Obesity and chronic diseases, such as cardiovascular disease and type 2 diabetes, are global problems. According to the World Health Organisation (WHO), the number of obese people worldwide has tripled since 1975. As many as two billion adults and 38 million children under five are overweight.
While there is a wealth of knowledge about what a healthy and sustainable diet looks like, it is very difficult for many people to make healthy and sustainable choices. ‘The Corona epidemic has once again put us face to face with the facts,’ says Maartje Poelman of the Consumption and Healthy Lifestyles (CHL) group. ‘People with obesity and chronic illnesses appear to have a significantly higher risk of developing the disease and being admitted to the ICU.’
‘For a long time, public health and nutrition policy has been based on the idea that knowledge and intention among individual consumers are the key to a healthy and sustainable diet,' says Poelman. ‘If someone gets the right information and wants to eat differently, he or she will change. But from the behavioural and health sciences we have known for a long time that this is not how it works. Food choices are very complex. The social and physical environment in which people live, for example, also has a strong influence on our eating behaviour.’
A question of balance
At CHL, we ask questions such as: why does our social and physical environment influence our food choices? What mechanisms play a role in this? How can socio-economic differences in food choices be explained? If we understand this even better, we can also develop better tools. This is also what we at CHL are looking at: how can we develop interventions based on such fundamental insights? And which interventions are then effective and how do you implement them?’
If we want to collectively switch to a healthier and more sustainable eating pattern, a system change is needed, Poelman observes. ‘Just look at the streetscape and in supermarkets. In shopping streets, the majority of the food on offer consists of unhealthy and highly processed convenience foods. That's no different in supermarkets. I estimate that the ratio is 75% unhealthy and highly processed food compared to 25% healthy food. In advertising and promotion, too, that is roughly the ratio we see. If that were to be reversed, we could take a huge step forward. It is a question of balance. Healthy and sustainable must become the norm.’
Something is not right
With the criticism that that would be patronising of the consumer, Poelman makes short shrift: 'If you encourage people to make healthy and sustainable choices via an alternative offer or nudging, that would be patronising, but if you promote unhealthy and unsustainable food via advertisements and offers, it is called 'marketing' and is it allowed? Something is not right there!’
Social norms play an important role in behaviour, the researchers know. ‘We found that the larger the number of fast food outlets in a neighbourhood, the more common and normal it is for inhabitants of that neighbourhood to eat fast food. You can do something with that, for example in environmental policy for a healthier living environment', says Poelman.
A system change takes a long time, but Poelman is cautiously optimistic. ‘The system can be changed. I can already see small but important shifts. The political support for tackling the food environment to promote a healthy lifestyle is much greater now than, for example, ten years ago. The Dutch National Prevention Agreement also addresses the food environment. It is encouraging that the knowledge we are developing from the behavioural and health sciences is now being translated into policy.’
The recently released European Union Farm2Fork strategy also defines important strategies for a food environment that makes it easier for consumers to make healthy and sustainable choices. Poelman draws the comparison with smoking: 'It took a long time, but now we have reached the point where everything in the environment discourages smoking. And that really has results. We are also heading in that direction with unhealthy and unsustainable food. That is a matter of politics and policy, but as scientists we lay an important foundation under those political and policy choices.'