A wake-up call for anyone who thinks posting calories will be the silver bullet that changes eating habits

Based on the scientific literature, we know that people who seek out and use calorie information are likely to be different from other eaters in many ways, including their motivation to cut calories. Sure, it’s possible that some people who looked at the information were persuaded to consume fewer calories, but it is equally plausible that those who were intending to order lower-calorie meals were more likely to seek out the calorie information.

By helping consumers make more informed decisions, calorie posting may be desirable even if it fails to reduce calorie intake. But effective policies to deal with obesity will need to involve much more than posting calories. People eat too much because calorie-dense foods are convenient and cheap, with large portion sizes priced to encourage overeating.

That’s Julie S. Downs, George Loewenstein, and Jessica Wisdom on the effectiveness of calorie posting nudges.

Wharton’s Kevin Volpp thinks a revised menu design might be a better nudge.

Incentivizing convenience of ordering low calorie food, by clustering these options together at the top of the menu, seems to have a significant impact. This indicates that traditional measures of informational provision are not always sufficient to motivate changes in unhealthy behavior.

Assorted links

1) Atlanta is testing out an incentivized recycling program where residents can earn and exchange points for “rewards, gift cards, groceries, and products” with participating retailers. (Hat tip: Mike Erskine)

2a) Rewarding first-graders for eating fruits and vegetables with small prizes.

2b) “‘If you want to know if an urban environment supports cycling, you can forget about all the detailed ‘bikeability indexes’—just measure the proportion of cyclists who are female,’ says Jan Garrard, a senior lecturer at Deakin University in Melbourne, Australia, and author of several studies on biking and gender differences.” From Scientific American.

(Hat tips: Christopher Daggett)

3) A scale that tells the world how much you weigh via Twitter. (Hat tip: Justin Holz)

4) Photos of calorie counting nudges at Freakonomics.

Musical stairs

Thanks to all the Nudge blog readers who pointed us to this terrific video from Sweden that asks: How can choice architects get people to use the stairs instead of the escalator?

For others curious about the background: The videos are part of something called the Fun Theory project (sponsored by Volkswagen it appears) that, according to its web site, is dedicated to coming up with fun ways to do things we otherwise wouldn’t, usually because of sheer laziness. Like throwing away the trash.

How does a German senior center stop alzheimer’s patients from wandering off?

It builds a phony bus stop outside its entrance.

The nursing home was continuously relying on police to find wayward patients who left the site in search of old homes and families (that sometimes did not exist).

“It sounds funny,” said Old Lions Chairman Franz-Josef Goebel, “but (the fake bus stop) helps. Our members are 84 years-old on average. Their short-term memory hardly works at all, but the long-term memory is still active. They know the green and yellow bus sign and remember that waiting there means they will go home.” The result is that errant patients now wait for their trip home at the bus stop, before quickly forgetting why they were there in the first place.

Nursing home staff members then approach them and invite them inside for coffee.

Hat tip: Ana Nelson

What would it take to get you to take the stairs more? How about music and a view?

The stairs between the upper floors of the University of Chicago’s Booth School of Business are made to be used. They are placed smack in the middle of blocks of faculty offices. They zigzag back and forth up open columns, allowing people to see easily between floors. They have plenty of light, are carpeted, and blend into the design of the building.  By placing the stairs in a common area (the elevators are a longer walk away) and making them inviting, the architect created a nudge to encourage a smudge of healthier behavior in the work place.

Creating more accessible staircases through public policy and physical architecture is one way to promote an active lifestyle, say Dr. Ishak Mansi of Louisiana State University, and his wife, Nardine Mansi, an architect, in the Southern Medical Journal. A small 2.8 percent increase in stair use would cut 300 grams of weight from a typical person, they say.

So how does one design a building where people actually use the stairs? There are three key features.

1) Fewer turns between the stairs and the closest entrance.
2) Stairs with large surface areas (not too narrow and steep).
3) Create a view, either up, down, or across, from the stairwell. No one wants to walk up a tiny, white box.

The Booth School of Business staircases meet all of these requirements (perhaps it’s no surprise the building won a major design award last year). For those who can’t build new stairwells, there are a few other nudges to try. Displaying motivational signs in the lobby and throughout the building, and playing music in the stairwell can increase stair use. Together, these two nudges can increase usage by as much as 9 percent. Hanging artwork on the stairwell walls, closing elevators occasionally, and offering incentives like fruit are also known to work.

The journal article is gated, but a short news summary is here.

Health care reform ideas inspired by Nudge

Jeff Kling of Brookings slips on the cloak of a choice architect to design some innovative health care reforms. Kling makes the case for five nudges for the U.S. health care system.

Establishing automatic enrollment is valuable for any type of health insurance coverage expansion, regardless of whether there is an individual mandate

Allowing states to augment a national base of health care reforms would enable refinement of various approaches

Determining eligibility based on data collected through the tax system, either on tax forms or through data matching, would greatly facilitate automatic enrollment

Implementing collections of individual contributions to premiums through the tax withholding system may facilitate continued enrollment and reduce administrative costs

Creating a system in which third-parties provide enrollment advice to individuals and are rewarded for their performance may be preferable to legislating how to select a default plan

Figuring out how to simplify the sign-up process for the 47 million Americans without insurance would be one of the biggest challenges facing any new system. Like others who think there is great potential for the government to creatively use tax records, Kling says people might be required to use W4 withholding forms to pick a plan, states might make an initial rough estimate of those eligible for subsidies on the basis of last year’s tax returns, and the IRS might merge data on taxes and immigration status to better determine eligibility. Kling even has an idea for building social norms by creating special accounts for health insurance payments. Private employers providing insurance would deposit money in employees’ accounts, while those without insurance would be required to set aside money each month to pay for certain medical costs or premiums. The goal of these accounts would be to ensure that all Americans, without or without coverage, contribute to the costs of a product that ultimately benefits all of us.

Can a horoscope save a baby’s life?

An organization in India called the Deepak Foundation has used a deeply rooted cultural practice to come up with an interesting nudge for improving infant mortality. Numbers on infant deaths in rural areas are often low because the inaccessibility of health facilities hinders accurate reporting of vital health indicators like birth weight. In many of these areas, a horoscope – known as a Janmakshar – is used to determine a baby’s name based on date and times of birth. Janmakshar’s are typically provided by religious groups, which charge a fee for them. The Deepak Foundation thinks that offering families a free Janmakshar in exchange for birth information can produce better statistics and healthier babies. The hope is that by identifying low birth weight babies, medical advice referrals can be provided more quickly and early breastfeeding can be started. Currently, Project Janmakshar, as it is known, is in a pilot stage, with the hope of expanding it to a rural area of 2 million people soon. A video explaining how the process works is below.

Health nudge winners announced

Ashoka and the Robert Wood Johnson Foundation have announced the winners of the Designing for Better Health competition, which asked innovators around the world to come up with nudges for health and health care. The contest’s judges picked three winners, each of whom will receive $5,000 for their idea:

1) Healthy amazon. A program for turning waste in the largest Amazonian community in Peru into compost for vegetable gardens. The organization that came up with the program, San Francisco Saludable, gives compost away freely to anyone who contributes their recyclables, garbage, and trash, which is a serious problem in the area. The Spanish/English web site is here.

2) Just a cloth piece? A small, affordable piece of cloth that is meant to improve menstrual hygiene and spark conversations about an otherwise taboo topic. In India, where the project is based, women commonly use sand, wood ash, old rags, newspapers, and plastic bags as a substitute for sanitary pads. The organization responsible for the idea, GOONJ, is partnering with grassroots groups, NGOs, the Indian Army, and others to distribute the cloth pieces.

3) Child promoters on oral health. A Venezuelan program to help children, not nagging adults, teach other children about the importance of clean, healthy teeth. Poor dental care is common in Venezeula, and the program Fundación BOCA SANA is intended to reach 20,000 kids between ages 3 and 12 each year. A project web site (in Spanish) is here.

Find out more about Ashoka’s contest and read the full entries here.

What if you told your kids how much they like eating vegetables?

Cognitive Daily points to an interesting new study with a strategy not recommended for parents interested in getting their kids to eat more greens. In grand psychology fashion, this experiment involves some serious manipulation. Participants were lied to about their actual preferences. Ahem, in the words of the study, the authors “planted the suggestion that subjects loved to eat asparagus as children.” (No pun appears to be intended with the verb choice “plant.”) These “new (false) beliefs” had an immediate effect for many, including “increased general liking of asparagus, greater desire to eat asparagus in a restaurant setting, and a willingness to pay more for asparagus in the grocery store.” But beware the unintended consequences when you tell your teenager why she loves asparagus so much.

Dave Munger sums up the experiment and the key result below:

Participants were told they’d be taking a survey about food preferences and personality. First, everyone was asked about their “food history,” with 24 questions about particular foods — all these questions except one were only there to distract from the key question, which asked them to rate how likely it was that they “loved asparagus the first time they tried it” on a scale of 1 to 8.

After taking a couple of other questionnaires, again, to distract from the primary goal of the study, they were asked how likely they were to order each of 32 dishes from a hypothetical restaurant menu, again on a scale of 1 to 8. Again, asparagus was one of the dishes.

One week later, all the students were brought back and given a phony analysis of their responses to the previous week’s survey. Here’s the key to the study: as part of this analysis, half the students were told that their responses indicated they “loved to eat cooked asparagus” as a young child, while the other half were not told anything about asparagus.

Then everyone was given the original two food preference questionnaires again (one about how much they liked foods during childhood, and another about what items they were likely to order in a restaurant today). Here are their ratings for the “loved asparagus the first time you tried it” question:

A full version of the paper is here.