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By: Elizabeth Rahavi, RD   Date: 3/25/11

The American Heart Association has set a goal to improve the cardiovascular health of all Americans by 20%, while reducing deaths from cardiovascular disease and stroke by 20% by the year 2020. Public awareness campaigns, like the AHA’s “Go Red for Women,” in February (coinciding with American Heart Month) can go a long way in increasing awareness of the incidence of heart disease among the public, and especially women. Indeed, according to our Functional Foods/Foods for Health Survey, “Forty-eight percent of Americans cite heart-related concerns, including high blood pressure, high cholesterol and cardiovascular health, as their top health concern. Heart-related concerns were ranked higher than weight and cancer, which were second and third, respectively. Yet, even with the best intentions many Americans still fumble in their effort to improve heart health.

Why is it that we still fall short when it comes to making diet and lifestyle changes that we know are in our best interest? Last week, IFIC worked in collaboration with the American Heart Association to produce a webcast,“Bridging the Gap between Consumer Behavior and Heart Health” to explore how Americans can become aware of the barriers that might prevent them achieving their diet and lifestyle goals.

Why Did I Eat That?
Joanne Guthrie, PhD, MPH, RD, and assistant deputy director for nutrition at the USDA’s Economic Research Service, provided an overview of how behavioral economics can shed light on consumer food and beverage decisions. Unfortunately, in order to make progress, we all have to step back and realize that we may not make these decisions rationally. In fact, traditional economic theories are based on the belief that given adequate information we will all make decisions that are best for ourselves. Nutrition education programs often have a similar premise. For example, if we know that too much saturated fat in our diet can lead to heart disease then we will use this information to choose products that are lower in saturated fat. Yet, even with this knowledge we often find ourselves eating a brownie instead of a banana. Behavioral economics explores why observed behaviors don’t always seem rational based on traditional economic models of how we should act, given adequate information or education. It also offers insights on how we can help people make healthier choices.

Barriers to making changes
Consider the predicament that most people find themselves in everyday when they decide what to eat for lunch. You have a short term decision to make: what do I want to eat right now? This may be coupled with the long-term desire to improve heart health or lose weight. What motivator will win out in the moment? According to Brian Wansink, PhD, and Director of the Food and Brand Lab at Cornell University, the average American makes over 200 hundred food decisions every day. Consuming a balanced diet is the result of making consistent food decisions on a daily basis, balancing what you eat for breakfast with what you eat for lunch and dinner on a single day and throughout the week. Keeping track of all of these decisions may sound overwhelming, which is why we are often foiled by inconsistent decision making. Here are just a few of the unconscious things that can influence the foods and beverages we ultimately decided to consume:

 What’s the Default: If you order a sandwich at a quick-service restaurant that comes with fries and a drink, you may be more likely to consume these foods. The same may be true if the default was apple slices and bottled water.
• What’s visible: Wansink has done numerous studies exploring how food that is within eyesight might influence consumption. In one study he found that keeping your back to the buffet bar at an all you can eat restaurant can keep you from going back for seconds. The same is true for the office candy bowl.
• Package and serving size: What’s your preference, eating chips out of the bag or pouring a serving of chips into a bowl? Studies have found that portioning out servings can help to limit what is consumed during that eating occasion. Similarly, eating food off of smaller plate can trick your eyes into thinking that you are eating more than you really are.
• Contrast Effects: Are your friends always eating extra-large portions of food? This can make your large portion appear like a regular portion even though you are both eating over-sized portions. Become familiar with portion size here.
• Names: Old fashioned-fresh squeezed lemonade is more enticing than lemonade.
• Variety of all kinds (e.g., taste, color, shape): How often do you search through your salad looking for crouton to create the perfect bite? Taste, texture and variety all add to the pleasure of what we eat, enticing us to eat more.  Consider what types of tradeoffs you can make to your meals. For example, if you like croutons on your salad, perhaps cucumbers could provide you with the crunch and mouth feel with fewer calories.

Social Norms Matter
A study in the New England Journal of Medicine found that obesity can spread through social networks. Therefore, if your friends put on weight, you might be likely to put on weight too. This was true regardless of distance. The researchers found that even people who lived 200 miles away from each other, but were related or friends still were susceptible to weight gain. According to James Fowler, one of the authors of this research, obesity doesn’t spread because you are going out to eat with your friends and hanging out together. It’s spreading through ideas about what appropriate behaviors are, or what an appropriate body image might be. This speaks to the need for public awareness campaigns like the First Lady's Let’s Move! and the AHA’s Go Red for Women campaigns that can bring awareness to a cause and aim to change social norms. Providing clear and actionable steps that people can take to move toward a heart-healthy diet are necessary in order to achieve long-term success. Also, key is the need for us to make changes together and not just as individuals.

How can we move forward together?
Insights from behavioral economics suggest that success can be gained by making decisions in a “cold state.” For example, don’t decide what you are going to eat for lunch or dinner when you are already hungry. Ordering groceries online can also help you buy only the items that you need. Retailers and restaurants may also have role to play by creatively showcasing healthier options together within a store or on a menu and by naming them with enticing descriptions that kids and parents would find appealing.

If you are interested in getting started with some tips to improve heart health, we recently provided some ideas that Americans can use today to promote heart health.  You can also review Tami Ross’ presentation from the webcast and check out our new video, “Foods for Health: Eating for Heart Health” produced in partnership with Dave Grotto, RD.

What surprises you the most about behavioral economics?


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