Is nudge an effective public health strategy to tackle obesity? No

BMJ 2011; 342 doi: (Published 14 April 2011)
Cite this as: BMJ 2011;342:d2177

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Practice in the health sector has shown us that pushing people gently is not a good strategic method to achieve evolutionary success in solving the great current problems in people health around the world.

The Colombian health service has created and even now creates several nonprofessional figures of health manpower to nudge people into tackling problems related to malnutrition, and not only are there not solutions, but there are also an increasing number of overweight people and a higher morbidity and mortality rate from diabetes, hypertension, cardio and brain vascular diseases. This kind of nudge has created more corruption, nepotism, bad use of health economics resources and new forms of dirty business.

After the sixties of the last century the Colombian Association of Medical Faculties promoted a new educational dynamic and we passed from the traditional Flexner medical educational system to another which focuses on social dynamics as a strategy to bring students of nursing and medicine to the most depressed suburbs and quarters to solve the health problems of poor communities. The result was to fill the medical and nursing curricula with a lot of subjects typical for students from sociological careers.

In Colombia malnutrition is mainly the result of people's inability to buy adequate foods rich in essential nutrients. As a second factor we can name the people's failure to understand the importance of proper nutrition in growth and development. A third factor is related to the coming of new technologies, which are producing radical and critical changes in dynamics of all societies around the world. A fourth factor is advertising and permission of distribution and selling of dangerous street foods.

The correction of these situations requires:
To increase workers' salary wages, to a globalized economical level. People don't have the necessary money for eating and living well. We are living a similar time to that lived by people during the eighteenth century when new engines and industrial procedures appeared, but with a big difference, nowadays' machines are more powerful and productive than those of the industrial revolution. For this reason it's necessary to create a wide social security system for poorest people and to decrease the big gap between riches and poor people.

To educate people at a primary humanitarian compulsory school (in Colombia we have a basic primary one), in aspects related with the importance of nutrition in human life and social behavior. It's urgent and indispensable to prohibit and to eradicate forever distribution and selling of rambler street foods. Don't permit the official opening of restaurants, better called "degradants", where people eat bad quality products, which don't have indispensable nutrients for living and restoring our body. At street level it's necessary to rule with a rod of iron.

To promote a new living culture characterized by a permanent daily physical activity. It's necessary to move the people.

Competing interests: None declared

Emilio Polo Ledezma, Teacher of Clinical Biochemistry.

Carlos Polo Rivera - Ninth Semester Medical Student.

Health's Faculty of the Surcolombiana University, Paca Research Group, Neiva -Huila -Colombia.

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