We all know we should be eating better, reducing sugar and fat, exercising more & eating a balanced diet. Disturbingly what I don’t see raised is, what makes healthy choice more difficult for most people to put into effect? I think the fact that this question largely gets ignored is part of the problem. Just about every policy to promote healthier lifestyles & reduce obesity has had one thing in common; relying on individual behavior change, whilst totally ignoring the wider factors that influence those choices.
Before carrying on, let’s highlight some of the factors that are fueling the obesity epidemic;
- Sedentary jobs and lifestyles (long, unbroken periods sat down are major factor, even if going to the gym)
- Car-centric transportation system (limits opportunity for daily physical activity)
- Sedentary recreation activities (partly fueled by technology and partly by dispersed living patterns which in some cases limits people’s opportunity to meet up)
- Decline in the amount of home cooking & more eating out (further research needed into factors fueling this trends)
- Increasing portion sizes in restaurants and ready meals
- Widespread availability of snacks & junk food
Individuals don’t make choices in a vacuum
One thing that just about every article, tv program & piece of public health advice has in common is this; it totally ignores the wider factors that that make the ‘healthy’ choices harder. This is not to argue that individuals shouldn’t make good choices or to excuse bad choices but it does mean we should look beyond ‘behaviour change’ and consider the wider context which influences people’s behaviours.
Cycling in Holland vs. driving in the USA; an example of why we need to look beyond the individual
Many people know that they shouldn’t use the car for short trips and that they should cycle instead. Even though it maybe quicker, more reliable, cheaper, easier to find a place to park, & exercise with no willpower, but the question is, why in some countries do few people cycle for everyday transport & in other places they do? Sure, anyone can choose to cycle instead of drive, but what factors influence that decision? Why do so many people cycle in the Netherlands and Denmark & so few in the UK and USA?
The answer is simple;
- In low-cycling places, it’s perceived by many to be less safe & thus less attractive than driving; this is mostly due to car-centric road design, lacking bike lanes on main roads (a primary factor)
- It’s also not normalized as a way to get about, there’s something called ‘modal stigmatization’; lots of negative stereotypes have arisen about people who cycle (the lycra-clad guy hogging the road, or the kid terrorizing old ladies on the footway)
- In low cycling contexts where few people cycle for transport, many people often aren’t even aware of the advantages over the car for short trips (quicker, more reliable, easier to find a place to park)
- In low-cycling cities & countries, there’s a lot unhelpful myths & lies people believe about it being impractical (e.g. that you need lots of ‘stuff’, that it makes you sweaty, that you can’t carry very much)
People’s choices in any behavior are strongly influenced by the environment, cultural factors, norms & many other factors.
Truth is, if the ‘good’ choice is the more difficult, attractive or less convenient one, then I’m afraid to say, most people will vote with their feet & that you won’t be very successful in achieving large-scale change. The Netherlands recognized this in the 70’s & moved away from car-centric road design & thus made cycling for short trips relatively stress free to a degree that people would choose the bike over the car. As a result of this, cycling never declined to the point where it wasn’t seen as normal. Other countries continues the car-centric mistakes of the 60’s, relied on ‘behavior change’ and ‘encouragement’. Have they achieved the same results? The answer is NO. Why? Reliance on behavior change & ignoring the factors that affects people’s choices. The same is true for reducing obesity.
The limits of individual behavior change; examples
What reliance on individual choices fails to do is look at the factors that influence people’s lifestyle choices. Let’s look at some examples;
- We can choose to cycle short distances, but we can’t make it look ‘normal’ in an area where few people cycle and most the cyclists are sportive-looking, nor can we choose the fact that a lot of people would find close encounters of vehicles renders the bike unattractive in comparison to the car
- We can choose to eat organic, but we can’t change the fact that a lot of people might not be able to afford it
- We can choose to make a couscous salad for lunch instead of getting a takeaway, but we can’t change the fact that if there’s a takeaway on every corner, temptation will always be there & a lot of people will opt for that option
- We can choose to drink in moderation, but we can’t change the fact that the environment you’re drinking in is highly unpleasant to be in when sober
- We can choose to use the bus instead of the car, but we may not be able to change the fact that it’s infrequent, expensive, slow or requires buying a separate ticket to change buses & if given a choice between bus or car for that journey, a lot of people will opt for the car
- We can choose to throw a party with no alcohol involved, but we can’t change the fact that a lot of people believe that alcohol is necessary to have a good time
- We can try going without a mobile phone, but we can’t change the fact that other people may depend on it
- We can choose to ride a practical sit-up and beg bike instead of a mountain bike, but we can’t change the fact that in low-cycling contexts it’s socially-unacceptable, that people will think you’re an ‘old man’ or your riding a ‘woman’s bike’ in a, (this is a direct result of the bike market largely catering to recreation rather than transport, which in turn is a result of cycling for transport being unattractive)
You see what I’m saying? Individual choices are not made in a vacuum. Things like cultural norms, the infrastructure, environment, policies, people’s habits, normalization & many factors are significant factors.
So long as the ‘good’ choices remain the difficult & less attractive choices for the vast majority of a population, you’re very unlikely to achieve much in the way of success and make much of a real difference at a population level.
Mass gym membership won’t solve the obesity crisis
All this drive to get more people running and into gyms although healthy, won’t be very successful for the following reasons; firstly, it’ll only appeal to a limited segment of the population, secondly; this is not really addressing the route causes of physical inactivity & third; it could potential reinforce people’s unhelpful beliefs about physical activity. It’s important a more positive message is given about physical activity, that it can be enjoyable, that you should find something that’s right for you, that you can stick to. The key to boosting physical activity is to integrated it into daily life.
Also, the widespread promotion of gyms and running reinforces the idea that fat people are somehow lazy and should be punished. That is not the message that should be sent about physical activity. It is this message about physical activity that puts people off.
The secret about low-obesity countries
In places like Japan and Italy, people are not as fat is mainly because the reasons that have been highlighted in the beginning of the post are not as pronounced as they are in countries like the USA, it’s as simple as that. The culture, the local food environment, what sorts of foods are available & food shopping habits that do not promote over-eating are still relatively normalized & convenient. In southern Spain, I remember that in all the supermarkets I went to, the Isle of snack foods and sugary cereals is significantly smaller than it would be in most UK supermarkets. In the same way that cycling is normalized and convenient in the Netherlands and Denmark, healthy eating patterns and portions need to be normalized & made convenient the same way.
Of course, shifting from cars to cycling or cycling+train for longer trips is part of the solution, even though I was using the cycling example to illustrate how looking beyond individual actions can achieve results at a population level, this still is part of the solution. By far the easiest way to get a population active is through transport and recreation.
People in low-low obesity countries are no less ‘lazy’ than people of high obesity countries, it’s just the the culture and the physical environment makes the healthier choices & patterns easier, more convenient and normal. If you’re a policy-maker, then having that stance will not help you identify the route cause nor will it allow you to achieve anything.
The dangers of blaming each other
It’s true that individuals taking positive actions can inspire each other to follow suit, but what they don’t tell you is there’s a potential caveat. Seeing social problems as purely a result of individual changes can be divisive & create an ‘us and them’ mentality;
- Those who make positive changes to their lives in an environment which is (to be honest) largely rigged to bad choices are likely to see themselves as superior and to develop a sense of smugness & superiority
- The other danger of ignoring the context which shapes people’s lifestyle choices is that it can deflect attention away from the institutions, cultural norms & the myriad other factors which influence people’s lifestyle choices
There’s a bit of stereotype out there about people in health and fitness being arrogant, this doesn’t describe every fitness fanatic but isn’t entirely inaccurate either.
If we’re focused on labeling those individuals who don’t make good lifestyle choices as ‘lazy’, then we’re in danger of diverting attention away from the questions that really need to be asked; why do people make the choices that they do? What is it that makes the ‘good’ choices difficult or less practical? In some ways, we argue that some promoters of fitness could even be a hindrance rather than a help if they are guilty of any of the above.
So you’re saying individuals are not responsible?
Some will be jumping to the conclusion that this is an argument against all individual choice. That is not what this is saying at all. Good choices are ultimately up to the individual, but that doesn’t mean that the the context in which choices are made should be ignored. I’m fully aware of how black-and-white, all-or-nothing people tend to think. It’s important to recognize yourself doing this.
Why aren’t these issues more widely-addressed?
Raising bigger picture issues like this, a lot of people like to try and resort to the technique of accusing the individual who’s raising these points as ‘making excuses’ for bad choices & then accusing the individual raising the point of making those choices, even if there’s no evidence at all to suggest that they are. I can’t remember the name is of this type of deflection technique, but it’s dreadfully common.
The fact of the matter is that obesity continues to increase despite lots of ‘awareness campaigns’, ‘fat taxes’ and many other ‘soft measures’. What’s never, ever raised are the factors that influence people’s choices or what makes the ‘healthy’ choices harder, or what might make daily physical activity difficult, or what makes less sitting time more difficult. We need to go beyond the individual and go to the next level; what makes the ‘good’ choices hard for the average person to put into effect? What’s driving the trends that I highlighted at the beginning if the article? How can we change these? These questions need to be asked if we want to stand any hope of making a difference on a population level. It’s about time that this was given some thought.