Is nudge an effective public health strategy to tackle obesity? YesBMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d2168 (Published 14 April 2011) Cite this as: BMJ 2011;342:d2168
All rapid responses
The debated Cabinet document aims to make improvements in public
health, however the means suggested, such as incentivising healthier
choices, are questionable and risk becoming a short term political scheme
with no measurable sustained change in public health.
In his 'yes' argument Oliver refers to a systematic review
evaluating financial incentives for weight loss, which showed no
significant difference to controls. In addition, the referenced RCT
also showed no significant sustained difference between financial
incentive and control. The Stockholm musical stairs experiment was
conducted over just one day. Indeed, a Cochrane review examining
incentive schemes to improve smoking cessation also showed no sustained
change in all but one of the included trials, despite promising early
improvements. Short-term incentives give individuals a short-term
reward for behaviour change that does not seem to translate to sustained
long-term health gains once the incentive is no longer there.
One wonders whether more effective and sustainable strategies could
be employed to target attitudes and social norms, perhaps by open
education rather than covert coercion. Raynor and Lang comment in their
'no' argument on the "complex multifactoral interplay" contributing to
obesity in the UK. Indeed, perhaps attention could be channelled into
education, provision of community facilities for exercise and access to
fresh foods particularly in deprived areas, rather than putting chocolate
at the back of supermarkets where, after all, requires more of a walk!
1 Cabinet Office Behavioural Insights Team. Applying behavioural
insight to health. Cabinet Office, 2010
2 Oliver A. Is nudge an effective public health strategy to tackle
obesity (yes)? BMJ 2001;342:d2168
3 Paul-Ebhohimhen V, Avenell A. Systematic review of the use of
financial incentives in treatments for obesity and overweight. Obesity Rev
4 Volpp KG, John LK, Toxel AB, Norton L, Fassbender J, Lowenstein G.
Financial incentive-based approaches for weight loss. A randomised trial.
5 The piano stairs: thefuntheory.com.
6 Cahill K, Perera R. Competitions and incentives for smoking
cessation. Cochrane Database of Systematic Reviews 2011, Issue 4. Art.
No.: CD004307. DOI: 10.1002/14651858.CD004307.pub4
7 Raynor G, Lang T. Is nudge an effective public health strategy to
tackle obesity (no)? BMJ 2001;342:d2177
Competing interests: No competing interests