A Little Nudge to Treat Childhood Obesity

Bless their hearts. Really. We know they mean well. Three health policy gurus have a new viewpoint in JAMA Pediatrics on childhood obesity treatment. They explain “how children and families make daily obesity-related decisions.” Because they’re “not rational.” So you have to “keep it simple” for them. Thus, behavioral economics can provide a wonderful little nudge for childhood obesity that will work wonders.

Though they acknowledge that treating child childhood obesity is “so difficult,” they’re optimistic. They see “opportunities” to “maximize the impact of our counseling” through the magic of the behavioral economics.

Not So Fast

It’s not at all clear that these policy gurus have chatted with anyone from the real world of childhood obesity care. So we did that for them. And it seems that this beautiful theory of behavioral economics for childhood obesity care might have a rough ride in the real world.

Nancy Tkacz Browne is an obesity medicine nurse practitioner delivering obesity care on the front lines in rural Maine. She suggests that concepts in the JAMA viewpoint are nothing new:

Meeting families where they are, incremental goal setting that is attainable, and family centered care is hardly new. What they are suggesting is foundational to family and child care. So it’s not obvious that this proposal will solve the problems we face in childhood obesity care.

In other words, they’ve dressed some basic concepts of pediatric care in the jargon of behavioral economics.

A Caricature of Childhood Obesity

Michelle Cardel is a pediatric dietitian and obesity researcher who understands both the science of childhood obesity and the clinical reality. She told us this viewpoint might be a little simplistic:

The authors seem well-intentioned and their recommendations fall in line with current guidelines. But pediatric obesity does not simply result from the inability of individuals to adhere to current recommendations and their desire to “buy candy” and “binge-watch TV.” That is not what the data shows us.

Research tells us clearly that obesity is a multifactorial and complex disease. It develops as a result of a variety of factors. Thus, simply using these behavioral economic principles to change how we frame the same recommendations is unlikely to move the needle on obesity at a population level.

It’s a lovely idea. Let’s just nudge childhood obesity away. That’s a pretty fair description of efforts to date. But it hasn’t had much effect. Rates continue rising. It would be silly to think that borrowing some jargon from behavioral economics will make things better.

What will make things better is to get seriously objective and curious about this chronic disease and provide better care for the children and families that it affects so profoundly. Nothing less will do.

Click here for the viewpoint in JAMA Pediatrics and here for a well-informed perspective from Nancy Tkacz Browne.

Nudge, photograph © Four Doxn / flickr

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February 24, 2020

One Response to “A Little Nudge to Treat Childhood Obesity”

  1. February 24, 2020 at 5:19 pm, Shaari said:

    There is much for me to learn. Along with focus on eating behavior I would ask you all to consider making walk-able/cycle-able safe communities. Physical activity and community engagement has been very helpful.
    Often one must cross a busy parking lot to get to the front entry of the grocery or school. Some towns, like mine, situate the schools separate from the housing and those from the sport fields. Sidewalks in our unincorporated areas are hit and miss, mostly miss. Thank you for your consideration and your focus on childhood related to family health.