Childhood obesity and nudges

Perhaps you heard the good news that childhood obesity rates are going down.  Hooray!  Nobody is quite sure why, but there’s a number of theories.  The New Yorker’s Margaret Talbot weighs in (pun only semi-intended) on one policy-based explanation:

In 2009, the U.S.D.A. made a major revision in the list of foods that could be bought with coupons from the federal program known as W.I.C. (short for the Supplemental Nutritional Program for Women, Infants, and Children). The new package included more healthy items (fresh, frozen, and canned fruits and vegetables, whole-grain breads and cereals, and low-fat milk) and fewer dubious ones (sweetened juices, cereals and breads that are not whole-grain). This was significant not only because the changes were so purposefully aimed at improving nutrition for low-income Americans but because W.I.C. serves so many of them—fifty per cent of American infants, twenty-five per cent of children under five, and twenty-six per cent of postpartum women are enrolled in the program…

In many of the low-income neighborhoods where women and children rely heavily on W.I.C., supermarkets are few and far between. Residents with limited funds for transportation are often forced to shop at the kind of gas-station quick marts and dusty-shelved corner stores where they can find plenty of beef jerky, chips, and soda and, other than a bruised banana or two, not much in the way of produce. But when a team of researchers from Yale University’s Rudd Center for Food Policy and Obesity studied W.I.C.-authorized stores across Connecticut, they found that the stores had responded to the new rules by “improving the availability and variety of healthy foods.” The businesses “found a way,” as the researchers from Yale put it, to make room for low-fat milk on their shelves, and to stock fruits and vegetables and whole-grain breads and other products they had not sold before. In so doing, they revealed a previously unsatisfied consumer demand. The researchers found that nearby stores that did not accept W.I.C. also started offering healthier foods, either because they now had new supply chains to take advantage of, or because customers were now asking for them, or both.

Marlene Schwartz, the director of the Rudd Center, thinks the W.I.C. reforms surely played a role in the reduction of obesity reported this week. The sheer number of families affected is part of the reason. And for two- and three-year-olds, who don’t need as many calories, a relatively small change—a switch to low-fat milk, a dip in the amount of sweetened juice they’re chugging—“can be pretty significant.” …

Information and moral suasion—Michelle Obama’s Let’s Move campaign and the like—are important, but in the salty-sweet sea of temptation we all swim in, they’re not really enough. Big Junk Food, with its ubiquity and its advertising juggernaut, will always swamp earnest nutritional pamphlets and public-service announcements. Unless, that is, there are rules and money on the other side. The Republicans have, by and large, taken to treating public health as a private matter—as though we could all count calories in a self-actualizing vacuum. And that’s too bad, because when it comes to battling obesity, we all need some of the will power that only government can provide.

Writing about the broader idea of government “nudging” citizens towards their enlightened self interest through changing policy defaults, David Brooks comes down on the side of the nudgers (here’s what I’ve written on the matter in the past):

But this raises a philosophic question. Do we want government stepping in to protect us from our own mistakes? Many people argue no. This kind of soft paternalism will inevitably slide into a hard paternalism, with government elites manipulating us into doing the sorts of things they want us to do. Policy makers have their own cognitive biases, which will induce them to design imperfect interventions even if they mean well.

Individuals may be imperfect decision-makers, but they still possess more information than faraway government rule-makers. If government starts manipulating decision-making processes, then individuals won’t learn to think for themselves. Even just setting a default position reduces liberty and personal responsibility.

The pro-paternalists counter that government is inevitably setting contexts and default positions anyway, so they might as well be aligned with individual and social goals. There’s very little historical evidence that there is an inevitable slippery slope leading from soft paternalism to hard paternalism. If companies are going to trick people into spending more on, say, bank overdraft fees, shouldn’t government step in to prevent a psychological market failure?

I’d say the anti-paternalists win the debate in theory but the libertarian paternalists win it empirically. In theory, it is possible that gentle nudges will turn into intrusive diktats and the nanny state will drain individual responsibility.

But, in practice, it is hard to feel that my decision-making powers have been weakened because when I got my driver’s license enrolling in organ donation was the default option. It’s hard to feel that a cafeteria is insulting my liberty if it puts the healthy fruit in a prominent place and the unhealthy junk food in some faraway corner. It’s hard to feel manipulated if I sign up for a program in which I can make commitments today that automatically increase my charitable giving next year. The concrete benefits of these programs, which are empirically verifiable, should trump abstract theoretical objections.

Yep.  Not always happy with Brooks, but I think he gets this very much right.  When it comes to abstract theory versus empirical data, I’ll go with the actual data every time.   And the data suggest that policy “nudges” are a very sensible approach to public policy that do not inevitably lead down a slippery slope to tyranny (every now and then a slippery slope argument is actually right, but not usually in my experience).

About Steve Greene
Professor of Political Science at NC State

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