Behaviour change: personal or social accountability?

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The conference debate titled ‘Behaviour change: personal or social accountability?’ was hosted by the BBC’s Gavin Esler on 18 November 2014 at Food Matters Live. Joining the panel were Professor Mike Kelly, Director at NICE; Michael Hallsworth, a Senior Policy Advisor at the Behavioural Insights Team; Jane Wardle, Professor of Clinical Psychology at UCL and Linda Hindle, Lead Allied Health Professional at Public Health England.

Starting the debate, Professor Mike Kelly explained how humans all have automatic and reflective responses to their environment, which can influence how they live, engage and contribute to society. He said, “if people are dominated by automatic responses and have learnt unhealthy and bad habits it is very hard to break out of that mindset,” adding that the public health service generally worked with a reflective system, which aimed to educate and perhaps even frighten people into healthier lifestyles but this clearly wasn’t working. He went on to say it would take many years to shift the kinds of behaviour that resulted in such widespread and growing malnutrition, diabetes and obesity.

Professor Mike Kelly then asked the panel whether they agreed that the success of the UK anti-smoking campaign proved that cross-industry strategies can succeed in changing public behaviour and habits although it took nearly 60 years and involved regulations to the industry, advertising, broadcasting and public health messages. The panel all agreed that to effect such change in the behaviour of the nation’s eating habits, far swifter action was needed and all industries must be involved.

Professor Kelly also compared smoking and unhealthy food but concluded they are not the same; nicotine is a drug, which causes disease, but we all need food to live and many can eat processed foods in moderation with no ill effect. He added that he was worried that the burden of rising obesity and diabetes on our already struggling NHS system would be far worse than that of smoking.

Linda Hindle explained that the problem also stemmed from generations in the UK having grown up without learning to cook simple healthy meals, not sharing mealtimes and relying on unhealthy processed food and takeaway meals. She felt that health professionals could do more to educate people, and went on to add that “few people really understand calories and how to eat healthily and can only manage to change their behaviours in the short term.”

Michael Hallsworth explained how by looking at unconscious factors, which influence what we eat, we can learn ways to change. For example, larger plates encourage bigger servings; drinks in short, fat glasses encourage consumers to drink more than tall thin glasses; and we all eat more if we sit in front of the television. These behaviours become habit and some really simple changes could help improve health.

Professor Jane Wardle explained that most people want to eat healthily but struggle to achieve it in a world where there are opportunities to eat at every turn. People also think they eat more healthily than others. They don’t see themselves as overweight, they see others adopt eating habits and assume they are okay in comparison.

Linda Hindle agreed and said “people can lose weight in the short term but cannot maintain it. This is no surprise when you consider how much society has changed in just 20 years. Fewer families eat meals together and we all eat out more, people eat walking along, on the train and between meals.” She went on to add that people’s ability to change was limited by the lack of time to prepare, cook and wash up and many don’t have the skills anyway.

Professor Mike Kelly thought there were big lessons to learn from the smoking campaign which worked by providing more information about the dangers, increased pricing, massive public information, regular reinforced messaging and legal restrictions regarding advertising. Professor Jane Wardle added that just as with the ‘No Smoking’ campaign the food industry is fighting change. She went on to add that industry wants to move the emphasis towards the crucial role of physical activity but calories are just as much to blame.

The debate went on to discuss how media and marketing campaigns could do a much better job of engaging the public. For example, the anti-smoking campaign used pictures of normal people. Professor Mike Kelly said “articles featuring totally inappropriate pictures of a scruffy, morbidly obese person eating a burger are completely ineffective at illustrating the problem, as the majority of people don’t associate themselves with these images.”

A member of the audience asked why so many health professionals are also overweight or obese. Michael Hallsworth said that doctors and nurses are under the same cultural and social strains as the rest of us; working long hours in a challenging environment with few healthy food options available. He agreed that if even they struggle to make the right choices, despite being educated about the implications, it’s not surprising the general public struggle too.

Linda Hindle said she thought much more work needed to be done to help people to engage with health professionals. For example, regular weighing and addressing increases in weight early on could make a difference. She said, “we can learn from an integrated approach and techniques of how to broach the subject with patients without making them feel criticised.”

Professor Mike Kelly thought that public sector procurement policies at hospitals and schools could have a massive impact. “There has been a trend towards widespread vending machines and newsagents stocked with unhealthy snacks like chocolate bars, sugary drinks and crisps.” He urged the panel that decisions needed to be made soon, saying “these kind of contracts usually run for many years so decisions to change must be made now before it’s too late.”

The panel all agreed that ultimately consumers were accountable for their own behaviour but that the government, industry and society as a whole must all help change systems and processes so that educational measures can be put into place. Even though we live in a world where obesity is now normal it is too easy to say it is everyone’s responsibility to help encourage healthy behaviour.

Professor Mike Kelly urged everyone to act now saying, “no, we can’t wait. The rise in obesity levels is too high. We need to stop blaming those grossly obese people and realise retailers, government and all of us need to act.”

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