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DHAVAL DAVE: If you think about obesity increasing over the last 30 years, it’s because people are making more unhealthy decisions in terms of what they eat. They are in most cases choosing the doughnut over the apple and they’re not exercising enough to make up for that. Cumulative decisions are happening over multiple years.
PHOTO BY CHRIS CONTI
What are the prevailing economic principles illustrated in people’s food choices? DD: Normally when you think about economics, you think about employment and income. But health economics shows that even when people are making decisions that don’t seem to be within the purview of economics, they are inherently guided by economic principles of cost and benefits. Changing demographic trends play an integral role in the decision toward unhealthy food choices: More labor-force participation by working couples means time constraints have increased and people don’t have the time to cook healthy meals at home; jobs have become more sedentary so people don’t expend as much energy as before; technology in production has favored convenience, which may not always equate to healthy choices. All of these changes, even if small on a daily or annual basis, cumulate over time and one’s life cycle. The cost of certain foods has actually decreased, including the price-per-calorie of unhealthy food choices with high fructose corn syrup, due to subsidies to the corn industry. It’s the law of demand: When prices go down, individuals will react by demanding more of that product. From an economic standpoint, there are very valid reasons for these choices. BG: This obesity epidemic costs the government huge amounts of money. The government’s decision to subsidize corn in the 1970s radically changed the cost-per-calorie and the convenience of foods. Companies jumped on this and are making unhealthy calories not only affordable but hyper-palatable for us. What are the everyday realities that drive food choices? BG: Lifestyle is huge. We work with a lot of health plans that say the big issues driving poor food choices are cost and “food deserts” [urban
BEN GARDNER: There won’t be one simple solution. It’s going to take some individual ownership for people to acknowledge they have responsibility. I also think society can help. There’s a role for business and the government in helping people make the choice between the apple and doughnut.
neighborhoods and rural towns without ready access to fresh, healthy and affordable food]. But a lot of folks have never cooked a potato before; they wouldn’t know what to do with a piece of squash. They don’t know how to prepare it and they probably don’t prefer the taste because they’re accustomed to the high-sodium taste of fast food. Culture and lifestyle often trump access and price. DD: That’s a great point. You can’t expect individuals to make drastic changes. You present them with this ideal plate that says half of it should be fruits and veggies, but realistically, it’s not going to happen right away. Policies and interventions that go from Point A to Point C have their work cut out for them; people aren’t going to react very well. Policies that go from Point A to Point B to Point C will have a lot more effectiveness and probability of working. As is true for the problem, incremental changes on the positive side can cumulate and have a strong health-promoting impact over time. BG: We need to start having a realistic conversation. Too often as consumers, we’re asked to make ideal decisions in our daily lives, like eating fresh vegetables every day or running marathons. We tend to inherently seek perfection. But as we know, “perfect” is too hard and it’s not realistic, so we sometimes don’t even try. I’d much rather see modest, incremental changes in the direction of healthier food choices: Small decisions or changes in behavior are easier to make, and we are more likely to stick with them. DD: A lot of behavioral economics suggests that most individuals may not act as “rationally” as economists think they do, and you need to take into account everyday considerations. For example, most people don’t make healthy food choices because the cost of doing so is very immediate. If I let go of the doughnut and go for the apple, I’m not getting the satisfaction
that I crave right now — and I’m not going see any nutritional benefit in choosing the apple until years down the line. Linkwell is making it easier by sending coupons for healthier options of foods that individuals are already eating. Is it fair to say that most people think healthy foods cost more? DD: If you look very basically at price-per-calorie, the apple will cost more than the doughnut. But if you adjust for nutritional content, the costs start converging. If you also take into account the cost on your health, the cost on your disability, mobility and chronic conditions — that’s a cost to the individual. When you bring those costs into it, then the apple becomes really cheap. The point of economists is that people think healthy food costs more, but only because they are taking a very present-minded approach. BG: There’s also the issue of preparing food versus convenience. You can prepare healthy foods on par with going out for fast food — if you buy intelligently. We know that convenience is king, and we’re starting to see shifts with grocers doing some of the work for us with prepared foods; there’s an increase in options where it isn’t just the apple or the doughnut, and that’s encouraging. In today’s society, people don’t plan. Nutritionally we’re much better off if we can plan ahead before going to the supermarket; studies show if you don’t have a list and you’re hungry while shopping, you tend to make poor decisions. I don’t think price is the big hurdle in getting us to eat healthy; it goes back to lifestyle. What interventions stand the best chance of pointing people toward a healthy food choice? BG: I’m a strong believer that it takes a village. I’m not a big policy person, but I don’t have any problem with First Lady Michelle Obama creating standards for nutrition. It’s got to happen on BENTLEY MAGAZINE | 9
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