Thursday, September 27, 2012
Healthy habits are easier when you stop thinking about it
Raising health awareness has done little so far in actually improving global health. Humans seem to be stubbornly attached to certain behaviors, even when fully aware that such behaviors pose a health risk.
Currently, the four most prevalent noncommunicable diseases are diabetes, cardiovascular disease, lung disease, and cancer. The risk of death from any of the four can be significantly lowered by changing basic behaviors such as lowering the consumption of calories, alcohol and tobacco, while increasing physical activity and the consumption of fruits and vegetables. It sounds simple, in theory, but certain behaviors are so engrained in the society that despite widespread campaigns, we still haven't been able to change people's habits. And not surprisingly so, since much of our behavior is often automatic rather than dictated by consciousness. As Marteau et al. state in , not even personalized risk assessments like gene variants and other biomarkers have succeeded in dissuading people from certain behaviors.
We are complex beings, constantly shifting from full awareness and reflective, goal-driven behavior, to more automated actions where deep thoughts are far removed. The former behavior is more costly in terms of metabolic resources and energy. The latter is more efficient in our daily routine, but it has the disadvantage of taking over even when the consequences are undesired. For example, lab animals that have been trained to repeat certain behaviors, they will keep repeating them even when unpleasant consequences are introduced in the experimental setting. Therefore, in order to prevent noncommunicable diseases, Marteau et al. argue that we need to target automatic behaviors rather than conscious ones.
How can this be achieved?
Well, for example making fruits and vegetables very easy to find at the store, and relegate the so-called junk food to some hidden, desolate aisle that requires extra walking to get to. Also (and I know I'm totally going against common economy rules here), making fruits and vegetables cheaper than junk food would cause a huge switch in people's eating habits. If this may sound much of an utopia (yeah, I can see that), here are a few more practical things that can be changed: make stairs accessible from everywhere in a building, and hide the elevators. Make the elevators really slow that it's a lot more practical to take the stairs. Make tobacco and alcohol harder to find (though I have doubts about alcohol, since I grew up in a country where alcohol is on the table every day and somehow we seem to handle alcohol addictions better than other countries with lots of rules and prohibitions). Use smaller serving portions and smaller (but taller) glasses and plates. Marteau et al. even suggest "standing desks" in classrooms to have students spend more calories (this one made me smile).
Here's my two cents. As you know, I grew up in Italy, a country that very much cherishes food and spending social time at the table. I think Italians have pushed things to the far extreme, and now, when I go back to visit, after about one hour of sitting at the table "socializing" I get a little restless. Much of the overweight problems in Italy come from spending too much time at the table. After a while you don't feel hungry anymore but you just keep eating because food is being offered to you.
On the other hand, I see that the United States have the exact opposite problem. There's no definite time of when to eat lunch or dinner, and when you look around you see people eating at any given time of the day. This is just my personal opinion, of course, but I truly believe that introducing fixed eating times in the day can greatly help towards healthier eating behaviors. Also, we should learn from our children. When they are full they stop eating. Parents tend to get edgy and force them to eat more, whereas maybe it should be opposite, it should be the children telling the parents to stop eating so we can all get back into the habit of eating only when we're hungry. Unfortunately, because eating is so much part of our social life and social celebrations, in real life, things tend to get more complicated.
 Theresa M. Marteau, Gareth J. Hollands, & Paul C. Fletcher (2012). Changing Human Behavior to Prevent Disease: The Importance of Targeting Automatic Processes Science