Dr Rachel Crockett, Lecturer in Psychology, Faculty of Natural Sciences, University of Stirling
In the latest bite-sized lecture, Dr Rachel Crockett considers the role of behaviour in understanding how both #Covid-19 the global obesity pandemic might be tackled.
Watch the lecture online or read the transcript below.
Hello. I am Rachel Crockett and I am a Registered Health Psychologist and Lecturer in the Psychology Department at Stirling University. I am fascinated by the complexity of human behaviour particularly in relation to health. In this lecture I want to draw your attention to the role of behaviour in understanding how we might tackle both the Covid-19 pandemic and the obesity pandemic.
Obesity – a global pandemic
Obesity is a problem that we are all probably very well aware off. In 2016 the World Health Organization estimated that more than 1.9 billion adults globally were overweight or obese. This is equivalent to 39% of the population of the world. We worry about these rising rates of obesity because obesity is associated with a range of serious health conditions such as heart disease, type 2 diabetes and cancer. Although it is difficult to estimate the impact of obesity on the health and well-being of individuals. However, in the UK the National Obesity forum report figures estimating that on average, obesity deprives an individual of an extra nine years of life.
We are also all very well-aware of the current Covid-19 pandemic. In less than a year Covid-19 has come to challenge every aspect of our day to day lives. The seriousness of the pandemic is reflected in figures from the World Health Organization who reported that on the 5th August this year, 2020, there had been 18,354,342 confirmed cases of COVID-19, including 696,147 deaths, reported to WHO. As we are all aware many cases of Covid-19 are going unreported or untestested so these figures are likely to be an underestimation. These cases have resulted in nearly 700,000 deaths twhich have been reported to the World Health Organization.
Obesity and Covid-19 might seem to be very different conditions but there share significant characteristics. Specifically, both are related to behaviour and obesity increases the risk for experiencing severe cases of Covid-19.
The types of behaviour that relate to obesity include whether or not we are physically active, whether or not we eat a healthy diet or whether we tend to eat less healthy foods and a range of other behaviours including consumption of alcohol. The spread of Covid 19 between individuals can be contained vy a range of behaviours including, handwashing, social distancing and wearing mask.
In the UK we live in a society in which, sufficient financial resources, we expect to be able to take a high degree of control over our lives. We believe that we are autonomous individuals and therefore we are responsible both for our actions and the consequences of those actions. In addition, we believe that we have freedom of choice and that failures to make choices which support our health and well-being are the result of our individual failures in self-regulation.
The UK government has, throughout the Covid-19 pandemic, shown a hesitancy to behavioural restrictions preferring instead to rely on the “innate common sense” of the British people. The hesitancy to impose measures to control risky behaviours in relation to Covid-19 reflect similar reluctance to regulate behaviour in relation to overweight and obesity.
Arguments that the individual, rather than the state or any other body, is responsible for regulating behaviour are predicated on a specific understanding of choice. That is, that we all start from a “choice-neutral” situation and that the only influences on our choices are our own preferences or, where we make a choice which goes against out preferences, our lack of self-control. However, I argue that there are substantial constraints on our ability to make free choices. While my research focusses on constraints to in relation to healthy food choices, there are similar constraints across a range of health-related behaviours.
The process of making a choice in any situation is complex and influenced by a wide range of issues, not all of them salient to the individual. At the individual level a choice consists of the cognitive processes associated with the selection of a preferred option and the behavioural enactment of that choice. However, making choices in this highly rational manner is time consuming and cognitively demanding, particularly in the face of the many competing demands that we meet on our time and attention. Consequently, we all too frequently fail to make the healthy choice and instead, in the face of a tempting food choice, make an automatic, rapid choice based on emotional and physiological processes.
Rising rates of obesity cannot be attributed to decreases in self-control among individuals. Obesity is a complex issue and there is no single explanation for these rises. However, rising rates of obesity have occurred alongside significant changes in the day-to-day environments in which we live.
People live in an environment in which they are faced with many convenient and highly palatable food options. Modern lifestyles make these food options appealing because they are quick and easy to prepare. Pre-packaged foods tend to be high in calories and energy-dense by which I mean that they provide a large number of calories relative to the size of a portion.
These foods are also highly marketed using advertising, packaging and promotional pricing.
So I hope you’ll see that one of the reasons we find it difficult to make more healthy choices about what we eat is because the environment in which we live promotes less healthy choices on many occasions.
Tackling obesity – strategies and success
The Prime Minister, Mr Johnson’s, experience of being seriously ill has apparently led to a realisation that being overweight put him at greater risk from the virus. It has been widely reported that this has led to a change of heart towards greater regulation of food production and marketing with a proposed strategy including nutritional labelling on restaurant menus and banning the advertising of foods high in fat, salt and sugar on television before the nine pm watershed. These measures have been fiercely resisted by the food industry, lobbying organisations and politicians including, in the past, Mr Johnson himself. Such measures have been understood as limiting individual freedom to make unhealthy, as well as healthy, choices.
But how effective are strategies like nutritional labelling likely to be? With colleagues I recently conducted a review of all the evidence of the impact of nutritional labelling behaviour.
Our research suggests that strategies such as nutritional labelling on restaurant menus can be effective in reducing calorie consumption. For example our research showed a significant reduction of 47 calories purchased in a restaurant when a menu had calorie labelling. These effects are small and, in isolation, will not contribute to large reductions in obesity.
This is not unexpected; rises in obesity are not due to individual and isolated changes in the environment. Rather they are due to multiple changes in the environment all linked to the changing way we live our lives. Thus, a range of measures creating an environment that supports more healthy food choices will be required to tackle obesity.
Such measures might include differential pricing of more and less healthy products, changing the availability of these options and regulation of the production and marketing of foods which are high in fats, salt and sugar. Whatever measures are implemented they need to be based on a message that is consistent across government.
Resistance to regulation to tackle obesity is mirrored in resistance to regulations to manage the spread of Covid-19. In the long term we will need to make changes to our day-to-day behaviour to manage the spread of both pandemics. One conclusion we might want to consider drawing from the complementary experiences of managing these pandemics is that, even in a society in which we value individual choice, we recognise the value of balanced regulatory action to create an environment which supports those choices.