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The nudge challenge tackling obesity


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The Nudge Challenge: Tackling Obesity
Behavioural Economics

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The nudge challenge tackling obesity

  2. 2. TOPIC 1: TACKLING THE OBESITY CHALLENGE A recent report released on Tuesday by the Trust for America's Health and the Robert Wood Johnson Foundation used population trends and other data to predict that half of U.S. adults will be obese by 2030 unless Americans change their ways. It is estimated that 35.7% of adults and 16.9% of children aged 2 to 19 are obese, as the Centers for Disease Control and Prevention (CDC) reported earlier this year. The CDC predicts that these numbers are going to increase and exceed 60 percent in the next few years. Obesity raises the risk of numerous diseases, from type-2 diabetes to endometrial cancer. This will impose a greater burden on healthcare systems and associated costs. These projections supports a study published earlier this year in the American Journal of Preventive Medicine that found that by 2030, 42% of U.S. adults could be obese, adding $550 billion to healthcare costs over that period. Trust for America's Health sees an opportunity to change the growth in obese population with the right interventions. "We have learned that with a concerted effort you can change the culture of a community, including its level of physical activity, eating habits, what foods are offered in schools, and whether families eat together," said Geoffrey Levi of George Washington University. In New York City, for instance, obesity for elementary and middle-school students dropped 5.5 percent from the 2006-07 school year to 2010-11, thanks mostly to healthier school lunches, public health experts said. Source: Begley, S. (2012, Sep 18). Fat and getting fatter: U.S. obesity rates to soar by 2030. Reuters. Retrieved from Your task: Suppose you are appointed as a consultant to develop proposals for encouraging individuals or groups to make healthier choices. Propose a specific intervention to encourage healthy behaviours which may lower the increasing obesity rate. You could choose to focus on the U.S., or even suggest a nudge in your home country. Please specify the target group and the behaviour you want to change. For example, you can focus on reducing obesity among adolescent boys or old women. Likewise, you may reduce the obesity by increasing the level of physical activity or by consuming more vegetables and less saturated fat. Think about the decision process relevant to the target behaviour and the factors might cause the problem and promote the desired behavioural change. Describe what behavioural principle you are using and how your solution intervenes the decision making process in a way to induce the desired behaviour. Next, please design and describe an experiment which will be helpful in testing the effectiveness of your intervention.
  3. 3. 1.- Background and objectives: A large number of people do not pay enough attention to their physical condition. Sedentary lifestyle, stress and fast food among other aspects promote non-healthy habits that affect, at least, in the first place our quality of life. Our physical state is eroded day in day out in a slightly perceptible manner, only dramatically noticeable after months and years. As a result a large sector of the society is prone to become obese, what will increase the number of people that actually at present are obese. Obese people are obese by many reasons. Always the easy answer is because they do not take care of themselves, because they eat in excess or simply because they have seen it at home. But, it is not true at all. Obese also suffer their overweight: they are their own victim and their kryptonite at the same time. In other cases, people are obese due to medical causes such as: hypothyroidism, Cushing Disease (in rare occasions), even brain processes that affect directly the centre of satiation. Experience show that people with relatives and friends obese are more aware of their situation and as a result reject obesity by means of adopting healthier habits of food consumption. But there are many others: - too many refined (processed) carbohydrates resistance (many people are insulin resistant without being aware of it) lack of exercise or insufficient exercise coupled with poor diet genetic disposition poor diet and lifestyle choices too much alcohol So, in this nudge project, we will focus on: Target group: Males from 20-40 years old. Behaviour to change: Lack of exercise or insufficient exercise coupled with poor diet 2.-Bias concerning obesity. “If I’m thin then I’m healthy”, right? Wrong. This is only one of the several misconceptions people have about weight, losing it and what’s healthy. But there are still more myths we’re better off busting. So, obese people do not even try to solve their obesity, because they simply think they are slaves of their condition, that they do not deserve the change, or because they have left their self-esteem and as a result “being fat is horrible, I’m not happy and I’ll never be any more”. One of the levers to activate will be: improve self-esteem. Kids have to lose weight to shed obesity: As children grow, they put on weight, but how much is normal, and how much is excessive and potentially a hazard to their health? In the latest study, published in the journal Lancet, researchers from the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health developed a mathematical model to differentiate between healthy weight gain and the extra pounds that contribute to obesity. The model takes advantage of more accurate assessments of how many calories heavier children take in, as well as how quickly and efficiently they burn off those calories, and the ratio of fat to muscle in their bodies. The resulting model shows some kids can outgrow their obesity around puberty even if they don’t lose weight. That’s because obesity is a measure of not just weight but the ratio of height to weight known as the body mass index (BMI), and as children grow, they transform fat into muscle, which can weigh as much, if not more than fat tissue. So kids with a high BMI that might suggest obesity may not actually be overweight.
  4. 4. Still, the researchers say that teaching children about portion control and balancing what they eat with physical activity to burn off excess calories are important lessons to learn early. You can eat what you want and just exercise to lose weight: Cutting calories by adjusting what you eat is actually the most effective way to lose weight. Ideally, consuming fewer calories and exercising is a more efficient way of dropping pounds, but for most people, passing up the chips is easier than sweating it out on a treadmill for an hour. Downing 140 calories from a can of soda, for example, takes only a few minutes, but would take half an hour of moderately intense walking to burn off. “You can greatly undermine weight loss efforts and general health by not considering the quality of the foods you eat. It is important to consider calorie density and nutrient density of foods to maximize exercise performance and improve health status,” says Gayl Canfield, the director of nutrition at Pritikin Longevity Center. Eating protein is the best way to feel full and keep calories in check: Lean protein is indeed a good way to get filled up, but fiber is even better, because it comes with fewer calories. To make sure you’re not feeling hungry but still getting all your nutrients, load your plate with fruit, vegetables beans and grains. Five Things You’re Getting Wrong About Weight and Weight Loss | 3.- Relevant aspects for the nudge. Here we have some aspects that will help us to design the nudge: a. Plan Ahead Plan dinners that you'll look forward to eating. In fact, having a plan forces you to keep healthier foods on hand. Planning ahead also helps you keep your eating on schedule. Write what you bite. Studies show writing down everything you eat helps you lose weight. Buy a journal or track it online. The more detailed your notes, the more they'll help: to start, try writing down what you ate, how much, and the calories it contained. You might also note where you ate or how you felt. b. Avoid "Portion Distortion" Size up portions. 1. Compare things: 3 ounces of meat or protein is about the size of a deck of cards, a medium potato is the size of a computer mouse and a 1/4 cup is the size of a golf ball. 2. Use your hand: for small-framed women, 1 teaspoon is about the size of the tip of your thumb, 1 tablespoon is the size of your thumb and 1 cup is the size of your fist. 3. Measure once: when you're at home, you're using the same bowls and utensils over and over again. Find out how much they hold. Measure out the amount of soup that your ladle holds. If it's 3⁄4 cup you'll know forever that two scoops equal a satisfying 11⁄2-cup serving. On the flip-side, you can measure out a given portion of a particular favorite food and serve it in the dish you'll almost always use when you eat that food. Once you know that one serving of cereal reaches only halfway up your bowl, you'll know to stop there. Cooking individual-size portions like Broccoli & Goat Cheese Souffle, which is made in a 10-ounce ramekin, will help you control calories without even thinking about it. c. Enjoy a Balanced Diet Of course, there's more to good nutrition than counting calories. When you're cutting down portions, you're reducing your intake of helpful nutrients, too, so it's even more important to make healthful choices. (In fact, it's probably a good idea to take a multivitamin that provides 100 percent of the Daily Values, just to cover your bases.)
  5. 5. Here are the 5 foods you should be eating as part of a balanced diet every day: Whole Grains: Whole grains provide fiber, trace minerals and antioxidants and slow-release carbohydrates that keep your body and brain fueled. Aim for 4 to 9 ounce-equivalents per day.* Get more with these delicious whole-grain recipes. Fruits & Vegetables: Fruits and vegetables are low in calories, but high in vitamins, minerals and other phytochemicals—compounds that fight disease-causing free radicals and amp up enzymes that clear toxins. Choose a rainbow of colors to get the widest variety of nutrients. Aim for 1 to 2 cups of fruits and 1½ to 3½ cups of vegetables per day.* Get more with our 15-minute fruit desserts and healthy recipes for fruits and vegetables. Lean Proteins: Some studies show that, gram for gram, protein may keep you feeling fuller than carbohydrates or fats do. For overall health, choose sources that are low in saturated fat: seafood, poultry, lean meat and tofu. Eat 3 to 6½ ounce-equivalents per day.* Try our delicious: chicken recipes, beef recipes, fish recipes and tofu recipes. Low-Fat Dairy: Nonfat (or low-fat) milk and yogurt provide a satisfying combination of carbohydrate and protein. They're also good sources of calcium, which dieters often fall short on. Cheeses contain calcium, too, but pack in calories. Choose cheese with bold tastes so you don't need a lot to get great flavor. Eat 2 to 3 cups of dairy daily.* Enjoy more low-fat dairy with these yummy yogurt recipes, recipes with cheese and recipes with milk. Healthy Fats: Heart-healthy monounsaturated fats (in nuts, avocados and olive oil) and polyunsaturated fats (in canola oil, plant oils and fish) infuse food with flavor. Eat 4 to 8 teaspoons per day. Enjoy them in these delicious nut recipes and fish recipes. *Daily intake guides are those recommended by the USDA's for a calorie level of 1,2002,600 calories. d. Share Delicious Meals Studies show that people lose more weight when they do it together, so boost your chances for success: enjoy real meals with your friends and family. Crab cakes, steak, dessert—they're all possibilities on a diet. Tempt your family and friends to join you on your quest for better health with our recipes for delicious lower-calorie versions of your favorite foods. After they see how great your diet is, maybe they'll pick up your healthier lifestyle changes, too, and suddenly you'll have a whole slew of friends to join you in your weight-loss efforts. e. Move On From Slip-Ups You planned out your meal, snacks and treats too. So you “shouldn't” have felt deprived and you “shouldn't” have binged on that pizza, but—guess what—you did. It happens. Making a plan helps, but it doesn't ensure total success. What you really shouldn't do is throw in the towel and go on an eating free-for-all. The key to overcoming slip-ups is to forgive, forget it and get right back on track. Guilt begets more bingeing; don't give in to that. Don't fall into the splurge-and-then-skip diet—it's not healthy or enjoyable and you end up hungry and guilty. Besides, punishing yourself with tiny meals doesn't inspire healthy habits you can keep and enjoy throughout your life. Plan a week's worth of delicious calorie-controlled dinners so you can stay satisfied and happy. f. Treat Yourself Recognizing realistic expectations is the key to slimming down. Aiming to be "too good" sets you up to fail. Don't deprive yourself of everything you love, just keep your little splurges in moderation and calculate them into your plan for the day. Dieting isn't about perfection; it's about balance. So if you love chocolate, eat a little, or if you love wine, drink a little. Just make room for the calories by passing on something else— perhaps bread. In other words, prioritize.
  6. 6. 4.- Nudge Development Process. Map the context Understanding the decision making process Determine the main heuristics and influences Select the Nudge Identify suitable nudges Identify the levers for Nudging Possible constraints and areas where nudges can be implemented I have to understand why I need to lose weight. This is the BEST for me. I know I CAN. I need to read every day that I’m doing the BEST. (Availability Bias) Use the applet i-Nudge at (social proof) Reduce the loss aversion Use debias when buying fruit and vegetables (green basket) Modify my consumption habits Tempt friends and family Forgive, forget and get right back on track Lack of self-esteem Lack of willpower 1st: Modify consumption habits. Write them and pin them up in the fridge frozen. 2nd: Reduce loss aversion: we must fight the idea of “I am not able to lose weight, so I prefer what I have than feeling better”. Break the assumption and help the person desire the change by means of reinforcing his/her self-esteem. Experiment Prioritize nudges and test for effectiveness 3rd: Use the Green Basket: a little basket that we add to the shopping cart. It has different nets, one for vegetables, one for fruit, one for fiber. Each time I take a sausage, I must place 1 vegetable, 1 fruit, 1 good rich in fiber. Each Ok good equals to 1 point. At the end of the week, a rappel of points will generate a gift. 4th: Forvige, forget and get right back on the track: if today I fail, no problem. F.F. and G.R.B. on the T. Don’t bomb your self-esteem. You are better than that. 5th: Tempt family and friends to join you in the experience. Iterate Iterate and improve the nudge Then, I WANT to do it. (I am part of the solution) I am socially engaged in achieving my goal, with my relatives and friends. Gift the good behaviour Gift the good behaviour
  7. 7. MINDFUL EXTERNALLYIMPOSED EXTERNALLYIMPOSED DISCOURAGE ENCOURAGE DISCOURAGE Write down my food, modify consumption habits, green basket This should be the next step, as the person WANTS to lose weight and enjoys result. SELF-IMPOSED BOOSTING SELF-CONTROL ACTIVATING DESIRE BEHAVIOUR ENCOURAGE MINDLESS This should be the third and final step. I WANT to be like this and KEEP it. 5.- Experimentation. It should be a field study, because motivations are stronger when it is taken for real. Most of the people want to change but due to the hyperbolic discounting they do not feel the necessity of changing today rather than the day I get into troubles. We will take two groups or experimental units and will be split each one in two, A and B, as follows: E.U.1-A: Obese people that have tried at least 1 diet before the nudge and will be asked to join the nudge. E.U.1-B: Obese people that have tried at least 1 diet before the nudge and are directly introduced in the nudge and later interviewed about the result. E.U.2-A: Obese people that have never taken a diet and will be asked to join the nudge. E.U.2-B: Obese people that have never taken a diet and are directly introduced in the nudge and later interviewed about the result. a. factors and their levels you want to test in the experiment: Factor 1: Taking the nudge or not taking it. Factor 2: Depending on previous experiences with diets, some obese can choose to join the nudge, some others won’t. If they do it obliged, evaluate the degree of achievement compared to those that accept willingly the challenge. (That will serve to improve the nudge) Level 1: Taking the nudge and abandoning it. Level 2: Taking and accomplishing the nudge. b. procedure of the experiment and manipulation methods for creating each experimental condition Post an announcement in a local newspaper and invite obese people to join a nudge for Tackling Obesity. Divide people in 4 different groups. Do not give more information so far. Proceed as discussed previously. Operate the four teams as indicated.
  8. 8. Start the nudge with those whether accept willingly or were forced to join it. The nudge will long at least 8-12 weeks. Check every week the results obtained, the effort, points obtained using the green basket, give gifts publicly with all the participants gathered, check what friends and relatives explain about the efforts made by the candidate and later, explain the candidate how much all his friends and relatives appreciate his great and sincere effort done so far. Motivate the others to keep on doing the nudge. Interview all of them at the end of each week. Make them check their loss of weight by means of i-Nudge (Nudge Fitness website). Depending on the results of each Ex. Unit, gather data and information extracted from the weekly interviews to trace the evolution of each participant. c. statistical method for analysing the data and expected results Two-way Analysis of Variance or ANOVA.