You’ve seen the news on fitness and the American diet. It’s not good. In “Our Food Is Killing Too Many of Us,” authors Dariush Mozaffarian and Dan Glickman outline the dismal state of the union:
More than 100 million adults — almost half the entire adult population — have pre-diabetes or diabetes. Cardiovascular disease afflicts about 122 million people and causes roughly 840,000 deaths each year, or about 2,300 deaths each day. Three in four adults are overweight or obese. More Americans are sick, in other words, than are healthy.New York Times, August 26, 2019
Their recommendation? Address the raw (and cooked) materials of the healthcare crisis at the point of nutrition. Trillions of dollars–as well as our national defense–depends upon it. They offer a host of recommended changes to save “a net $9,000 in health care costs per patient per year” and make a convincing case that changes from above are needed.
In a recent analysis and commentary in JAMA Network Open, researchers tested the capacity for changes from below. The study (info here) addresses the following question:
“Is it more effective to disburse fixed total financial incentives at a constant, increasing, or decreasing rate to encourage physical activity?”
With three experimental groups (constant, increasing, or decreasing incentives), they found that incentives doled out at a constant rate proved most effective. The behaviors line up nicely with Prochaska’s ideas on the pathway to behavioral change. The stages are fairly clear: precontemplation (not shopping, literally or figuratively); contemplation (research), preparation (comparative evaluation), action (purchasing), sold (maintenance), and advocacy (termination). In the last two stages, the marketing campaign–or incentive model–needs to keep working. As David Chapain notes, in Making the Complex Compelling,
“Change does not end with action; otherwise, the first trip to the gym after a commitment on New Year’s Eve would be sufficient to ensure attendance all year long.”Making the Complex Compelling, ch. 5
The key, then, is the maintenance of commitment, a word that appears only once in the commentary, and not at all in the analysis. Commitment is likely going to be a labor-and time-intensive process, but with nudges from above and our peers, change may be possible.
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