What’s the best way to stay healthy
in the face of so much conflicting nutrition information?
Well, ideally, you would go to the source.
The gold standard;
the peer-reviewed medical literature.
Read through stacks of the latest medical journals.
But who’s got time for that?
I do!
Welcome to the Nutrition Facts Podcast.
I’m your host, Dr. Michael Greger.
Today we look at how adding a healthy option
can actually drive people to make even worse choices,
thanks to a mind-blowing glitch of human psychology.
In 2017, and to much fanfare, menu labeling for calorie counts
began to be mandated in national chain restaurants.
I mean shouldn't consumers have the knowledge needed
to make healthy eating choices outside the home?
It just makes sense that caloric information on menus will help
consumers limit food intake to stay within daily energy needs,
but it didn't work. It turns out calorie labels are not effective,
perhaps shaving on average an insignificant 8 calories off of a meal.
You could have totally predicted that. Why?
Just as one might divine the value of front-of-pack traffic light labeling
from the ferocity of the food industry response against it,
one could probably gauge the futility of calorie labeling
by the ease at which some regulations have been passed.
McDonald's voluntarily started publishing calorie info
nationally back in 2012 after a labeling mandate
in New York City was found
to have no overall effect on consumer behavior.
So studies suggest such labeling could boost "perceptions of
the restaurant's concern for consumers' well-being"
while carefully not undermining any Big Mac attacks.
At the same time, McDonald's announced plans
for adding seasonal produce to their menu.
How cynical do you have to be not to at least recognize that as a good thing?
Ironically, adding a healthy option can actually drive people
to make even worse choices. Ready to have your mind blown?
If you offer people a choice of side dishes—something unhealthy
like French fries or something more neutral like a baked potato—
only about 10% of individuals with high self-control will splurge for the fries.
Good for them.
French fries are so unhealthy though that as a public health do-gooder
you add a third option, an even healthier option than the baked potato—
a side salad to appeal to their better natures.
So then, instead of choosing between an indulgent choice
and the more neutral baked potato, they have their pick of
the indulgent choice, the neutral choice, or an even healthier choice.
Even if everyone doesn't choose the salad, more will go for
the middle-ground baked potato over the fries, right?
So how much farther does French fry fancying fall
by adding the salad option to the mix? It shoots up, tripling to 33%.
Without the salad option, only 1 in 10 chose the fries,
but that jumped to a third of people just at the sight of salad.
The same thing happens when you offer people the choice between
a bacon cheeseburger, a chicken sandwich, or a veggie burger.
In a "No Healthy Option" scenario where people were
offered the cheeseburger, a chicken sandwich, or a fish sandwich,
17% chose the burger.
Swap out the fish sandwich for a veggie burger
and bacon cheeseburger preference doubled to 37%.
How can just seeing a healthy option push people to make unhealthier choices?
The paper described in these series of experiments was entitled
"Vicarious Goal Fulfillment: When the Mere Presence of a Healthy Option
Leads to an Ironically Indulgent Decision."
The thought is that seeing the salad or veggie burger,
people make the mental note to choose that at some nebulous next time,
thereby giving them the excuse to indulge now.
See, there's a fascinating glitch of human psychology called self-licensing.
This is when we unwittingly justify doing something that draws us away
from our goals after we've just done something that brings us towards them,
like justifying eating a donut because you lost so much weight last week.
We reward ourselves with an indulgence that sets us back.
If you give smokers " vitamin C supplements,"
they subsequently smoke more cigarettes
than if you give smokers what you explain are "placebo" pills,
even though both groups were given identical sugar pills.
The group who thought they were taking supplements smoked
nearly twice as much, perhaps thinking at some subconscious level
that since they had just done something good for their health,
they could afford to "live a little,"
which may have in effect indeed occasioned them to live a little less.
You can see how this could translate into our lifestyle arenas.
Those given placebo pills they believed to be dietary supplements
not only expressed less desire to subsequently engage in exercise,
but followed through by walking about a third less.
Compared to those who were told the pills were placebos,
misled participants were also more likely to choose a buffet
over what was described as a "healthy, organic meal."
Would they eat more too?
A seminal study entitled
"The liberating effect of weight loss supplements on dietary control"
put it to the test.
Participants were randomized to take a known placebo
or a purported weight loss supplement— actually just the same placebo—
and later covertly observed at a buffet.
Not only did the supplement subjects eat more food,
they chose less healthy items. They also ate about 30% more candy
in a bogus "taste test" and ordered more sugary drinks.
Hence, the investigators concluded, "people who rely
on dietary supplements for health protection
may pay a hidden price: the curse of licensed self-indulgence."
So, circling back, what the vicarious goal fulfillment studies added is that
not only does making progress towards a goal rationalize decision making
that undermines us, but even just considering making progress
can have a similar licensing effect.
Note the study subjects were not only moved to make
the unhealthier choice, but the unhealthiest choice.
You'd think that even if people didn't go for the salad or veggie option,
the presence of a healthier alternative might at least have encouraged them
to choose something in-between: not as healthy, but not the unhealthiest,
but instead it moved people in the opposite direction.
Compared to the "No Healthy Option" of chocolate-covered Oreos,
regular Oreos, or golden Oreos, adding a "lower-calorie" Oreo option
doubled the likelihood that the study participants would go straight
for the most indulgent chocolate-covered option.
This is attributed to another illogical quirk of human psychology
indelicately named the "what the hell effect."
This is when one forbidden cookie can lead dieters to eat the whole bag.
Once you've already strayed from your goals,
well then, why not go all the way?
So once people decide they're going to get that salad next time
and spoil themselves just this once, they might as well go for
the most indulgent choice.
The halo of healthy foods can even warp our perceptions.
Show weight-conscious people a burger and nothing else,
then ask them to estimate the number of calories, and the average answer
is 734 calories. Now show folks
the exact same burger accompanied by 3 celery sticks,
and they guess the total comes out to 619 calories.
Did they think the celery had negative calories?
No, most knew the celery had calories, too,
but just the juxtaposition of the burger with the celery
made the burger seem healthier.
The same thing happens when you add an apple
to a bacon-and-cheese waffle sandwich,
a side salad to beef chili, or some carrots next to a cheese steak.
About a hundred calories appear to disappear.
Health halo effects may explain why people are more likely
to order a dessert and more sugary drinks
with a "healthier" sub at Subway versus a Big Mac at McDonald's,
even though the sub used in the study— filled with ham, salami, and pepperoni—
had 50% more calories to begin with.
Even just a reference to healthy foods can do it.
Show people a picture of a Big Mac and people estimate it has 646 calories.
Okay, then just add the words
"For your health, eat at least five fruits and vegetables per day,"
and all the sudden, the same burger in the same ad was thought
to only have 503 calories.
Merely offering or even promoting salads and fruit
can bring McDonald's accolades and bolster consumer loyalty
without, ironically, helping their health.
In our next story,
we look at how mandating healthy eating messaging
on fast-food ads ironically only makes things worse.
Denmark ended up canceling its saturated fat tax
on meat and dairy and shelving their sugar tax,
because the farming and food company interests claimed
too many jobs would be lost if people ate healthier.
Apparently, a healthy economy was more important
than a healthy citizenry.
Ironically, the fat tax was abolished
just when evidence of the effects started to appear.
The intake of saturated fat among Danish consumers
from some meat and dairy products was declining,
but not from sour cream.
The public ended up eating so much more low-fat sour cream
that it ended up outweighing the smaller reduction
in high-fat sour cream.
So, you always have to think about the unintended consequences.
If incentives have people swapping out sugary cookies for salty chips,
for example, it might not be doing the public’s health many favors.
One field study of a tax on soda found
that you can drop soft drink purchases,
but households may just end up buying more beer.
Another study found that calorie labeling of sugary drinks
ironically led to an increase in consumption,
presumed to be because the consumers
may have previously overestimated their caloric content.
Stark warnings about the risks of unintended negative consequences
of obesity-targeted health policies are trumpeted by those
with ties to the likes of Coca-Cola, Kraft, PepsiCo, Wrigley,
Red Bull, the World Sugar Research Organization,
the National Cattlemen’s Association, Mars,
and corn syrup giant Archer Daniels Midland
(and that’s just a single scientist).
The concern about unintended consequences shouldn’t paralyze
our efforts, but should serve up a healthy dose
of humility when considering policy proposals.
How about releasing a video game for kids that promotes fruit?
Sounds good, right? Well, what do you think happened
when kids were sat down in front of bowls of fruit and candy
and randomized to play one of three different computer “advergames”
(advertising-game hybrids incorporating product placements)
promoting either candy, fruit, or toys?
The pro-candy game group ate more candy, but disappointingly
the pro-fruit group didn’t eat more fruit.
But then it gets interesting.
They ate more candy in the fruit game, too.
Compared to the toy promotion control group,
having a kid play a video game promoting fruit
led them to eat more candy.
Presumably, both the candy and fruit games
just made them think about food,
and they naturally gravitated to their preferred snack.
One of the most fascinating phenomena I came across
was the boomerang effect of “remedy messaging.”
One might presume that the advertising of smoking cessation aids
like nicotine gum would help make quitting easier.
After all, the vast majority of smokers want to quit and so
availing them of helpful options couldn’t help but help, right?
Instead, such remedy marketing can create a vicarious
“get out of jail free card”
that ends up reinforcing risky behavior.
Exposure to nicotine replacement product advertising
was found to undermine quitting intentions,
especially among the heaviest smokers,
the very ones who needed it the most.
The thought is that smokers may subconsciously interpret the remedy
as evidence that the hazards of smoking are more manageable,
hence less risky, and thereby help to justify their habit.
You can see how easily this would translate to the weight loss arena.
Previously, I explored how self-licensing could cause
those taking slimming supplements to inadvertently eat more,
but just exposure to a “fat-fighting pill” advertisement
appeared to have a similar type of effect.
So, even when companies are ostensibly selling health
rather than disease, they still may be inadvertently
making the problem worse.
In the marketplace, there’s just no incentive
for risk avoidance messaging.
Nobody makes money selling “just say no” unless
it can be somehow linked to saleable products and services.
A policy in France—where burgers now outsell baguettes—
may represent an interesting real-world example
of this counterintuitive remedy messaging effect.
Industry lobbyists morphed a valiant effort
to ban the advertising of junk into a mandate for
preventive health messaging on junk food advertisements.
So, now on products like “Lay's Chips Saveur Poulet Rôti”
(chicken-flavored potato chips),
you’ll see messages like
“Pour votre santé, pratiquez une activité physique régulière,”
"For your health, practice regular physical activity."
Sounds good, right?
But any time an industry agrees to a regulation,
one should get skeptical as to its effectiveness.
To see if such messaging might lead to a boomerang effect,
research subjects were randomized to view a Big Mac advertisement
with or without the preventive health message
“Eat five fruits and vegetables a day.”
I mean, wouldn’t it be great if McDonald’s
was forced to advertise healthy food?
The participants then filled out some BS questionnaire
and before they left were allowed to choose
one of two McDonald’s coupons as a reward for their participation:
a free sundae or a free bag of fruit.
Guess who was more likely to pick the fruit?
Only one-in-three of those who just saw
the straight burger advertisement chose the fruit over the sundae,
but that number fell to only one-in-six
among those who’d been prompted to eat healthier.
Let that sink in for a second. Isn’t that crazy?
The absence of the healthy message
doubled the choice of the healthy snack.
The health message made things worse.
This may be the remedy messaging boomerang effect in action.
By simultaneously offering a temptation with a reminder about
how they can dig themselves out later
justifies the excuse to indulge.
Subconsciously, it may give the chicken-y chip eater
the rationalization that they can just work it off the next day,
even if the next day at the gym never comes.
The advised antidote to avoid justification effects
is to instead use negative framing.
Instead of offering a way out to compensate for indulging
“just this one time,” cautionary messages may be more effective.
For example, on your next ham and cheese or
chocolate-filled croissant, a message like:
“For your health, avoid foods that are
too fatty, too sweet, or too salty.”
That’s a message for which I doubt Le McDonald’s
would be as enthusiastic.
Learning about this rebound effect has made me reflect about
my work on NutritionFacts.org, distilled into How Not to Die.
It doesn’t get much more remedy messaging than that!
If we can get such dramatic benefits with diet and lifestyle changes
so late in life, in such short amount of time,
why can’t we just live lives of gluttony and sloth
and then around 50 or so, just clean up our acts?
The reason is because it may be too late.
Our first symptom may be our last.
Most people know the number one killer of both men and women
in the United States is heart disease.
What people may not know, though, is that,
according to the American Heart Association,
for the majority of Americans that die of heart disease,
their first symptom occurs not years before they die,
but literally minutes before they die.
Sudden cardiac death is the first manifestation of heart disease
for the majority of individuals, particularly among women,
meaning that you had no idea you even had heart disease
until you’re literally dying from it.
Heart disease reversal is great,
but that’s why prevention is the key.
When it comes to sudden death, an ounce of prevention
truly is worth more than a pound of cure,
because there is no cure, for dead.
We would love it if you could share with us your stories
about reinventing your health through evidence-based nutrition.
Go to nutritionfacts.org/testimonials.
We may share it on our social media to help inspire others.
To see any graphs, charts, graphics, images, or studies mentioned here,
please go to the Nutrition Facts Podcast landing page.
There you’ll find all the detailed information you need –
plus, links to all of the sources we cite for each of these topics.
For a vital, timely text on the pathogens that cause pandemics,
order the e-book, audiobook, or hard copy
of my latest book, “How to Survive a Pandemic”.
For recipes, check out my new “How Not to Diet Cookbook”.
It’s beautifully designed with more than 100 recipes
for delicious and nutritious meals.
And, of course, all the proceeds I receive from the sales
of all my books go to charity.
NutritionFacts.org is a nonprofit, science-based public service,
where you can sign up for free daily updates
on the latest in nutrition research via bite-sized videos and articles.
Everything on the website is free.
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I just put it up as a public service, as a labor of love,
as a tribute to my grandmother,
whose own life was saved with evidence-based nutrition.