One of the biggest flaws in our nation’s approach to weight management has been our reliance on education. It is a basic premise of education and prevention programs that people who know better make better choices. Unfortunately, human behavior sometimes defies logic, and this is particularly true when it comes to food selection.
Calorie Counts Don’t Change Behavior
To date, large-scale public health interventions against obesity have failed to produce meaningful changes in people’s eating habits. In July 2008, New York City became the first major American city to mandate that certain fast-food, coffee and restaurant chains post nutrition information on their menus in hopes that people armed with information will choose healthier options. So far, it hasn’t had the intended effect.
Research shows that menu labeling has little to no effect on people’s food choices. A 2009 survey of fourteen locations of Wendy’s, McDonald’s, Burger King and KFC in low-income neighborhoods found that only about one in seven customers said they’d made use of the calorie information. Overall, there was no significant change in the number of calories purchased.
A more comprehensive evaluation of 15,000 fast-food patrons in New York City, published in the British Medical Journal, was only slightly more promising. Similar to the previous study, only one in seven people said they’d used the calorie information. On the bright side, those who did pay attention purchased 96 fewer calories than others (an 11 percent reduction).
Interestingly, the cost of food appears to impact people’s decision-making more than calorie information. In one study of people who made use of the calorie information at Subway, most actually increased their calorie intake because of the “$5 foot-long” promotion.
Does this mean that it’s useless to educate people about the number of calories they’re consuming? It’s too soon to say. Other states, including California, Washington, Oregon, Maine and Pennsylvania, and Britain are launching similar initiatives that will produce more data on people’s ordering habits over time.
In the meantime, it’s safe to assume that a baseline level of nutritional knowledge is essential. For example, people need to know that it’s better to eat whole fruits and vegetables than to drink juice, and that whole grains are better than processed snacks. But we’ve gone so far into the “good food, bad food” realm that most people don’t know what healthy means anymore. Is it low-fat, low-carb or gluten-free? All the confusion has led many Americans to simply tune out dietary recommendations.
Why aren’t people making healthier food choices? In my experience working with people with weight problems, emotions almost always trump reason. Even those who have food allergies or severe gastrointestinal problems will continue to indulge on foods that make them sick.
The bigger issue is not how many calories are in food but how people are using food. Too often, food is our one and only coping mechanism. Even though there are healthier ways to cope, we only see one option – eating – as a quick fix for every uncomfortable emotion.
We use all kinds of tactics to convince people to change their lifestyle. We reason with them, educate them and even scare them into making healthier choices, yet none of these approaches has been effective. So what’s the alternative?
What works in the long run is finding an emotional “hook,” or a motivating factor that makes people willing to do the difficult work of changing their lifestyle. Examples of “hooks” may include:
• A lifelong goal of running a marathon, particularly if the race is held in a desirable location. One of my clients was struggling with her motivation to train until she discovered a marathon in Spain, where she had friends she hadn’t seen in 20 years. The emotional pull of reuniting with old friends in a place that held sentimental value was enough to keep her working toward her goals.
• Getting healthy to be able to keep up with your kids or be present for major milestones in their lives. It’s often not until our health is threatened by conditions that once seemed far-off or unlikely that we get motivated to change.
• Planning an active vacation (e.g., walking, swimming, snorkeling or hiking) that you don’t want to miss out on because you can’t keep up with your travel companion(s).
Each person must find their unique hook. Ideally, this would be a long-term passion (such as wanting to be able to play with your grandchildren) rather than a short-term goal (such as losing weight for a high school reunion). Otherwise, you’ll need to continually find new hooks that keep you from returning to old patterns.
For a hook to be effective, first it needs to have an emotional component. Because eating is often an emotional response, it cannot be combated with logic but rather an equally compelling emotion. Second, the hook needs to have structure around it. For example, you can’t decide one day you’re going to run a marathon; it requires planning and a training schedule.
There are a number of obstacles that prevent people from achieving their goals. The first is identifying the payoff. Although most people will say there’s no benefit to overeating, when we evaluate their patterns on a deeper level, there is some payoff. For some people, it might be relief from stress or boredom. For others, carrying extra weight may be an excuse to avoid getting into a relationship. Still others may use their weight to get attention (even the negative kind) from their family or to rebel against someone who has always told them they aren’t good enough because of their weight.
The second block is identifying negative core beliefs. Beliefs like “I’m not worth anything,” “No one will ever love me” and “I’m not safe if I’m thinner” keep people from making healthier choices. Challenging these core beliefs can be a difficult process, and is often best undertaken with guidance from a therapist or a self-help book that can walk you through the steps.
When we rely on knowledge to fix our weight problems, we ignore the fact that obesity is a complex condition. It’s not as simple as “calories in, calories out.” If it were that easy, overweight and obesity wouldn’t be such a widespread problem. This message is not only oversimplified, but it’s also damaging to people who feel they should be able to lose weight and keep it off but cannot.
Instead, let’s be up front: Lifestyle change is incredibly difficult. It typically takes three to five years, if not longer, to address a weight problem and the process requires a steady investment of time, energy and emotional work. Knowledge is only power to an extent; then it’s a matter of addressing the deep emotional scars that drive us to overeat.