Solving Obesity through Behavioral Economics

Evolution of Obesity

Obesity is one of the most taxing problems to the national healthcare system today. According to Ogden et. al (2012), a whopping 35% of adults in the U.S. are obese. Another recent report by Dunning (2012) projects obesity to add an extra $66 billion to healthcare costs as adult obesity levels reach 44% by 2030. That is a 25% increase in less than two decades! What’s more is that obesity itself can be infectious as the network effects of obesity are well documented. (Christakis & Fowler, 2007) So the rate at which obesity will grow is exponential if not dealt with immediately.

The most common propellants for obesity include poor eating habits and lack of exercise. (American Academy of Child & Adolescent Psychiatry, n.d.) To address poor eating habits such as overeating, one behavioral economic concept that can be applied is framing. For a quick review, ‘framing’ refers to how choices are influenced by guiding an individual or group’s interpretation or by constructing their perception. One way public policy can influence portion control is by regulating plate and cup sizes, thus changing the default perception. Given the resistance seen with Bloomberg’s Big Gulp Ban in New York, however, the challenge here is to do this without creating an intense paternal state of burdensome regulations.

Poor eating habits are also a result of conflicting information from ‘trusted’ government sources, such as the USDA, who have been promoting low fat yet high carb diets. A reexamination of the nutritional framework will be needed to reflect our modern understanding of nutrition science. Perhaps elements of exercise should be introduced to the nutritional framework allowing both components to be framed together.

Another way to influence healthy behavior may be to introduce a gamified healthcare platform where rewards are given at frequent intervals inducing constant motivation. Fitbit and Nike Fuel Band are some successful examples that have been building these types of social-motivation based platforms. Using Fitbits or similar devices, governments and insurance companies could develop a frequent flyer type point system where for every action towards healthy lifestyles you are awarded points that can later be redeemed for rewards such as a tax credit. This way the ‘player’ is rewarded with virtual points at frequent intervals and then rewarded again at point redemption.

One caveat to these all solutions however is that “even people with severe obesity tend to think of the word as applying only to people much heavier than they are.” (Griffin, n.d., p. 3, para. 3) Because of this illusory superiority effect, public awareness campaigns that define what is obese will also be needed. To overcome any overconfidence bias, a virtual scarlet letter type badge that only the user could see on one of these platforms could also be implemented. Even though these practices are sensitive in nature, this awareness campaign has the potential to reverse the incidence of obesity along the same network effect transmission mechanisms.

In case you are wondering if you’re obese, if you live in the US, it’s likely that you are. Here’s a chart to compare how you measure up. Your BMI = 703 * [(weight in pounds) / (height in inches)2]

Obesity Table

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“Trust Me I’m a Doctor” – Are Doctors As Smart As You Think They Are?

Are doctors smart?

The odds to becoming a doctor are incredibly low. Let’s take a look at the credentials required to become one:

  1. You need a bachelor’s degree (only 479 million people or 6.7% of the world population have one)
  2. You believe you’ll do well on the MCAT (86,181 people took the MCAT in 2011)
  3. You believe your GPA and MCAT scores are competitive (45,266 people applied to U.S. medical schools in 2012)
  4. You are accepted into an M.D. program (only 19,517 matriculated into a U.S. program in 2012)

While the figures in the list above don’t tell the whole story (people who delay or decide against medical school or those who pursue alternative pathways to practice in the U.S.), they give you a general idea of the selectivity surrounding the profession. Given this tough selection process, it’s no wonder why so many people assume that doctors are really smart; it’s pretty likely that they are smarter than the average person.

But how smart are doctors really? Doctors can’t possibly know everything about everything. It’s unreasonable, for example, to quiz them on how to rebuild the engine on your Volkswagen Jetta. Yet so many people trust doctors with non-medical related advice all the time. Pretty much anything that is said can be qualified if it is coming from a doctor.

Camel Life

But you my friend think critically and realize how audacious it is to believe everything a doctor says. How critical should you be though, when it comes to your doctor’s medical advice? The majority of people, 70%, trust the accuracy of their doctor’s advice without the need for additional research or opinions. That figure is especially surprising when as much as 42% of the public report having experience with doctors making diagnostic errors. The error rate is so high that the International Journal of Healthcare Management is labeling misdiagnosis an epidemic. And rightfully so, 220,000 Americans die each year from preventable harm due to medical errors (with some estimates reaching 400,000).  To put that into context, doctors are killing 25 to 45 people every hour.

The fact of the matter is our knowledge of medicine and how we practice it is still fairly primitive. Doctors are human and humans are sometimes irrational decision makers who are prone to making mistakes. Adding to these limitations, there are few mechanisms to tackle issues that contribute to diagnostic errors. For one, the current culture at hospitals is to sweep mistakes under the rug, making it incredibly difficult to share and learn from them. Two, HIPAA regulations restrict access to medical records making it extremely difficult for the public to scrutinize. Three, very few hospitals will voluntarily publish or come forth with their error rates. The amalgamation of these problems, among others, leads to information asymmetry which leaves patients to either rely on geographic availability or word of mouth recommendations from friends, family, and insurance companies. This happens despite patients knowing what information should be most influential in their decision-making framework to choosing a healthcare provider.

While companies such as HealthGrades are hoping to solve the information asymmetry bit, current privacy regulations limit what they can do. Other attempts to eliminate the root causes of misdiagnosis are still challenging endeavors. To answer the question in the title, doctors are smart but not as smart (or competent) as you think they are. It is in your best interest to do your homework when you choose your doctor and vet his or her advice.

*For more reading, here is a behavioral economics approach to study potential root causes of medical errors by researching physician overconfidence and its influence on misdiagnosis drafted by my colleagues Rachelle Lee, Seungwook Moon, and myself Robin Kabir.

 

The Incredible Non-Edible Magnificent Pig

Pigies

Several world religions including Judaism, Christianity, and Islam discourage followers from eating pork. Though none of the Holy Books offer a reason, that fact hasn’t stopped pundits from developing their own. The most common rationale that is given is pigs are “filthy creatures”. Along similar lines, some have mentioned that the meat is difficult to rid of parasites when cooked. Others even go as far as saying the technology to cook the meat properly wasn’t available back then; so eating pork is now justified. 

 

Why do pigs get such a bad rep? Are pigs really that filthy?

The short answer is no. It doesn’t help when negative stereotypes perpetuated through idiomatic speech such as “filthy as a pigsty” are ingrained into our culture.  Derogatory phrases referencing pigs aren’t limited to English either: cochino sucio (“filthy pig” in Spanish) or 懒猪 (“lazy pig” in Mandarin).

No matter your spiritual belief, I hope to dispel some of these myths and reeducate you on the incredible non-edible magnificent pig. I’ll do this by showing you that pigs are clean, intelligent, and similar to humans in many compelling ways. So if you choose to abstain from pork, do so for humane reasons, not because of mistruths. Continue reading

How to Train with a Heart Rate Monitor

Heart Rate Monitor

Trouble losing weight? Plan on running a marathon? Afraid of overtraining? You really should consider training with a heart rate monitor (HRM).

In the running world, miles that are run without achieving any benefit are called junk miles. Training with an HRM will help you reduce junk miles by targeting optimal heart rate zones that enable you to increase speed/strength, burn fat, or recover from overtraining and injury. While the examples in this article are for running, you can easily adapt them for other cardio pursuits such as cycling or swimming.

There are generally three types to choose from: finger sensor, chest strap, and strapless.

Types Pros Cons  Examples
Finger Sensor watch Cheap Non-continuous monitoring Timex Health Touch
Chest Strap w/watch Cheap Inconvenience of putting on strap Polar FT7
Strapless watch Convenient Expensive Mio Alpha

I personally use the strapless Mio Alpha watch synced to the Endomondo app on my iPhone. It works well for its first iteration but hope they release a backlit version soon. Go ahead and purchase one now. I’ll wait.

Got it? Okay, let’s learn how to use it. Continue reading

Ten Things Every Young Person Should Know

ten-things

I originally created this list to share with family but thought you could benefit too. Our younger years are often filled with extreme highs and lows and the aim of this list is help reset you for a happy and mature life. So here it goes:

  1. Not everyone will like you. And that is okay.
  2. As long as one person loves you, you will be okay.
  3. Learn to love yourself first (but don’t get carried away).
  4. You can make yourself happy just by smiling. This notion is grounded in science; we smile because we are happy and we are happy because we smile. So smile.
  5. How you see yourself is different from how others see you. Be aware.
  6. People who hate will always hate. No matter what. Trying to win them over is pointless. Figure ways around them.
  7. However, people who are objectively critical of you see potential in you, and are genuinely trying to help. Learn the difference.
  8. Don’t assume people will have your back until they prove they actually do; assuming so will lead to disappointment.
  9. How you choose to encode your memories (positively or negatively) is entirely up to you. Prefer the positive route.
  10. The smartest people in the room are smart not because they have the right answers, but because they know how to ask the right questions. Recognizing your stupidity is the first step towards wisdom.
  11. There are more than ten things that you should know.