THE NUDGING

CHALLENGE

TACKLING THE OBESITY CHALLENGE

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

http://www.reuters.com/article/2012/09/18/us-obesity-us-idUSBRE88H0RA20120918

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.

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.

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 | TIME.com

http://healthland.time.com/2013/07/31/five-things-youre-getting-wrong-about-weight-and-weight-loss/#ixzz2mXC2Jk4h

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.)

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 MyPyramid.gov for a calorie level of 1,200-

2,600 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.

4.- Nudge Development Process.

Map the context Understanding the decision

making process

I have to understand why I need to

lose weight. This is the BEST for me. I

know I CAN.

Then, I WANT to do

it. (I am part of the

solution)

Determine the main

heuristics and influences

I need to read every day that I’m

doing the BEST. (Availability Bias)

Use the applet i-Nudge at

http://www.nudgefitness.com/i-

nudge.html

(social proof)

I am socially

engaged in achieving

my goal, with my

relatives and friends.

Select the Nudge Identify suitable nudges

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

Gift the good

behaviour

Identify the

levers for

Nudging

Possible constraints and

areas where nudges can be

implemented

Lack of self-esteem

Lack of willpower

Gift the good

behaviour

Experiment Prioritize nudges and test for

effectiveness

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.

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

MINDFUL MINDLESS

ENCOURAGE DISCOURAGE ENCOURAGE DISCOURAGE A

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as the person

WANTS to lose

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enjoys result.

SE

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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.

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.