The Nudge Challenge: Tackling Obesity Behavioural Economics PNL

1. THE NUDGING
CHALLENGE
TACKLING THE OBESITY CHALLENGE

2. 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.

3. 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.

4. 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.)

5. 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 1,2002,600 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.

6. 4.- Nudge Development Process.
Map the context
Understanding the decision
making process
Determine the main
heuristics and influences
Select the Nudge
Identify suitable nudges
Identify the
levers for
Nudging
Possible constraints and
areas where nudges can be
implemented
I have to understand why I need to
lose weight. This is the BEST for me. I
know I CAN.
I need to read every day that I’m
doing the BEST. (Availability Bias)
Use the applet i-Nudge at
http://www.nudgefitness.com/inudge.html
(social proof)
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
Lack of self-esteem
Lack of willpower
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.
Experiment
Prioritize nudges and test for
effectiveness
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
Then, I WANT to do
it. (I am part of the
solution)
I am socially
engaged in achieving
my goal, with my
relatives and friends.
Gift the good
behaviour
Gift the good
behaviour

7. MINDFUL
EXTERNALLYIMPOSED
EXTERNALLYIMPOSED
DISCOURAGE
ENCOURAGE
DISCOURAGE
Write down my
food, modify
consumption
habits, green
basket
This should be
the next step,
as the person
WANTS to lose
weight and
enjoys result.
SELF-IMPOSED
BOOSTING SELF-CONTROL
ACTIVATING
DESIRE
BEHAVIOUR
ENCOURAGE
MINDLESS
This should be
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.

8. 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.