Insecurity and the Spread of Obesity in Social Networks

A number of recent studies have provided evidence suggesting that increases in body weight may spread via social networks. The mechanism(s) by which this might occur have become the subject of much speculation, but to date little direct evidence has been available. We provide evidence for one such mechanism: economic insecurity. Using a sample of working-age men from the National Longitudinal Survey of Youth, we show that cohabitation with working (but not non-working) adults appears to be protective against weight gain. We address the potential endogeneity of the independent variable by employing instrumental variables in our regression analysis.

Is behavioural economics ready to save the world

www.thelancet.com/diabetes-endocrinology Published online May 4, 2016 http://dx.doi.org/10.1016/S2213-8587(16)30060-2 1 Modern medicine has long doled out helpful advice to ailing patients about not only drug treatments, but also diet, exercise, alcohol abuse, and many other lifestyle decisions. And for just as long, patients have been failing to follow doctors’ orders. Many of today’s most pressing public health problems would disappear if people would just make better choices. Enter behavioural economics. A fairly recent off shoot of the dismal science, behavioural economics aims to take the coldly rational decision makers who normally populate economic theories, and instil in them a host of human foibles. Neoclassical (ie, conventional) economics, after all is the study of optimising behaviour in the presence of material constraints—why not add constraints on cognitive capacity, or self-control, or susceptibility to the formation of bad habits? The hope is that by incorporating insights from other behavioural sciences (most notably cognitive psychology and neuroscience) while retaining the methodological rigour of neoclassical economics, behavioural economics will yield a more richly descriptive theory of human behaviour, and generate new and important insights to better inform public policy. Policy makers have taken notice. In an era in which free-market rhetoric dominates the political landscape, the idea that small changes to public health policies might serve to nudge consumers towards healthier behaviours holds great appeal. Even though some (irrational) consumers might be better off , the argument goes, if certain unhealthy food products were banned (or worse, taxed), this approach would infringe on the rights of the many consumers who want to indulge occasionally, and fully understand the consequences. If governments could instead use evidence from consumer science to make food labels more eff ective, or to improve the way that healthy foods are presented in school cafeterias, more politically unpalatable interventions in the marketplace might not be needed. This idea, dubbed “libertarian paternalism” by Richard Thaler and Cass Sunstein, has been pursued with gusto in both the UK (David Cameron’s Government formed the Behavioural Insights Team—unoffi cially described as the Nudge Unit) and the USA (where Sunstein spent time in the Obama administration’s Offi ce of Information and Regulatory Aff airs). Whatever public health practitioners might think about these developments—or indeed, of economics as a discipline—this turn of events has rather suddenly given scholars at the cutting edge of consumer science an infl uential voice in the regulatory process, and some of the best and brightest have stepped up to contribute. Behavioral Economics & Public Health (edited by Christina Roberto and Ichiro Kawachi) is the product of a 2014 Harvard University exploratory workshop on applying social science insights to public health. As might be expected in a volume that aims to bring together two such inherently multidisciplinary fi elds, the book’s 11 chapters off er an eclectic mix of perspectives. The editors begin with an excellent overview of the fi eld of behavioural economics and its applications to public health, and an economic perspective can also be found in four of the other chapters: Justin White and William Dow write about intertemporal choice, Kristina Lewis and Jason Block review the use of incentives to promote health, Michael Sanders and Michael Hallsworth describe their experience working within the UK’s Behavioural Insights Team, and Frederick Zimmerman concludes with a thoughtful critique of the fi eld of behavioural economics. The other contributions are largely from the perspectives of psychology and marketing: Dennis Runger and Wendy Wood discuss habit formation, Rebecca Ferrer and colleagues emphasise the importance of emotion in decision making, Brent McFerran discusses social norms in the context of obesity, Jason Riis and Rebecca Ratner explain why some public health communication strategies are more eff ective than others, and Zoe Chance and colleagues and Brian Wansink off er frameworks for designing environments (eg, in schools and workplaces) that are conducive to healthy choices. This collection of essays holds many hidden gems, but the one that surprised me the most was the attention given (by Runger and Wood briefl y, and Zimmerman extensively) to a dirty little secret that behavioural economists rarely mention: once it is acknowledged that sometimes-irrational consumers can be manipulated into making healthy choices, it does not require much of a leap to conclude that business interests can—and do—use the same methods to push back in the other direction. This conclusion leads Zimmerman to a discussion of power in the marketplace and in our collective political economy, and to a call to action on these larger structural issues in society that neoclassical theory has long neglected. Behavioral Economics & Public Health off ers a view into a chaotic fi eld that is rapidly generating new insights into human behaviour while actively contributing to populationlevel public health interventions. It is essential reading for practitioners engaged in designing public health policies or programmes, and would be an excellent resource for all students of behavioural economics, public health, or public policy.