Dale Rayman explains how the growing obesity crisis can be tackled through policy change, better-designed wellness programmes and smartphone apps
It's not a pretty statistic. According to research published by the Health and Social Care Information Centre, nearly a quarter of all adults in England are obese and 62% are overweight. Even more worrying is that approximately a quarter of children aged 4-5 and 10-11 are overweight.
The main culprits behind this obesity trend? Sugars and fats. The massive intake of sweet treats and an obesity crisis fuelled by poor nutrition have captured the attention of UK policymakers. In October 2015, Public Health England published a report: Sugar Reduction: The Evidence for Action (the Sugar Report), which detailed the harmful impact of eating too much sugar and outlined a framework for action.
In the US, health-related problems from sugar consumption and poor nutrition are even more pervasive than in the UK. Prior to 1980, energy intake remained relatively constant, but subsequently there has been a dramatic increase for both children and adults, with obesity and diabetes reaching epidemic proportions. The Centers for Disease Control and Prevention report that 35% of adults are obese and 69% are overweight, while 20% of teenagers are obese.
Unless something changes drastically, the UnitedHealth Center for Health Reform & Modernization predicts that 52% of Americans will have diabetes or pre-diabetes by 2020.
In countries with social healthcare systems, the speed to action may be greater because the government can measure the direct impact on programme costs of health issues like obesity. For example, in the UK a study published in the Journal of Public Health shows that obesity and its consequences cost the NHS £5.1bn per year.
Norway, Finland, Hungary, France and Mexico have imposed higher taxes on products with added sugars, and initial results indicate that this has reduced sales.
The UK is set to undertake such a programme, and the Sugar Report does recommend regulation of price promotions on high-sugar foods, especially those targeted at children, and increasing prices of such foods, possibly through taxation. In the US, initiatives to increase taxes on products with added sugars have generally failed, with manufacturers arguing for freedom of choice.
In the US, employers bear the brunt of costs when personnel are hospitalised or miss work owing to nutrition-related illnesses like diabetes and heart disease. In the absence of government-led action on nutrition, most large employers have deployed wellness programmes to help employees get and stay healthy. However, many of these have failed to slow the progression in weight gain, mainly because they invest disproportionately in fitness, stress reduction and tobacco cessation, relative to improving nutrition.
Yet evidence shows that poor nutrition has a significantly greater impact on health status. In fact, a 2013 study in the Journal of the American Medical Association (JAMA) reports that dietary risks have almost three times the impact on both mortality and disability as low physical activity.
Food choice complexity
Why is the most consequential of the wellness pillars being given short shrift? Many wellness companies simply have not developed effective solutions to manage unhealthy eating. Traditional approaches to improving nutrition haven't worked.
Persuading people to order special foods, go on diets or track what they eat is unsustainable. Telling them to eat more vegetables and fruits and less sugar and fat isn't adequate, nor is outlining the consequences of obesity. As BJ Fogg, director of the Persuasive Tech Lab at Stanford University, recently noted, "We shouldn't believe that providing information leads to action - we humans aren't so rational."
What failed healthy eating solutions don't take into account is the complexity of an individual's daily food choices. Employees' lack of engagement in their own health is a top obstacle to changing behaviour. To counteract this, many US companies offer incentives for participation in wellness programmes or for achieving health-related goals. However, even with incentives, eating nutritiously in our current society is extremely challenging for the average person.
We are surrounded by fast-food chains, junk-food manufacturers, price promotions and clever marketing campaigns. The food industry bombards us with advertising of high-sugar, high-calorie foods and beverages. More is spent on promoting these products than on healthy foods.
Furthermore, today's portion sizes are much larger than in the past. In the 20-year period between 1977 and 1996, the average portion size for many foods increased at fast food outlets, other restaurants and even at home. Based on one JAMA study, Patterns and Trends in Food Portion Sizes, these included a 33% increase in the average portion of Mexican food (from 408 to 541 calories), a 34% increase in the average portion of cheeseburgers (from 397 to 533 calories), a 36% increase in the average portion of french fries (from 188 to 256 calories) and a 70% increase in the average portion of salty snacks such as potato crisps and popcorn (from 132 to 225 calories).
Choosing to eat healthily is also complicated by the fact that, for the average person, selecting the right balance of fibre, carbohydrates, fats, sugar, vitamins and sodium isn't easy. A busy lifestyle makes such calculations especially difficult, and it is easier to get a burger and chips at a favourite fast food joint than to try to make sense of nutritional details.
People also have social factors to contend with. They want to go out to restaurants with friends and family and to eat at work with colleagues, while at home they want the option of cooking or ordering in. They do not want nutrition plans that restrict these choices.
Getting with the programme
Wellness programmes need to make it simple to eat well and to recognise the complex social factors that affect eating behaviours, through the use of technology and the latest research on behavioural economics.
They would work across the country with grocery stores, restaurants and company cafeterias on the nutritional content of their meals. Participants would be informed of the healthier choices, whether they are at home, at work or on the go, with the information being personalised to match individual dietary needs (whether vegetarian, vegan, pescatarian or paleo), health status (diabetic, hypertensive) and allergies such as peanuts.
Some vendors now provide simple smartphones apps that navigate the complex maze of food choices and point individuals to healthy options wherever they choose to eat. Armed with these, people no longer need to become experts in navigating the nutritional landmines, as they have their own, personalised, virtual nutritionist.
Empowering people to improve their eating choices in this way works, as evidenced by the experience of a Silicon Valley-based technology company with more than 50,000 employees worldwide. In a pilot programme using such a solution, this company saw an impressive 75% improvement in the eating habits of participants. They increased their intake of fruit by an average of 135% and vegetables by an average of 91%, along with other substantial increases of 106% in fish, 82% in nuts and seeds, 91% in water, 34% in fibre and 15% in calcium. Most importantly, 45% of employees who began the programme overweight had moved into the ideal weight range by the end of the 12-month pilot.
Experts predict that it won't be long before doctors are replacing medication prescriptions and the associated myriad of side effects with personalised food prescriptions carried on our phones, all without limiting where we choose to eat.
Dale Rayman is vice-president of analytics and chief actuary of Zipongo