How nudge science might help achieve healthier eating habits.

Nudge is a concept in behavioural science, political theory and economics which proposes positive reinforcements and indirect suggestions as ways to influence the behaviour and decision making of groups or individuals. Nudge Theory presents a new collection of methods, deemed "nudges".

It proposes to help overcome the fact that humans make irrational choices even against their own interests. In the nutrition context, it helps explain how food marketing can make unhealthy choices easy and why health policies fail.

The history of nudge science

The term was coined by James Wilk in 1995 but was popularised by a book published in 2008 called Nudge: Improving Decisions About Health, Wealth and Happiness   by behavioural economist Richard Thaler and legal scholar (and prolific author) Cass R. Sunstein. It has gone on to be used in more than 80 countries including the USA, UK, Germany, Canada, Denmark, and the World Bank.

Nudging is the field of applied behavioural science that is still in its infancy and there has not yet been a large-scale evaluation of its effectiveness despite widespread use.

Nudge theory key terms (from Thaler & Sunstein)

Nudge: any aspect of the choice architecture that alters people’s behaviour in a predictable way without forbidding options or significantly changing their economic incentives. Nudges are easy and cheap to avoid, whereas mandates are not. For example, putting the fruit at eye level is a nudge; banning discretionary foods is not, but rather a form of regulation.

Choice architect: a person with the responsibility of organising the context in which people make (food-based) decisions. For example, a school or workplace canteen manager, or a supermarket manager.

Can nudge science help promote health?

We know that unhealthy food environments are a significant cause of obesity. Nudge theorists would describe obesity as being brought about in part by the prevailing ‘choice architecture’ that influences what and how much we eat, and how little we exercise.

Nudges may have the potential to guide healthier lifestyle choices. An example of nudging in action is a conference catering intervention; placing fruit at the start of the morning tea snack table and the cake at the end resulted in an 84% increase in fruit consumption and a 30% decrease in cake consumption.

A systematic review and meta-analysis on the efficacy of nudge theory strategies to influence dietary behaviour in wealthy nations found nudges resulted in an average 15.3% increase in healthier dietary choices. The authors concluded Nudge holds promise as a low-cost public health strategy to combat obesity without the need for restrictive regulation, although they say more research is needed in varied settings and more geographically and socioeconomically diverse populations.

The behavioural science of nudging

One of the basic slogans of nudging is ‘make it easy’, which is like the tenet of health promotion to ‘make healthy choices easy choices’. Nudging is developing evidence-based ways of making target choices cognitively easy or intuitive to perform against the background of automatic and non-automatic cognition and information processing. This is done by making the desirable choices psychologically salient, intuitive to navigate, associatively attractive and endorsed by the social environment. These principles that encourage positive behaviour change may be simplified by the acronym E.A.S.T.:

E – Easy. Easy changes are more likely to happen

A – Attractive

S – Socially acceptable. Humans follow herd norms and don’t like to stand out.

T – Timely

The opposite also applies. The elements that discourage positive behaviour can be simplified to the acronym D.U.S.I.

D – Difficult

U – Unattractive

S – Socially unacceptable

I – Inconvenient

OBSERVATION IS KEY. Nudging is based on the principle of observing what people do, and not trusting what they say. This will no doubt resonate with the experience of nutrition professionals and supports the difficulties of designing methodology to obtain accurate food intake data.

THE MAJORITY RULES. Go with the majority (there are always exceptions); if most people will make the change, it is worth doing.

DON’T SHAME. Dr Paul Harrison, Senior Lecturer in Marketing and Consumer Behaviour at Deakin University said on a podcast about nudge science that shaming people for their undesirable behaviour is not helpful as shame causes people to reject the desired message.

Nudge example using E.A.S.T.

How can we nudge people to drink more water and less sweetened beverages? (Much of this work is already being done by both marketers and governments).

EASY – place drinking fountains in public spaces, and water in retail environments.

ATTRACTIVE- Keep public drinking fountains clean and well maintained and use appealing designs. Make bottled water packaging attractive and re-usable water bottles desirable.

SOCIALLY ACCEPTABLE – make it commonplace to take water with you.  (This has already happened, and water bottles have become a fashion and lifestyle accessory.)

TIMELY – Place water where people are likely to be thirsty. Place public drinking fountains in busy areas. For example, Sydney Water provide tap water dispensers and distribute water marketing materials at summer festivals and events.

Nudge or regulate?

The nudge approach to behaviour change has challenged the traditional use of regulation in public health policy. Critics of nudge theory say it is rooted in the idea of individual responsibility and lets business and government off the hook. Nudge proponents argue a balance needs to be struck between nudging individuals toward healthier choices and creating healthier environments.

From a political perspective, public health policy must grapple with how a democracy can employ a combination of nudges and regulation to shape better lifestyle habits. Regulation including increasing taxes, mandates and bans on certain foods are unpopular with governments and the public. The challenges of traditional regulation include high costs, ineffectiveness of health campaigns, unintended consequences and invasive choice regulation that curtails personal liberty.

It is worth noting that nudges can operate independently of regulation, but they can also work alongside traditional regulatory approaches.

Conclusion

The nudge approach to behaviour change provides new, low-cost, socially and politically acceptable nutrition policy intervention options that may help increase desirable eating and exercise behaviours and promote public health. More inter-disciplinary collaborative research and evaluation in a public health nutrition context is needed.

Further reading

Cass R. Sunstein's 2016 book The Ethics of Influence – Government in the age of behavioural science is an examination of the ethics of using social and cognitive psychological principles to influence behaviour and decision-making.