Evelyn Murrell
The UK government may start offering financial rewards to the public for eating healthily and exercising more, in an effort to tackle obesity. Evelyn Murrell gives her perspective on the enterprise.
A similar initiative in Singapore, called The National Step Challenge, was undertaken by 26% of the population, who earned ‘health points’ which could be exchanged for rewards worth up to $10.
36% of adults in England are overweight and 28% are obese
It cannot be argued that policies like this are unnecessary; the need to do more to tackle obesity in this country is evident. In 2019, The Health Survey for England estimated that 36% of adults in England are overweight and 28% are obese. Katharine Jenner, the campaign director of Action on Sugar and Action on Salt, said: “Whilst there are some effective weight management support services which are mainly accessed through the NHS, many are often limited, underfunded and have extensive waiting lists. It’s therefore imperative that multi-disciplinary supported weight loss services are adequately funded and signposted and their long-term effectiveness properly researched.”
Obesity related illnesses cost the NHS £6 billion a year and the scale of the challenge has been emphasised by COVID-19 disproportionately affecting those who are overweight. Whilst such a scheme would be costly to the NHS, if successful it seems likely that it would save money and reduce morbidity in the long run.
But are financial incentives the best way to wage this war on obesity? Are they cost-effective? And are they morally sound?
monetary incentives… may not be the most effective way to encourage healthier living
Whilst monetary incentives are increasingly recognised as an important way to invoke behavioural change, they may not be the most effective way to encourage healthier living. It has been found that they are more effective for increasing infrequent behaviours such as having vaccinations, rather than routine behaviours such as exercising and eating a healthy diet.
Additionally, humans react more significantly to losses than to profits of a similar magnitude. So, rather than rewarding each healthy behaviour, it may be more effective to provide renumeration at the end of a programme, with each missed session or target resulting in a painful reduction of the final reward.
Behavioural economics also provides arguments against using incentives, as evidence suggests that this may lead to ‘crowding-out’ of personal motivation. A meta-analysis of experimental studies revealed that once a certain behaviour is associated with a reward, people are less willing to fulfil the behaviour of their own accord. Simply, extrinsic rewards undermine intrinsic motivation. This may mean that financial incentive schemes that increase healthy living in the short term may lead to a reduction over a longer period.
failure to teach children to cook at school is partly to blame for UK householders wasting food worth £12bn each year
The practicalities of such schemes are a minefield. Whilst monitoring individuals’ activity levels is achievable through heartrate monitors and smart watches, tracking what people eat is almost impossible without imposing a 1984-esque ‘telescreen’ system. Could this policy be a significant step towards the much-feared nanny-state? It is also undeniable that any system which offers financial rewards will be abused and exploited by the more unscrupulous members of our society. Surely there are more air-tight ways to confront obesity?
Instead of paying people to enact healthy behaviours, perhaps our leaders should be educating the public on how and why to lead healthy lives, and making it more affordable to do so? The national curriculum must place more emphasis on educating young people on how to make nutritious, affordable meals. Failure to teach children to cook at school is partly to blame for UK householders wasting food worth £12bn each year, at an average annual cost of £700 to each family.
A report from 2018, which evaluated the affordability of the UK’s Eatwell Guide, found that 27% of households would need to spend more than a quarter of their disposable income after housing costs to meet the guidance. Making healthy choices can be hard enough without financial burdens.
A report by Public Health England discovered that the sugar tax on soft drinks introduced in 2017 has so far led to a 29% reduction in the amount of sugar contained in such beverages. However, despite this, overall sugar consumption in the UK has continued to increase. Clearly the stick alone is insufficient. Perhaps the carrot and stick could be combined by increasing tax on unhealthy foods and using the money to subsidise healthy food and sporting activities. This amounts to the same as a financial incentive scheme, but is far more even-handed and all-encompassing, and less vulnerable to exploitation.
Tightening the rules surrounding the advertisement and sale of junk foods will also aid the public in making healthier food choices, without forcing change via financial repercussions. The government has set out plans to ban TV advertising before the 9pm watershed and all online advertising of high fat, sugar and salt products, by 2023. Are these measures strong enough and soon enough?
The long-term strategy must be to educate young people on how and why to maintain a healthy lifestyle
Ideally, financial incentives of any kind would not be necessary, and it would be sufficient simply to educate and empower the public to make good choices just for the sake of living happy and healthy lives. However, this is unrealistic. As long as non-nutritious high-calorie food is available in affordable abundance, obesity will persist as a public health issue. After all, humans have an inherent instinct to consume as much as possible when food is abundant and store fat in preparation for bad times ahead.
A more pragmatic approach must be taken. The long-term strategy must be to educate young people on how and why to maintain a healthy lifestyle. In the short term, the government must make it easier and more affordable to be healthy. Pharmaceutical interventions may act as a backstop for those who need more help. In 2020, a new weight loss drug called liraglutide which works by inhibiting appetite, became available on the NHS. Semaglutide, a similar drug, has not yet been licenced for weight loss but has been found to be even more effective than liraglutide.
Fundamentally, offering money in direct return for living healthily doesn’t sit right with me. Improved education and more indirect financial engineering would be more robust strategies with which to wage the war on obesity.
Evelyn Murrell
Featured image courtesy of Anupam Mahapatra via Unsplash. Image license found here. No changes were made to this image.
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