If soda bans take an implicitly cynical view of human nature, food labels that give consumers the impression of freedom might be their opposite.
Massachusetts General Hospital
From New York City's point of view, humans are notoriously bad at making good decisions. That's what makes a ban on large sodas necessary: the idea that Americans can't be trusted with their own health. But maybe there's a middle ground between letting people gorge themselves on junk food and making it illegal. The key to making it all work is creating an environment where consumers still believe they're in control.
Data released this week by the Massachusetts General Hospital describes the efficacy of a stoplight-style color-coding system that researchers applied to foods and beverages sold to hospital cafeteria-goers. Products were labeled as red, yellow, or green according to three main indicators:
- How many of the item's main ingredients contained either fruit, vegetables, whole grains, or low-fat dairy?
- Did the item have a lot of saturated fat?
- Did the item have a high caloric content?
Items that had healthier ingredients and less of the bad stuff were given a green label that advised diners to "consume often." Items that had good and bad in equal proportions were given a yellow label; customers were told to consume these products "less often." Items with a great deal of calories and saturated fat were given a red label. "There is a better choice in green or yellow," diners were told. After launching the labeling system, the researchers then took the added step of moving things around so that the green-labeled items were more accessible.
After six months, the researchers found that the labeling initiative had succeeded in curbing red-item purchases, and it had even increased purchases of green products. Red-item purchases fell by 11 points. Green-item purchases rose by 6.6 points.
Beverages in particular saw some of the biggest changes. "Overall, employees' red beverage purchases decreased 23.8 percent during the Phase-1 labeling intervention," the study's authors wrote, "and they further decreased by 14.2 percent during the Phase-2 choice architecture intervention." Mayor Bloomberg, call your office.
Broken down by race, Latinos, blacks, and whites all saw big gains in terms of green-item consumption -- 9.4, 6.7, and 6.6 percentage points, respectively -- and the biggest decreases in red-item consumption -- by 11.4, 10.1, and 11.2 points, respectively. It's hard to say whether the decreases were the result of the labels themselves, peer pressure (nobody wants to be the only one buying heaps of red items if all their lunchtime friends are buying green, am I right?) or some combination of factors. But the improvements happened.
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The experience of the study at Mass General suggests that people will choose healthier behaviors with even a mild level of intervention. That's great news. It turns out it's actually possible to transform our susceptibility to suggestion into an asset that works for us. By hijacking the same weaknesses that in other circumstances cause us to do what advertising, plate size, and other subtle external cues tell us to do, we might be able to keep ourselves healthy without the need for more heavy-handed measures.
This isn't the only example in which public health officials have stolen a page from food marketers' playbook. Though still hamstrung by legal challenges, a federal proposal to slap all cigarette packages with disgusting photos of oral decay and diseased lungs is backed by strong evidence that aggressive warnings keep would-be smokers at bay -- especially those who have already quit. Putting cigarettes in plain packaging helps, too -- the warnings stand out more. The case is less clear for menu labeling (in which restaurants are required to post calorie counts beside their food items), but the menu rules may also have the side effect of getting restaurants to alter what they put on the menu in the first place, which ought to achieve much the same result: a cutback on Americans' calorie intake.
Even if color-coded food labels gain acceptance as a useful alternative to outright bans on unhealthy products, though, that doesn't mean they'll necessarily be adopted. The food industry hates restrictions on its behavior, and there's nothing more threatening to its earnings than a scheme that tells consumers explicitly what not to buy. Beyond that, it's unclear how far such a program could spread. A lot depends on who's running the show. Hospitals or city governments can get away with it because they're either nimble and small, or their authority is so complete that resistance to the program becomes pointless. But at the federal level? Don't hold your breath. Bickering over what red, yellow, and green actually mean is likely to be as difficult -- if not more so -- than actually putting the system in place. There are a lot of political reasons, in other words, why a stoplight-style labeling initiative would fail before it even began.
Such a program would be a radical attack on the way we think about food -- if you're a member of Big Food. But for the rest of us, it's a more compassionate and incremental way to go about fighting obesity. New York's faith in humanity must be low indeed if it thinks only the most blatant coercion can get people behaving differently. Whether collectively or alone, people are hopelessly incompetent, is the message Bloomberg's soda ban sends. A more accurate way to put it might be that people are incredibly malleable, open to having their decisions swayed in terrible ways by factors that are out of their hands. The difference is slight, but in the small gap between those two statements lies an opportunity to move people in the right direction without taking away their freedom. Just because we often fail at making good decisions doesn't mean we can't.
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