Friday, November 11, 2011

Health education is not enough to promote healthy diets and physical activity

Today two PhD candidates from the EMGO Institute for Health and Care Research defended there theses at the VU University here in Amsterdam. In his thesis 'Efforts to prevent diabetes and cardiovascular disease in primary care' Jeroen Lakerveld explored the effects of a health education program based on motivational interviewing and problem solving treatment to motivate and enable people with high risk to adopt health behaviors that contribute to diabetes prevention (e.g. healthy eating and physical activity). The effect study showed generally no effects of this health education approach.  Dr. Lakerveld states that the approach taken may have been too limited, and that for interventions to be effective changes in the environment, i.e. the availablity of and social support for health choices may be needed.
Willemijn Vermeer studied the role of portion sizes of foods and the development and evaluation of interventions to motivate or enable people to take smaller portion sizes. Earlier research shows that portion sizes have increase quite abit over the years, e.g. coke, candy bars, fast food entrees are sold in much bigger portion sizes nowadays than a few decades ago. Additional research strongly suggests that these increases contribute to overeating and to overweight and obesity. Dr. Vermeer research shows that policies to actually reduce portion sizes are not acceptable for the general public or for food catering organisation, while interventions that are regarded as acceptable, i.e. better labels to explain portion sizes or more choice between different portion sizes, appear to be ineffective.
Both studies suggest that health education is not enough and that people need to be nudged toward healthier behavior - that the healthy choice should be made the easy and default choice. The present Dutch government disregards this and earlier (and even stronger) evidence. Theb Dutch policy is that people are ablle and will make informed choices about their health behavior and that freedom of choice and autonomy should be promoted. In an environment that promotes supersizing and lack of physical activity, that freedom of choice appears to be quite relative.