Changing Habits, Not Just Diets

With rates of obesity and diabetes at epidemic levels, you’d think it would be enough to simply tell people what they need to do. But the messages about how to eat healthfully — buy local, eat seasonally, shun industrial meat — can be overwhelming and unrealistic for both low-income and time-stressed, middle-class families.

Moreover, much of today’s dietary advice ignores a fundamental truth: Most Americans seek out fast and processed foods, not for the price, but for the convenience and the taste. A recent study in the journal Population Health Management revealed that households earning $60,000 a year ate the most fast food. Households bringing in $80,000 were actually more likely to “have it their way” than those with $30,000.

Until now, mainstream "solutions" to the obesity crisis, and to the broader problem of how to forge a healthier American diet, have focused on making fresh food more affordable and accessible. But as I saw last year while reporting a book on what people eat, and why they eat it, in Huntington, W.Va., many Americans do have access to, and can afford, better food. They just choose not to eat it. Or rather, they choose not to take the time to shop for it, to plan and cook their meals, when they can hit the drive-through or have a pizza delivered or pop a Stouffer’s entrée into the microwave.

Does this mean the battle is lost? On the contrary. A new and growing group of studies point to a third way to persuade Americans to make small but essential changes to their diets and lifestyles. Based on behavior-change theories — a kind of grassroots behavioral economics for public health — these strategies address a range of personal, cultural and environmental factors that affect what people eat. America on the Move, a Denver-based nonprofit, has shown that if overweight and obese people add 2,000 extra steps to their daily routine or cut out 100 calories a day, they can effectively prevent weight gain. In Kentucky, a program called Healthy, Well-Thee and Wise is tracking its multiyear effort to help Appalachian women make realistic changes, such as baking their pork chops instead of frying them, that lead to healthier lifestyles.

Sadly, this approach doesn’t appeal to our culture’s love of quick fixes, the kind of dramatic overhauls that make hits of reality TV shows such as “The Biggest Loser.” But they are simpler and less expensive than plans to pass new regulations or plunk Wal-Marts in the inner cities. Plus, they are about what’s realistic, given the nature of the problem we face. They help Americans to understand not only how to eat well but also how to incorporate a healthy diet into their own lives.

http://www.nytimes.com