The Health of Nations | The Health Care Blog

A good discussion of the purist versus ‘nudging’ approach to changing behaviour, using the example of a program called LinkWell that provides discount coupons for better, if imperfect, food choices. I tend towards the realistic approach argued for below:

The purists among my colleagues criticize such guidance because it does not advocate for consumption of pure foods only — although those, of course, do score highest of all. But I am not aware of any scientific evidence that encouraging people to eat pure foods, mostly plants has ever changed health outcomes — because such advice only reaches people already inclined to live that way. Such advice is routinely cheered by those who embrace it already. Such guidance makes no difference at all to the people who most need some help.

In contrast, I am aware of real-world evidence that guidance for trading up every food choice to a slightly better one can make an enormous difference. And that it actually has done so, repeatedly. And that simply by making slightly better choices often, the net nutritional benefit can add up tolower rates of both chronic disease and premature death.

If only perfect would do, then calorie counts, nutrition fact panels, and ingredient lists would be moot. We could simply tell everyone to eat more spinach, and leave it at that. If only perfect would do, then modest doses of daily physical activity would be pointless. Either make the Olympic Team, or enjoy your couch.

But just last week came evidence that a mere 20 minutes of daily physical activity can be the difference between a child succumbing to Type 2 diabetes — or not. That matters. As do the actualchoices made among foods in packages. So the public health can, in fact, be advanced with programming to empower modest amounts of daily physical activity in adults and children alike, and by programming in schools, supermarkets, or that is sent in the mail to help people trade up their food choices.

The Health of Nations | The Health Care Blog.

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