An Alternative to Calorie Labels
We just published a new paper:
A top cause of preventable death, obesity is a growing threat to an able-bodied, functioning society. Simply put, overeating is one of the biggest contributions to the obesity epidemic, and despite widespread efforts to promote health education, there may be better ways to combat this problem than by giving people nutritional information and relying on them to use that information to make wise choices. After all, we live in a country where chef Jamie Oliver’s shocking chicken nugget demonstration was absolutely no deterrent to the appeal of a fried blend of gooey chicken carcass.
If even this shocking intervention had no effect, we may need to do more than post calorie labels, a movement that (albeit well-intended) has seen limited success (see 1,2,3). Traditionally, such interventions are more successful at changing attitudes than actual behaviors, and when it comes to health — attitudes and behaviors don’t always go hand in hand.
Of course, we know that just thinking about exercise and eating healthy will not keep us healthy – we can’t lose weight by intending to use the treadmill. We need to put on our gym shorts and start jogging. With food, we can start by simply eating less.
Janet Schwartz and I, along with Jason Riis and Brian Elbel, tested out an alternative to calorie labeling – merely asking customers at a fast food restaurant (with and without a small incentive) if they would like to downsize their side dishes (by taking a half portion of an excessively large high-carbohydrate side dish). We carried out this intervention before and after calorie labels were put in place, and found that while calorie labels had no effect on the number of calories consumed, the offer to downsize did! As much as a third of the customers who were given the offer decided to take less food (compared to ~1% who asked to downsize on their own) and consequently ate less (yes, we even weighed their leftovers), showing that a simple offer to downsize can go a long way toward encouraging a healthier diet.
The conclusion: Offering people a chance to exercise self control can be effective, but we need to stop people, slow them down and offer them to take a better path at the moment when they are placing their order.
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(1) Downs JS, Loewenstein G, & Wisdom J. (2009). The psychology of food consumption: strategies for promoting healthier food choices, American Economic Review, 99(2), 1-10.
(2) Elbel B, Kersh R, Brescoll V, & Dixon LB. (2009). Calorie labeling and food choices: A first look at the effects on low-income people in New York City, Health Affairs, 28(6), 1110-21.
(3) Bollinger B., Leslie P. & Sorensen AT. (forthcoming). Calorie Posting in Chain Restaurants. AEJ: Economic Policy.
The Honest Truth About Dishonesty: How We Lie to Everyone - Especially Ourselves
What kind of restaurant would offer this service?
A bankrupt one!
…unless they built it into their culture in the same way Starbucks got us to think “Tall” is small.
This is why fast food locations ask if you want to “super size” your order. I wonder if it has something to do with providing an option to people that the had not considered previously. The additional option sounds appealing if for no other fact that it’s been offered.
Sit-down resturants usually serve more food than most people should be eating at one serving. What if they provided take home containers when they served your food rather than once you were done eating? What if they served your food with half on the plate and half already packed to go home. You could eat the second half at the resturant, but you’d have to take it out.
I order a $5 footlong when I’m at Subway. I get an eat-in tray and a to-go bag. I eat half there, and take the rest home for lunch the next day.
Right on. My own research and experience points to portion control as being one of the main solutions to the obesity epidemic.
>we can’t lose weight by intending to use the treadmill.
Actually, research indicates that we don’t lose weight by getting on the treadmill, either. Weight loss is the one bio-marker than is not much affected by exercise, although all other health indicators generally improve.
Your understanding of the changes in the world food supply over our lifetimes is stunningly simplistic.
Cutting back on a grossly oversized side dish that offers only marginally different nutrient density from the grossly oversized, over-dressed, overcarbed surrogate meat product main dish is not going to make any measurable difference in a long term health outcome.
You’ve said a lot of NOs. What are you suggested DOES work?
Michael Pollan: Eat food, not too much, mostly plants.
Although Dan’s study may begin to touch the very edges of “not too much,” nothing at the restaurants mentioned in Dan’s study qualifies as “food,” hardly, and even the fries are a LONG way from “plants.”
As other posters have noted below, serious nutrition science is starting to come around what Dr. Atkins publicized 30 years ago. Low carb, plenty of good fat, and enough protein.
While a rose may be a rose may be a rose, a calorie is not… Carb calories, particularly the high-glycemic index ones sold in fast food restaurants, most COMPLETELY PARTICULARLY HFCS, get used in the body VERY differently from good fats (also from bad fats, for that matter, but I’m trying to forestall an argument), and very differently from proteins.
As other posters have suggested, read Gary Taubes if you’re up for the hard science, Atkins if you’re cheap and at a used book sale because there are always a dozen of his around, and Eric Westman (Duke Med, BTW) if you want the most current popular version. Eric is easier to follow and more pragmatic than Taubes, but Taubes doesn’t waste space on recipes. (My prejudice flares…)
Preliminary indications are that a high glycemic index diet (like that found in a fast food menu) promotes Alzheimer’s, in addition to plain old obesity.
I don’t believe 90% of anything I read on diets, including in this thread and your specific advice. It’s nothing personal. Everyone has a study for this or that, or anecdotal evidence for something … only to be overturned next year.
I find *this* study particularly useful for cutting ALL the opinions stated in this thread:
http://blog.seattlepi.com/timigustafsonrd/2012/02/05/for-weight-loss-cutting-back-on-calories-matters-most/
“People who swear by a particular diet to lose weight may be fooling themselves, according to a recent study… There is no real evidence that low-carb, low-fat or high-protein diets make as big a difference as overall calorie reduction when it comes to weight loss…… While these study results should not come as a major surprise, they are not necessarily welcome news for the diet- and weight loss industry. After all, Americans spend billions of dollars annually in a highly competitive market of weight loss programs and dieting ideas. Could the ultimate solution be as simple as eating less and burning off more calories for the rest of your life?”
David C, please read the book. You will be amazed.
Please read the study
I really would like to have access to it. From the article you sent we cannot take any conclusions.
For instance, in many of these kind of studies what the doctors say are “low-carb” diets are actually very high-carb in comparison with what we need to get thinner. Do you have any links?
Who paid for the study?
>“The major predictor for weight loss was adherence,” said Dr. Bray. “Those participants who adhered better, lost more weight than those who did not.”
True for any behavior change. Many people, perhaps not you, find it easier to adhere to a low-to-lower carb way of eating. YMMV.
what evidence is there that low carb diet is easier to stick with?
Again, everything everyone above has said is nonsense, as far as I can tell. Reading this book or that book proves nothing. This study shows that what diet you choose doesn’t matter much for weight lose. Make sure to get enough protein, sure, but assuming that, any diet works, if you stick with it.
http://www.pbrc.edu/news/?ArticleID=88
“People wanting to lose weight can choose one of a variety of diets – they all worked… Whether high or low fat, protein or carbohydrate, all diets studied led to long-term weight loss.”
Actually, Gary Taubes’ “Why We Get Fat” is very easy to read and follow.
His “Good Calories, Bad Calories” is in fact a lot more intense, but I think almost anyone can read, understand and enjoy “Why We…”.
Karen – did you forget you’re commenting on a behavioral economics blog, and not one dedicated to nutrition?
Dan noted that the side dishes were high carbohydrate, as many side dishes tend to be. By reducing the quantity of them offered/provided/consumed, it results in a reduction of the intake of high glycemic index carbs.
Idealistic solutions do not work. Dan is investigating a small tweak to the way we present food offerings. Without changing anything about food source, quality, nutritional ratios, or preparation, is there a way to fight obesity incrementally by changing the way the food is offered?
All else being equal, I think it’s reasonable to suggest that lowering your calorie intake could either lead to (a) a better chance at weight loss, or (b) a slower rate of weight increase. Again, all else being equal, either of those things would be an improvement to your average everyday omnivore.
As far as I know, you also burn calories while on a treadmill.
My criticism for Dan would be more on the behavioral side of things. An offer of a reduced portion is something NEW to people. They may react very differently after repeated exposure to the same interaction over time.
Would the same subjects persist with a reduction in quantity consumed indefinitely?
Of course, we can then drill down into how it affects related behavior. E.g. Do they justify the consumption of high calorie/GI dessert or subsequent snacks due to acknowledging their calorie savings?
>is there a way to fight obesity incrementally by changing the way the food is offered?
You think fast food fries are food. I think they are obesity pills.
Do you want less tobacco in your cigarette? Do you want 3.2 beer instead of the real stuff? We already know how these experiments turn out.
Karen, you’re being hyperbolic. I understand your passion and your argument. I don’t disagree with where you’re coming from, but you’re not providing a realistic, solution based response.
I’ll restate your question as “Do you think less of a bad thing is a good idea?”
Yes. I’m from an iterative and incremental school of thought.
The better option is complete removal of all bad things. Does that sound realistic even if a wonderful goal?
We have to balance benefit with feasibility, and I’d suggest restraint from dismissing small steps in the right direction.
You might like ideas like a significant fast food tax (for example) to discourage people from eating at any restaurant in that class as a sort of punitive strategy targeting the wallet instead of the body.
Joe, I understand (or think i understand
what Karen is saying: Dan is trying to apply behavioral theory to a obesity theory that says the solution is to eat less.
The fact is that other obesity theories exist, and particularly a very strong one that says that you need to eat less carbs, and that eating less in general can in fact be a nuisance to getting thin.
Hey Lucas,
If the criticism is regarding whether general calorie reduction is not as effective as carbohydrate reduction, Dan does make specific mention of carbohydrates:
“by taking a half portion of an excessively large high-carbohydrate side dish”
I just find it difficult to imagine that transitioning from a habit of always eating an over-sized side dish of a high carb food (or pseudo-food) product to 1/2 to 1/3 of the portion *indefinitely* would have absolutely no impact on body weight.
The research has to be relevant to the common habits of the obese who may certainly have difficulty making healthier choices (or sticking with them). I don’t think it’s directed at those with a healthy body weight, fantastic “real” food sources, perfect caloric ratios, and unshakable willpower. =)
Alas… I do wish we could all eat more like Karen suggests! No argument there. Just the feasibility and a differing opinion as to whether or not Dan’s findings *could* lead to a strategy yielding incremental improvement.
Thanks, Lucas; you get my point.
We’re talking about fast-food-french-fries. Some people think they are “food.” Other people (me, but I’m not alone), think they are highly addictive recreational-drug-like substances with close to zero nutritional value. While it’s true that people who smoke less have, perhaps, smaller chances of getting lung cancer than a 3-pack-a-day smoker, it’s not that much less.
I repeat: We’ve tested this approach with low-tar and nicotine cigarettes. People smoked more of them.
A realistic, solution based response is, “don’t eat french fries.” (It’s not about eating the way Karen suggests, BTW: I’m simply following Atkins, Taubes, Westman, and every other writer who understands the effects that a high-carb way of eating (generally understood to be more than 60-100 g/carbs/day) has on people who are developing insulin resistance.
That’s idealistic, Karen, and that’s my point. If a prohibition of french fries and every other non or lessor nutritious food was imposed and could not be circumvented, we’d be much healthier. Absolutely.
How do we make that happen for everyone? If it’s realistic, then you should be able to describe how it would come about? That’s the challenge. My contention is that it’ll require incremental improvements over time when we’re looking at a collective group of people with vastly different lifestyles and characteristics.
When I want to get healthier, I’ll be following your plan. How do we convince and recruit everyone else to do the same?
Yet, there are incremental options for change that can be made to move in the right direction. Examples:
- Impose a fast food tax as a disincentive to consumption
- Ban fast foods in schools and stop classifying pizza as a vegetable
- Use the revenues from the aforementioned tax to subsidize healthy foods for schools and fund early education programs on topics related to health, eating habits, and nutrition, etc.
- Create white papers for food manufacturers or restaurants that include recommended best practices on food selection, preparation, quality, and presentation, etc. Such best practices may include tweaks such as Dan is investigating here… and maybe we’ll discover later that it doesn’t have the intended effect in practice and will need to be abandoned. Note: In fairness, it doesn’t have a great chance of acceptance in a fast food market that profits from super sizing, but it’s still worthy of study regarding the behavior it invokes.
Then you measure the impact of such strategies and adjust or abandon what isn’t working or needs to be improved. Try new ideas, rinse and repeat.
We could try banning french fries or mandating that they be served in containers with pictures of worms or decaying roadkill or the bodies of heart attack victims on them (similar to what cigarette manufacturers must do in Canada), but the public (and legislators) are extremely unlikely to support it.
On a related note, I did hear recently about a town in the US that created a bylaw preventing new fast food franchises from operating within town limits. That’s an incremental experiment.
Obesity is growing because of misguided efforts that go into “eat less fat”, “exercise more” and “eat smaller portions”. I’m not a researcher like Karen seems to be, but my own anecdotal evidence (as well as what I’ve seen from people around me) shows that Karen is right on the money:
- Exercising more is great for your health, but barely marginal for weight lose (and takes a lot of conscious effort, which as Dan often proves, is a limited resource)
- Eating less makes you hungry, which leads to loss of control (again, a classic experiment of low blood sugar making it hard to exercise self control) and ending up eating more. Eating portions that make you full helps you lose weight
- Labeling “Low Fat” as the solution to the problem makes people give up on their diet since it “doesn’t work”. This then leads to theories about it being genetic or maybe “I have a different metabolism”
As for what DOES work, I think we know the answer, but sadly there’s been little to no formal research. Ketogenic diets work to everyone who tries them, yet there doesn’t seem to be any official body looking into them. Fighting sugar the way “Low fat” is currently presented is probably going to reduce obesity almost immediately.
Finding out a healthy, but low carb, diet regime will probably have the most impact. Finding a way to label glycemic index values of dishes will do 10 times more than labeling calories currently does
But my main point is that telling people (almost forcing them) to do something that will not help them lose weight in the long run, is probably the biggest contributor to obesity. Other ridiculous things like “low fat” and the “food pyramid” helps keeping those people obese.
Maybe those who took the smaller serving felt.shamed into it, then later offset these lost calories with a bigger than usual meal? Maybe they never came back to the restaurant that implied they were fatties .
German media seem to agree that the best dieting results are produced by the “FDH” diet (“Friss die Hälfte” = “eat half of it”).
Can you point to a validated scientific theory of obesity? Is it fat content in the food (but what about the french)? Is it too much food (but what about obese people in under-undernourished communities)? What about the theory that sugars/carbs are a bigger dietary problem (and yet they are the foundation of the government-recommended food pyramid)?
As much as I find the experiment with the kids interesting (it shows that education takes more than 10 minutes, especially if bad habits have been formed), it seems premature to study how to nudge people into specific diets until you have established a strong causal link to explain the problem. Gary Taubes surveyed the scientific literature and found no such strong link (yet the medical community preaches low fat, less food and more exercise diets).
He has a good interview with economist Russ Roberts on EconTalk at http://www.econtalk.org/archives/2011/11/taubes_on_fat_s.html
Do you have any links to scientific papers that prove taht obesity is a top cause of preventable death? Someone recently linked me to some stuff (that I haven’t had a chance to read yet) that claims that actually, it isn’t. I’d like to read both sides of the story. Ta.
I suspect you’ll find that obesity, in and of itself, is no different than “normal” weight. Obesity as the end product of a high-glycemic index diet, less than ideal exercise, and all the other “bad” markers that are now tracked in the category of metabolic syndrome, will lead to (theoretically) preventable death.
N=statistically invalid numbers, but the people who are larger than me at my local grocery store are not filling their grocery carts with foods that suggest a nutritionally healthy way of eating. Maybe they buy the good stuff somewhere else.
I accede with you only thinking about exercise and eating healthy will no way help any body unless we don’t put any efforts or have a positive view to really shed off extra fat. Eat healthy as an ideal diet plan can bring a great difference along with regular workout.
About portion control and seemingly large & small portions is written very well by Brian Wansink: http://mindlesseating.org/about.php
And the newest insights indeed show, like Karen Tiede says, threadmill-work won’t get you slimmer.
Eating smarter (Tim Ferris) and eating less works.
I’m with Julien, AJ and Karen: anyone wanting to get conclusions anout anything related to obesity should read Gary Taubes’ books “Why We Get Fat” and “Good Calories, Bad Calories”. There’s a paradigm change going on right now in nutrition science.
And, for a brief exposition, I suggest Peter Attia’s blog: http://waroninsulin.com/faq/quick-faq .
Obesity is not caused by overeating or lack of exercising, the data points that it’s just the other way around.
You really need not worry about half these comments. These people need to read it over and understand it for what it says. It’s not making any broad overall solution proposition. It’s showing something that worked compared to similar other approaches. On top of that who leaves comments about other articles they never read? Also Starbucks probably wants you to think tall as in big. Not as in small. So that you don’t have a venti or grande. Get it? The choice is urs. You can go back there if you need more coffee but the labels are fair.
Of course smaller portions will help. I lived in Japan for years and I must say that beside the quality of the food there, which may be considered low calorie in comparison to the West, I think another factor is the number of small portions in a meal. A typical ‘bento’ box meal has rice and a main dish but three or more side dishes. Most meals I made and eat then and now include many types of dishes and that variety prevents one from consuming too much of one dish (but noticeably those who filled up on one dish, seemed to have more weight problems.). Returning here to the States made me realize that many meals are consumed without utensils and in one big portion ( burger, sandwich, pasta) , and, on one big plate. This might be just my personal observation, but portion number matters as much as size.
Not only obesity is a problem, the extreme thinness also have if you can publish any post on the subject. I’d appreciate it.
You may notice that almost all of the major health problems “linked” to obesity are also linked to a Western meat-centered diet. If anyone can show me a peer-reviewed study that demonstrates that obesity causes significant health problems which controls for a meat-centered versus vegetarian diet, I’d love to see it.
It’s not portion size. It’s not sugar. It’s not fats. It’s not carbs. It’s not meats. It’s not processed foods. And the solution to growing obesity isn’t as complex as rocket science or as contrived as Pollan-pecking either.
It’s the constant noshing, snacking, guzzling, grazing right through the spells between meals that’s pervaded our daily routine that’s responsible for widespread obesity.
Thirty to forty years ago no one carried snacks or soft drinks, or coffees or energy drinks or smoothies everyplace they went or worked; no one toted candy bars or microwave popcorn everywhere they went or worked; and workplaces that had cafeterias served lunch only and then shut down for the day. Workplaces did not have all-day kitchen-lunch rooms (replete with fridge, hot plate, vending machines, microwave oven, coffemaker, &c.) in which someone – employer or coworker – daily puts out on the counter everything from bagels and doughnuts to cakes and sodas and candies for everyone to nosh on all damn day long.
Also, thirty-forty years ago coffee was just plain old java – with maybe two sugars and a jot of milk or half-&-half in it, and many people drank sugarless coffee, black or maybe with a tot of milk in it. In those bygone days the lone office coffee addict was an object of collective ribbing; while nowadays coffees are not only super-sized but are also jam-packed with all sorts of extra fats and sugars, and the super-richened consume-coffee-all-day habit has become epidemic.
Thirty-forty years ago most cars lacked…cupholders! There were no insulated super-sized travel mugs with dash magnets or Velcro-holder-pads. Having to hold your hot McDonald’s styrofoam coffee cup or paper soda cup between your thighs discouraged on-the-go consumption (also blame those thermoformed lids, which did not exist years ago, that are now snapped over the rim of foam and paper coffee and soda cups that make beverages eminently portable). Most people back then did not drink or stuff their pusses while they drove or sat behind the wheel in gridlock. And on the subway and buses – or in supermarkets or shops – you rarely saw anyone sucking down soda from Big Gulp cups or jamming snacks down their gullets.
Thirty to forty years ago except for pickled hard-boiled eggs, pretzels, or peanuts, corner taverns did not offer or serve chow – unlike today as just about every bar also shovels out burgers and fries and pizza and potato skins all night long to wash down with your does-not-compensate-except-your-guilt Lite beer.
People used to eat just Three Squares A Day – and these meals consisted of what we now think ourselves so-smart to denigrate as much-too-rich “comfort food,” and maybe folks snacked on a little something while watching their evening TV. But nowadays, all day and night long, even in bed (unheard of three or four decades ago) people in this round-the-clock instant-constant-gratification pomo culture are shoving grub and pouring rich drinks into their pie-holes.
Simple solution: TAKE A BREAK BETWEEN MEALS, FOLKS!
I know Mr. Ariely is talking about fast-food restaurants, but I’d love to see a slim waitress at a sit-down joint greet a table of overweight gals and ask them if they’d like to downsize their order. Hoo boy.
Recently at two different fast food chains I ordered a medium drink and was told the large (obscenely large) was actually cheaper. This occurred in eastern N.C. where obesity is out of control.
The first time I paid the extra 50% to get 50% less drink.
The second time I negotiated with the cashier when told of the inverted pricing scheme. I ordered the large but asked that she put it in a medium cup. She was puzzled for a bit but then did what I asked.
I think this is similar to the principle of the “100-calorie snack packs.” Manufacturers have figured out that people will pay more to be “saved from themselves” and served smaller portions. What do you think?
Kudos on down-sizing portions! I’d choose this every time I go out if it were available. Portions are waaaay too big.
Joe Ward: you are right. It’s valid even in a “low-carb” framework. But the lesson here is “if I’m going to nudge people to choose X, first let’s make sure that X is really the right thing to do”.
Nutrition science is really slippery (much like economics), and many conclusions people think are “already proved by thousands of studies” are really not. The difficulty of doing large-scale studies is such that “thousands of studies” don’t even exist in a single subject!
People of world are suffering these health consequences like obesity and related problems because of their bad choices of food and their unhealthy lifestyle only minding these habits would be the first step to initiate any weight loss plan.
Chik-Fil-A began offering its “small” milkshake a few years back. I’d only had one ‘regular’ C.F.A. milkshake before that and I remember thinking “Dear God that was huge and disgusting.” Now that they have the “small,” though, I’ve had more of them.
What kind of psychological thing is happening there? Why is it easier for me to completely ignore the ‘really big’ shake, but the small one is so much more tempting?
(An aside: In general, I eat an extremely calorically restricted diet. My general pattern of restrictive eating may have some effect on my decision but I consume the milkshakes on my ‘cheat’ days that happen once or twice a month.)
Apologies for going back to how food in Japan. Snacks are also often sold in individual one portion packs there which I think appeals to the consumer there, but I believe it also does regulate a person’s portion control decisions…Actually they are already made for you! The ‘cute’ aspect is appealing there, but it also has much to do how the most food is serve…in small portions and in variety.
But, here in the US,
I feel the psychology of getting a good deal or value may be hazardous to many consumers who don’t pay attention to portion control. The 2 for 1, the 10 for 10 dollars, the coupons all may contribute to the ‘more is better’ phenomena. So I wonder if this tendency could be used in a positive way, by offering a 2 for 1 or 5 for 5, but making only healthy choices available that can not be duplicated….
suggesting that customers should downsize their meal will help keep them healthier but its a conflict of interest for the restaurant? How can we make this a win win situation for the customer and the restaurant?
Forget McDonalds and fries, eat fruits and vegetables.
As an rational psicopath a.k.a. economist, who is no longer obese, I looked up in google “obesity and debt”. My take is that true freedom is dennying ourselfs the pleasures of life. How about a freedom index? Where if you are thin and out of debt, you have freedom to eat and spend. As an observation, I was fat, and lost weight just when my savings got to a reasonable level, that made me feel safe about my future. So my hypothesis would be that weight and debt is directly related in that they express the relationship we have with freedom: cutting down on present pleasure, for future freedom of choice. Now I need funding and guidance to test it. too bad I left my neoliberal education 10 years ago. Thanks Dan.
Dan – i just had a heartbreaking talk with a professional friend – very busy – very successful – but obsese. I see the merit of the slow down at point of decision (we don’t decide to eat a bucket of popcorn we decide to eat popcorn) … but has anyone segmented out if some approaches work better for those who need it most? our most at risk populations? is a binary approach (like you’ve said it’s easier to stop drinking than lose weight – it’s not a question of i’ll only drink 6 oz it’s simple/binary)?
Fast food restaurants should never have come up with the “super size” choice. I realize it was for their benefit, but it does contribute to obesity in this country. But, I guess you could look at it in a different way also. People need to take control of their bodies and not give in to temptation, and realize what this kind of food is doing to their bodies.
I accede with you only thinking about exercise and eating healthy will no way help any body unless we don’t put any efforts or have a positive view to really shed off extra fat.
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Hi Dan,
Im sorry but I think this research was a waste because you hinge on an incorrect premise, which is this…
“Simply put, overeating is one of the biggest contributions to the obesity epidemic,”
Let me say this, “simply put” , playing mind tricks in order to get people to consume less ‘calories’ will not change the obesity epidemic. Even if you fool someone to downsize his lunch, he will either compensate at dinner, or at some future meal. OR, if he continues downsizing his meals, his body will reduce its BMR to match his overall reduced calorie intake.
Its called negative feedback loop. And body-fat is regulated by such a mechanism.