Solving the obesity crisis: knowledge, nudge or nanny?

BioMedCentral Blog: ” The 5th Annual Oxford London Lecture (17 March 2015) was delivered by Professor Susan Jebb from Oxford University. The presentation was titled: ‘Knowledge, nudge and nanny: Opportunities to improve the nation’s diet’. In this guest blog Dr Helen Walls, Research Fellow at the London School of Hygiene and Tropical Medicine, covers key themes from this presentation.

“Obesity and related non-communicable disease such as diabetes, heart disease and cancer poses a significant health, social and economic burden in countries worldwide, including the United Kingdom. Whilst the need for action is clear, the nutrition policy response is a highly controversial topic. Professor Jebb raised the question of how best to achieve dietary change: through ‘knowledge, nudge or nanny’?

Education regarding healthy nutrition is an important strategy, but insufficient. People are notoriously bad at putting their knowledge to work. The inclination to overemphasise the importance of knowledge, whilst ignoring the influence of environmental factors on human behaviours, is termed the ‘fundamental attribution error’. Education may also contribute to widening inequities.

Our choices are strongly shaped by the environments in which we live. So if ‘knowledge’ is not enough, what sort of interventions are appropriate? This raises questions regarding individual choice and the role of government. Here, Professor Jebb introduced the Nuffield Intervention Ladder.


Nuffield Intervention Ladder
Nuffield Intervention Ladder
Nuffield Council on Bioethics. Public health ethical issues. London: Nuffield Council on Bioethics. 2007.

The Nuffield Intervention Ladder or what I will refer to as ‘the ladder’ describes intervention types from least to most intrusive on personal choice. With addressing diets and obesity, Professor Jebb believes we need a range of policy types, across the range of rungs on the ladder.

Less intrusive measures on the ladder could include provision of information about healthy and unhealthy foods, and provision of nutritional information on products (which helps knowledge be put into action). More effective than labelling is the signposting of healthier choices.

Taking a few steps up the ladder brings in ‘nudge’, a concept from behavioural economics. A nudge is any aspect of the choice architecture that alters people’s behaviour in a predictable way without forbidding options or significantly changing economic incentives. Nudges are not mandates. Putting fruit at eye level counts as a nudge. Banning junk food does not.

Nudges are not mandates. Putting fruit at eye level counts as a nudge. Banning junk food does not.

The in-store environment has a huge influence over our choices, and many nudge options would fit here. For example, gondalar-end (end of aisle) promotions create a huge up-lift in sales. Removing unhealthy products from this position could make a considerable difference to the contents of supermarket baskets.

Nudge could be used to assist people make better nutritional choices, but it’s also unlikely to be enough. We celebrate the achievement we have made with tobacco control policies and smoking reduction. Here, we use a range of intervention types, including many legislative measures – the ‘nanny’ aspect of the title of this presentation….(More)”