Innovative Ideas for Battling Adult Obesity at Invitational Choice Symposium

May 24, 2010, 7:39 AM, Posted by Lori Melichar

Last week, I went to Key Largo, Florida to attend the 8th Triennial Invitational Choice Symposium, hosted by the University of Miami and the University of Technology, Sydney.  Pioneer has had an ongoing interest in behavioral economics – also called choice architecture or “nudges” – which explores ways to influence people to make healthier choices.  You’ll recall that we sponsored the “Designing for Better Health” competition with Changemakers last year to identify health nudges. The conference convened researchers, psychologists, marketing folks and behavioral economists from around the world to meet together in small groups for three full days to present and discuss whatever they wanted. 

At the Invitational Choice Symposium, there were about 15 different groups that discussed topics ranging from marketing and politics to the intersection of perception, learning, thinking and feeling. My group, which was simply called “improving medical decision making,” brought together researchers with expertise in psychology, financial incentives, nutrition, law and economics to discuss how to improve medical decision making.…by physicians, nurses, patients and other actors in hospitals, medical offices, minute clinics, schools, at home and in the workplace.

Being that I work outside of the academy, I was invited by Dan Ariely and Ziv Carmon to join Kevin Volpp, Brian Wansink, Anup Malani, Barbara Kahn, Peter Ubel and others to provide a real-world perspective to the conversation. When the academics get too high up in the clouds, I was told, you should bring us down to think in a more focused way about how incentives can result in improved health and health care through improved policy or other tools to motivate and sustain favorable behaviors of providers, patients and others.

I don’t want to speak for the others, but I assume they were as gratified as I was for having the opportunity to spend so much time thinking and learning with those who had some of the missing pieces of the puzzles we were attempting to solve. We talked about LOTS of problems (conflict of interest, patient comprehension, adherence to medication) and lots of potential solutions (requiring cash payment, default second opinions, videos to change norms). The main issue that ran through the three days was adult obesity.  Though we  tried to leave the issue aside because we worried about wasting time on an issue that even Oprah can’t surmount, the fact remained that it was such a thorny behavioral problem that we couldn’t escape it.

In our discussion about how to address adult obesity, we talked about needing to understand why and how obese people become obese. Are they eating a lot at meals? (in which case, restaurants offering to serve half portions at 2/3 the cost of a full serving could provide a partial solution). Are they eating a lot when they are with their obese friends (then targeting interventions at social networks sounds promising). Are they eating the foods that are cheaper? (a fat tax could help). Are they eating the same amount as non-obese people, but just have a worse metabolism (need a miracle drug)? Are they eating because they don’t know how bad some things are for them or how good something are for them (calorie counts and other informational materials could help)?

The discussion dug in deeper to get at whatmight work to change eating habits.  Rules and restrictions? Financial incentives? Financial incentives to people’s friends?  Virtual incentives like those provided through the Farmville game? Points for good behavior redeemable the way frequent flyer/spender miles/points are? Making the world a Canyon Ranch? Limiting serving size by law? Shrinking plates?  Hiding appealing-looking food? Taking away people’s “heavy clothes” and buying them a new wardrobe to incentivize weight loss and maintenance?

Here is one idea that I feel enough ownership to share, though it was born of the insights of others: I think that a lot of people screw up their “good” day by eating something they didn’t really want.  Though I think that people who bring sweets to work and leave candy on their desk for people to nibble on have the best of intentions, free food is hard to pass up and good-looking food is a good way to start your day on a slippery slope.

What would it take to change the culture? To have co-workers consider it a rude thing to do to bring in cupcakes,  donuts, or cookies to a meeting, or put out chocolate when it is potentially damaging to someone else’s health? Would signs in the bathroom stall or conference room doors be enough?

At the conference, I accomplished the goals I set out to accomplish: to learn more about cutting-edge behavioral economics and decision science, and come away with an idea with “breakthrough potential” for possible future development by Pioneer.

I’ll expand more upon these ideas on future blog posts.



This commentary originally appeared on the RWJF Pioneering Ideas blog.