ISBNPA 2013: Sustainable diet & environmental changes

Halfway through the Annual Meeting of the International Society for Behavioral Nutrition and Physical Activity (ISBNPA 2013), jotting down some impressions and ideas from the conference so far. A more thorough report later on.

• Individual behaviour change should never be the only goal. It’s not enough. We need to change the environment in order to have lasting effects. It’s a long process, but meanwhile, we can help people cope with the environment.
• Translational part in experience sampling and photography studies that examine environment-health relationships is missing. Most of the world doesn’t live in environments like this.
• Theory-based instead of theory-inspired: systematic process of linking theoretical basis to the actual implementation and evaluation. Too many intervention studies don’t use theory properly.
• Program adoption and maintenance is also an intervention: adopters and maintainers need to change their behaviour and be sufficiently motivated to do it.
• We’re all hypocrites in terms of sustainability. How can you advise anyone to eat fish? If all seven billion people on this planet eat sustainably caught fish, it will all be eaten within a year.
• As European consumers, food is the single biggest impact on ecosystem that we are responsible of. Need to think about the entire production chain.
• Autonomy-supporting approach is not a bag of tricks to make a person motivated. It’s a sincere interest and curiosity in the person, a sincere desire to help and support.
• Many say “we don’t want a nanny state, we don’t want government controlling food prices”. But right now we are controlled by big corporations and retailer chains. Is this better?
• We can change the system. And we can change the world.

There is a clear message that environmental changes should be the main focus and the food system needs to change. Climate change is a driver for a more sustainable lifestyle – which also means healthy AND sustainable diet.

This is also the most health-promoting conference I’ve been to. Encouragement to stand up for applauses, standing lunches, small portion sizes, 5-minute walking distance between two conference sites (and two such walks scheduled in the program every day), stair-climbing, fruit for dessert and at coffee breaks. Best attempt in “practice what you preach” so far in academia, although strawberries hardly are the most sustainable thing to eat in May.

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ACR Conference

The last long trip on this continent this year: Association for Consumer Research North American conference. It was held this year in Vancouver, BC, October 4-7. Like Vancouver, the conference was very international, with more than 1000 participants and a large number of them outside North America. In terms of fields that were represented, consumer behavior and marketing seemed to be the most common. Or perhaps they were the fields where people tend to use clear labels on themselves. “Don’t put yourself in a box – research is research and it’s all interesting.”

Weather couldn’t have been more perfect.

Although the focus was consumer behavior, there was a solid awareness about the usefulness of technology as a tool and a source of data. In particular, Jeff Inman emphasized in his presidential speech how important mobile consumer research already is and will be in the near future. Doing research with mobile devices makes it possible to gather information real-time and about topics that earlier were only possible to study through surveys or observations. Data about everyday, moment-to-moment behaviors are now much more accessible.

Highlights from Presentations

I was impressed by the consistent high quality of the presentations – most of the sessions were really interesting and engaging. That shouldn’t be surprising, though, since the acceptance rate for presentations was around 20%. I had a poster about improving adherence in online habit change interventions. It attracted a reasonable amount of attention, but I think most people were a bit weary after the long day, since the poster session was held Friday evening.

Anyways, highlights from some of the most interesting presentations:

Food and nutrition

• Becoming a Mindful Eater: Improving Food Choices through Emotional Ability Training (Jonathan Hasford, University of Kentucky). The researchers demonstrated that emotional abilities can be trained, and increases in emotional intelligence decrease calorie intake in comparison to more traditional nutrition training group. Results were maintained after three months. I found this really interesting and could see similarities to the ACT framework, where mindfulness training increases emotional awareness and helps a person to recognize the influence of emotions and external cues on their eating behavior (and other behaviors as well). Perhaps we could use emotional intelligence scale in some of our studies?
• When Soft Drink Taxes Don’t Work: A Comparative Study (Andrew Hanks, Cornell). Drew and others from Food & Brand Lab found that putting a tax on soft drinks has unintended consequences: the effects of soda purchases are insignificant, and some shoppers actually switch to buying more beer and fruit juices, increasing the overall calories they purchase (although maybe they get a little bit more nutrients in?). Hence, only taxing soda probably isn’t the best approach in trying to decrease the fluid calories purchased.
• Increasing Serving Size Increases Amount Consumed (Chris Dubelaar, Bond University, Australia). This study tested whether people would eat more than their previous maximum consumption, if the serving size increased still. They measured the maximum consumption of pasta based on a sample (over one pound) and then doubled the serving size from that for the participants of the study. They found that people still ate about 22% more than the earlier maximum amount had been. This unfortunate finding means that people try to eat at least half of the serving, no matter how big the serving is.
• Taming Temptations: Targeting Self-Control Increases Healthy Food Behaviors (Janet Schwartz, Tulane University, USA). Simple prompts such as asking people if they want to downsize their portion is more effective than nutrition or calorie labeling, and doesn’t leave downsizers feeling deprived or hungry. Also, a study about pre-commitment done with Discovery Health Soutch Africa found that asking people to pre-commit to healthy purchases and receive a discount if they really purchased healthily really increased the share of healthy purchases.

Physical activity

• Exercising to the lowest common denominator (Leslie John, Harvard). This study looked into how peer behavior influences our own behavior. They gave employees of a company walkstations (sort of treadmills that can be used while working) and assigned them into one of three conditions: solo (information of only own performance), duo (information of one other’s performance), and quad (information of three others’ performance). Not surprisingly, performance declined in all three groups over time. But what was perhaps surprising is that decline was slowest in solo group. In other words, people who saw how others in their group behaved sank down to the level of the lowest performer. At least in this context, it would be better to compare just against own behavior (maintain the level of walkstation use) than let people know that others aren’t doing as much.

Social influences

• Blowing Out Candles to Make Ours Burn Brighter (Cait Lamberton, Uni. Pittsburgh). The findings of this research could be seen to be a bit depressing: basically, we all blow out other people’s candles, that is, try to sabotage others’ achievements. But our level of self-esteem has an effect on whether the sabotage is covert or overt. People with high self-esteem are more sensitive to ego threats, and therefore resort to covert harming (they don’t want other people to know that they’re envious). People with low self-esteem, in contrast, lack resources to cope and are more prone to overt harming and “sour grapes” effect (“I wouldn’t have wanted it anyway”).
• Facebook Therapy? (Eva Buechel, Uni. Miami). Emotionally unstable individuals have a need to share emotional experiences, but they often lack the close social network that could give support. They have a high need to share, but low social skills. The researchers did a series of studies on Facebook and found that Facebook status updates can work as an emotion regulation strategy for emotionally unstable people. That is, they can release their emotions on Facebook and it helps in affect regulation, even without actual responses. Anticipation of social support may be enough for benefits.

Even though I was a captivated member of the audience at the presentations about experimental research, I think that I gathered most food for thought from the doctoral consortium and the sessions about methodology and broader issues in the field. Summarizing some of these things in the rest of the post.

Building Bridges – Interdisciplinary Research

Next year’s ACR president Linda Price (Uni. Arizona) pointed out that ACR community is multidisciplinary, but not interdisciplinary enough: people still operate inside their own boxes and don’t reach out to other fields as much as would be beneficial. Akshay Rao from University of Minnesota continued on the same topic with this equation:

Research = Curiosity = Opposite of ignorance

When research is driven by curiosity, it will almost inevitably have to become interdisciplinary. However, it is also scary to step outside the box. Ethnographic studies have shown that increased diversity threatens community. Moreover, interdisciplinary work is challenging to get published, because unidisciplinary journals and reviewers often don’t understand other disciplines.

Do we want to let fear or curiosity to direct the paths our research takes? There is strength in working together. Think about sustainability, poverty, obesity, or communicable diseases. They affect everyone around the globe and need many curious brains and lively hands to work on them. The trick is to find people who are good at different things and use the pool of skills to do something extraordinary.

Besides, the things that people outside academia are interested in usually stem from interdisciplinary research. The novel, non-obvious, and useful findings are based on interest in phenomena, not the method. Keep the focus of the study on behavior and use all tools available.

Not to forget that making it personal, that is, focusing on issues that really matter to you, helps to maintain interest and stay invested. That’s why I veer towards projects which deal with mental well-being, stress management, emotional eating or such. Just need to remember that creativity is killed by stress.

Integrity

Opening plenary was dedicated to discussion about integrity in research. Apparently, last year some well-known researchers in the field were discovered to have fabricated their results by cherry-picking data. The plenarists pointed out several problematic issues in the nature of academia, including tenure process that pushes for publishing as much as possible, the urge to write a good story from muddy data, and the desire to make broad generalizations from a selected and biased sample (most often, undergrads). Job security, money, and fame can sometimes seem tempting enough to justify some shortcuts and white lies, right? Nope.

As Jeff Inman, the current president of ACR, stated: the game is not publishing. The game is research, and publishing is the outcome. Research should be done on important topics, driven by desire to understand what’s happening and why, and to explain it to others as clearly as possible.

Telling Stories

Writing a good scientific paper is like telling a good story. It needs to have a clear focus, plot structure, and engaging narrative. No one wants to read a story which doesn’t have consistent characters (your constructs and variables), is full of incoherent extra side plots, and characters have different names in different chapters. Ultimately, theories are just stories as well.

I think that this is one of the many reasons why it’s important to read outside one’s own field and also to read fiction: to maintain good writing skills and the feeling what a good and captivating story is.

Scientific papers are obviously not the only place where narrative power can be important in research. Health promotion initiatives can also engage the audience more strongly through narratives. Sometimes this means using testimonials, example characters and scenarios, and so on to stress the importance of healthy behaviors. Furthermore, I think that metaphors in ACT are a great example of how narratives are used to illustrate, educate and increase understanding. Stories can transport the reader/listener so that the experience is powerful, lasting, and attitude-changing.

Using Field Data

Several people, including Jonah Berger from University of Pennsylvania, said that most of the interesting ideas are usually found in everyday life. Observing, looking for intriguing data sources, getting ideas from personal interests and hobbies, and so on. Good research often has field data in addition to lab studies. People in the real world don’t really care about changes on scales (what does it mean that the scores on Bergen Burnout Index shifted from 9.7 to 6.8 in the treatment group, for example?), they care about actual behavioral changes (reduced absenteeism, for example). Field study is usually the most interesting part (especially for general audience).

Gathering field data can feel like a daunting task, but it’s worthwhile to keep in mind that one dataset can provide valuable insights from several different angles. The greatest value of field data is that this actually happened in the real world.

Transformative Consumer Research

Transformative Consumer Research (TCR) is a sub-community of ACR. Their vision is to do meaningful research so that findings have clear, relevant, practical implications. Transformative consumer research is characterized by focus on behavior, concentration on vulnerable groups, and aim to make an impact.

This is how they summarize it:

“[TCR] focuses on significant social problems and challenges presented by modern consumer society. It includes research on materialism, poverty, subsistence markets, sustainability, at-risk consumers, the role of technology, and health and nutrition, among others. Transformative consumer researchers are united in their belief that academic researchers have a duty to use their knowledge and expertise to develop research and programs aimed at increasing societal welfare.”

Hits the spot, right? “This is what I want to do”, methinks.

Dilip Soman (University of Toronto) mentioned that it is curious how governments have all sorts of economic advisors, but no behavioral advisors. He then listed three reasons why we often shy away from attempting to do research that is relevant to real-world issues:

• Problems are overwhelmingly big. Solution: decompose them to small, testable problems.
• Difficult to make a theoretical contribution. Solution: demonstrate in the field (ecological validity), then bring back to lab to explain the psychological process and advance theory.
• Hard to get data. One solution: start getting the word of your research out by blogging, talking to people, giving talks at events outside academia. Convenience samples could also be expanded by respondent-driven recruitment.

Next TCR conference is May 24-25, 2013 (in Lille, France). Closer to home for us Europeans, could be a good place to go!

Some Ideas for Research

When I left the conference my brain was full of half-baked ideas and thoughts that still aren’t very well formulated. I’ll write them out here, at least that way they can potentially spark thoughts in smarter people’s brains.

One thing that I’ve been wondering for a long time is the sometimes startling absence of healthy food options at conferences which deal with health at least in some ways. At ACR, I was able to find some fruit in the morning of the first day, but afternoon coffee breaks were dominated by cookies and cupcakes.

Healthy snacks?

Has anyone done a study about conference committees and how they end up deciding the menus? For example, one presentation was about people choosing food for someone else and feelings evoked by the choice, if the chooser is slender and the other person is heavier. Perhaps something like this is happening at committees as well – people don’t want to deny sweet treats from others. Or they just want to make people feel good about being treated with delicious stuff, which will make them more likely to return next year.

Social influences and networks are also immensely interesting. I’ve been following an excellent blog called Black Girl’s Guide to Weight Loss for some time now. I think it’s great not only because it’s very sharply written and draws a lot from research, but also because it reveals a lot about cultural differences in how weight and beauty are perceived. For a white Finnish girl, some of the things that the blogger Erika writes about I would never have even thought of without her blog. The thing is, I can’t remember how I originally found the blog. And that is intriguing in itself: how do people find and start following blogs about health and well-being? What are the demographics, and how does the word about blogs spread?

Online communities could be a rich source of data about user-generated content. For instance, what kinds of challenges people post in SparkPeople?

And finally, I remember reading about a guy who decided to start taking pictures of himself every day. It turned out to become a journey to self-discovery and self-actualization. Could we have a study about this, to see if this kind of “self-tracking” would have a positive influence on well-being?

SNEB 2012

I attended the Society for Nutrition Education and Behavior Annual Conference in Washington DC July 13-17. This is a brief summary about the conference in general and the main themes that stuck with me, even two months after the conference. The summary of the conference proceedings and many of the presentations are available here.

The garden behind the hotel was a place for quiet, relaxing moments.

As a sidenote: it’s somewhat embarrassing how it’s taken me ages to get this done. Reuniting with my significant other and having a summer vacation right after the conference was wonderful, but it caused this to get stuck midway in the priority pile. Still, better late than never.

Conference

Almost 600 people participated in the conference this year, making the attendance the highest in the past ten years. I might be biased, but I’m inclined to think that one of the reasons was the current president, no other than Brian Wansink. He has the skill to breathe energy and enthusiasm into anything he touches. And based on the talks I had with various conference attendees, the research that Food & Brand Lab does is generally considered not only quirky, but very interesting, original and practically useful as well.

Interest in practical usefulness was apparent in the audience demographics: in addition to researchers, a lot of dieticians, cooperative extension people, and health promotion program planners were present. Exhibition booths included potato and wheat promoters, developers of engaging educational materials, cancer researchers and so on.

Exposing kids to oranges and cantaloupes!

All in all, everyone’s focus was on practical and actionable things in nutrition education and behavior change. The overall theme of the conference was synergy, which encouraged people to find ways to collaborate and benefit from each other’s expertise. I think that the most inspiring thing for me was just talking with all sorts of people and feeling the empathy, enthusiasm, and the drive to learn and to make real changes. Feeling that others genuinely cared about people’s well-being and wanted to make a difference.

Community partnerships

Building partnerships was the focus of several sessions and talks. Not only partnerships between researchers and health professionals, but engaging the entire community: universities, schools, community organizations; researchers, students, activists, educators, parents, farmers, daycare centers, chefs, churches… the list goes on. Two centers, one from west and one from east coast, presented their visions and modes of operation.

• Center for Nutrition and Activity Promotion bridges disciplines to help people eat healthier and be more active.
• Center for Health & Risk Communication works with communities to promote health and social justice.

Both centers started by collecting the resources that were already available and expanded from that. They develop, implement, and evaluate health promoting services, using a lot of students to do the practical work. This is great for everyone: students get practical experience and a taste for civic engagement, researchers are able to focus on coordinating and evaluating, and community members are approached from many directions.

I participated in an exercise to create a network of partners in local community to achieve the objective of a given project. We were encouraged to think outside the box to identify organizations and companies that could be involved, such as grocery stores, environmental activists and so on.

It would be really great to get students more involved in Finland as well, to create actual health promotion projects. Small-scale, of course (at least at first), but it would have been awesome to do something real instead of just writing essays when I was a student.

Simple and cheap

One of the recurring themes was the need for simple and cheap tools to promote healthy choices, as well as the need for healthy choices themselves to be simple and cheap. The first person to talk about this was Sam Kass, the White House chef and advisor in Michelle Obama’s Let’s Move! initiative, which has the goal to reverse childhood obesity. One of the aims is to give parents easy, understandable tools that help them make healthy choices for their kids.

Another example that stuck in my mind was Leon T. Andrews’ “Healthy Cities for a Healthy Future” talk where he showed a series of pictures of a gradual transformation of a cross-section in a city: starting from a barren scene with no sidewalks or biking lanes, ending with a charming pedestrian-friendly cross-section with trees, flower beds, wide sidewalks, crosswalks, clear traffic signs and an entire street devoted to pedestrians. The point was that not everything has to be done at once, it can start from just adding a crosswalk and pedestrian traffic lights, and slowly become so that the entire environment encourages walking and biking instead of driving.

Besides, it makes sense to keep children active and give them nutritious food.

• Healthy kids = better students
• Better students = healthy communities
• Healthy communities = healthy future

The advantages of synergy and partnerships are clear from this perspective as well: what is simple and cheap for one person can be very difficult and expensive for another. That’s why it is crucially important to find the right person to work with. Sharing tips, tricks, experiences, and best practices is equally important. That’s really what education is also about. Technology can help a lot if it’s done right for the target group’s needs and fits into existing routines reasonably well.

Leon T. Andrews is from ChangeLab Solutions, who have collected lots of tools and policies on their website. For example, they have a toolkit for advocates who want to work with city planners to create healthier cities. Maybe something like this could be made more interactive to make it easier for ordinary people to figure out some basic things they could also do to help a little?

International perspective

I met several other international participants in an evening reception and in the International Division meeting. No one else from Europe, though. There was a wonderful woman from Argentina who had started her own initiative to develop educational materials and programs for schools to promote healthier eating and physical activity. She was extremely interested in how to leverage technology to lessen the need for people to travel around teaching, but the problem in Argentina is that schools don’t usually have Internet connections or computers for children. We came to a conclusion that the best way to start would be to develop a DVD for those schools which at least have computers on-site.

Other interesting perspectives included an energetic South Korean woman’s story of the country’s journey of advancing from malnourishment and poverty after the Korean war to being the 11th strongest economy in the world, and a woman from New Zealand who was doing her PhD in food literacy and how to measure it. Food policies in different countries and the sustainability of the entire food systems were also discussed critically.

And I just love hearing different accents from around the world!

Talking about weight

Rebecca Puhl from Yale Rudd Center and Dianne Neumark-Sztainer from University of Minnesota made compelling cases against dieting and weight stigma. Puhl presented research results that demonstrated how obese children are 63% more likely to be bullied, largely because overweight characters are always portrayed in a negative way in children’s media. It’s an awfully big problem because weight-based teasing easily leads to social isolation, lower performance at school, depression or anxiety, and less physical activity. Also, teachers and parents look at obese children more negatively. All this obviously results in increased emotional eating, which makes the original problem worse, which leads into more emotional eating and… you get the picture.

Neumark-Sztainer talked about dieting in adolescence and presented findings from longitudinal studies which showed that dieting predicted binge eating. Stopping a diet was not associated with greater weight gain than persistent dieting. So, diets don’t really work. Instead, I think that helping people form new small habits is the way to go. Figure out what the person can do and how s/he could do it.

We need to be able to communicate with anyone in a sensitive, respectful manner. Health at Every Size approach makes a lot of sense, especially since exercise really should be fun, stress-relieving, energizing activity instead of a dreary obligation.

My posters & technology

I presented two posters about predictors of adherence and water intake advice. Dieticians were more interested in water, researchers more in adherence. I discussed the importance of self-efficacy and mental well-being with a couple of people and got a reference to Ellyn Satter’s Eating Competence approach, which focuses on two aspects in healthy eating, which make a lot of sense:

• The permission to choose enjoyable food and eat it in satisfying amounts.
• The discipline to have regular and reliable meals and snacks and to pay attention when eating them.

Technology had a relatively small role amidst policies, education programs, partnerships and environmental influences. That is perfectly fine, I think. Nevertheless, a couple of posters focused on mobile applications and tablet games aimed for children. There was also a session about enhancing your presence in social media – how to best use Pinterest, Facebook, Twitter, LinkedIn and blogs. It seems to be pretty essential nowadays to have social media presence, but sometimes I wonder how fragmented our time (at least mine) becomes when we start following all these things.

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Recreation

It was so hot that I couldn’t really spend a lot of time outside without melting into a puddle. Nevertheless, we managed to get some walks in. The main attraction nearby was the National Zoo, which held animals from almost all parts of the world. Still, it just doesn’t feel quite right to keep living things imprisoned, even though giant pandas would probably be extinct without zoos by now. What affected me the most was seeing gorillas that were munching on snacks looking bored, orangutans trying to make their beds more comfortable by fluffing up the pile of hay, and other primates leading quiet family lives. Those guys looked just like humans, and I wondered why I was on this side of the bars and they on the other side.

Father’s taking a nap while mother’s nursing the baby.

We also went to see an eating disorder play called “Breaking Up With ED” with a colleague. ED is this nasty fellow who barges in uninvited and generally makes everyone miserable. The play was touching and funny, with monologues from various different characters, either suffering from eating disorders themselves or watching someone else’s suffering.

Next year

Next year’s conference will be held in Portland, Oregon, the healthiest and greenest city in the United States. Apparently, the founders of Portland were cunning fellows who wanted to attract more businesses, so they decided to make downtown blocks only half of the length of standard city blocks. As a result, the city is very pedestrian-friendly.

NordiCHI workshop: Designing for Wellness and Behavior Change

NordiCHI conference is coming up, October 14-17 in beautiful Copenhagen. My colleagues in Finland are setting up a workshop about designing for wellness and behavior change.  Ten days until the submission deadline:

http://ww.iki.fi/pasi.valkkynen/dfwabc

Wish I could be there, but since I cannot, you should go!

Mobile Health Conference

I attended the Mobile Health conference in sunny Palo Alto last week (May 16-17). It wasn’t a typical run-of-the-mill academic conference with suits and stiffness – we sat at round tables, the hall was decorated with balloons, and at one point we played a little game by throwing beach balls around. I felt that the relaxed and playful atmosphere really encouraged people to approach each other more freely. In addition, food was mostly healthy, even though there were a bit too many muffins, cookies and brownies around for mindless grabbing.

The focus this year was “baby steps” in three areas: behavior change, collaborations, and product development. BJ Fogg started the program by emphasizing the importance of starting small.

• Failure’s interesting only after you have something small that works. Start simple, test as soon as possible, learn from your mistakes.
• Which one would yield more insights and a better product: one 100-hour trial, or 25 trials of 4 hours each?

As an example, his slides about Top 10 Mistakes in Behavior Change didn’t take much time to do but they’ve reached a large audience and received a lot of attention. Simple and easy to understand, doesn’t require much effort.

I’ll attempt to cover the key themes from the conference in the rest of this post.

Agile science

Eric Hekler continued on the same line as BJ Fogg and tackled the problem of effective intervention development. He talked about the typical lifecycle of a research project, which is so slow that it can take 7 years or even more from the conception of the study to the publication of the results. Not to mention that the general public may not ever hear about the results, because they don’t read academic journals. Meanwhile, society and technology have moved on to perhaps unexpected directions.

We really need to get into the mindset of doing things as quickly as possible. Basically, we get ideas from three sources:

• Theory. Now, theory doesn’t need to be complicated. It can be just your own assumption of how something works.
• Users. That is, the real world. Observing, understanding, empathizing.
• Previous work. The mountains of literature.

We usually spend too much time on crawling through the previous work and too little time on looking around in the real world and trying to understand what people actually are doing and why. It would be better to just run crummy trials to test assumptions at first, and also trying to do those crummy trials without needing to code. After all, in the beginning we’re only testing the psychological experience/recipe to see if there’s any point to go further.

There’s obviously the challenge of finding rapid funding channels. Sometimes testing assumptions might mean doing it for free (or, at universities, doing it with students who do it for credits). But if you love what you’re doing and think it’s going to change the world for the better, wouldn’t it be worth it?

Anyways, in case it’s not clear yet, the concept of agile science sounds really good to me. In hopes of sharing resources and ideas between researchers and developers, Open mHealth initiative aims to create an open mHealth architecture and open community.

Fail Fast

Related to agile science, the recurring message in many speeches was that we must not fear failure. Failing fast will quickly give us an idea of what didn’t work so that we can improve. Moreover, if we build something small and test it quickly, we haven’t wasted a lot of resources, time and money in developing something that ultimately wouldn’t work anyway. Very few companies do exactly the same thing that they started doing – more often than not, they have had to change the course and re-think the original idea several times.

Research groups and companies should also embrace the mindset of failing fast so that there is the freedom to fail, honest feedback is given, and it’s okay to ask for help.

Someone in the audience raised a question that perhaps we shouldn’t fail fast when giving out health-related advice. Even if we’re giving right advice to 75% of people, what if 25% of people get the wrong advice? David Sobel, the wise man who the question was directed at, responded that we’re pretty dumb. The thing with science is that evidence keeps accumulating and changing, and we have to deal with what the current hypothesis is. And we can definitely say that some things are better than others, and with food it’s also about quantity.

Changing the World

Alexandra Drane from Eliza Corporation wants us to make health sexy. After all, that’s how the opponents (food, beverage, and tobacco industries) are trying to seduce us into succumbing to their temptations. And they are also spending enormous amounts of money per individual to achieve their goal, whereas spending into health promotion is miniscule in comparison. Brochures about weight loss and pictures about damaged kidneys are a lot less appealing and interesting to consumers than advertisements with scantily clad women who caress soda bottles. Perhaps we should be more outrageous, direct and unexpected when delivering health messages.

In addition, we have to mention the unmentionables: real concerns that people have in their lives and that drain their energy, making them want to turn to stuff that gives them short-term pleasure. Concerns such as relationship problems, trying to make ends meet, stress at work, or bad sex life. The vulnerability index combined from such factors has much higher predictive power on life expectancy and quality of life than disease index. Thus, people need to be treated compassionately and humanely. Most of us want to be healthy, but it’s difficult to figure out how. We should aim to help people do what they already want to do.

On another note, Nikhil Arora’s mushroom kits made me want to start my own home mushroom farm, and I wasn’t the only one. He told the inspirational story about his company Back to the Roots. In short, they got the idea of growing mushrooms in an urban home, starting with testbeds in buckets in dorm rooms and getting the first successful crops. They then moved on to iterating the idea and presenting it first to the ideal audience (farmers’ markets). Now they have a product which is innovative, useful and promotes sustainable lifestyle. He said that the most positive response has come from kids who are astonished by being able to grow their own food in 10 days.

So, you can have a business that does good for this world. It makes me happy.

Collaboration

One issue with dissemination of research is that too often we wake up to think about it when the project is about to end. Sheana Bull from University of Colorado Denver stressed the importance of designing for dissemination from the very beginning. This involves identifying and engaging the target audience and the people who have the ability to reach the target audience (schools, workplaces, organizations, healthcare). Community-based participatory research would be a good approach to take. Also, concepting and piloting can benefit a lot from online tools: focus groups can be conducted online, and various surveys are easily administered online.

One example of collaborative research is the project HealtheSteps which aims to increase physical activity among all patients in the area. They are screened through healthcare and the intervention is personalized to each individual through mapping the small changes that they can start making in their own lives.

A couple of speakers pointed out that personal feelings always play an important role in collaborations as well. Everyone wants something out of the relationship and wants to be treated fairly – people should be honest about their intentions.

Two alternate ways to think about ROI:

• Research of Interest
• Results of Importance

Besides collaboration in research and development, facilitating patient/citizen collaboration is also cool. PatientsLikeMe and CureTogether are nice services, but perhaps their sort-of weakness is that they are meant for everyone. Global networks such as Crohnology (currently in beta) that are focused on a certain condition or disease might be more inviting and empowering, since people’s experiences and needs are similar.

Confidence

In behavior change, belief in own abilities and in the benefits of the change are a must. While explaining his Behavior Model that consists of motivation and ability dimensions, BJ Fogg stated that ability is the most important thing. Motivation can fluctuate and it often wears off over time, but if we make the behavior very easy to do, it can be done even with relatively low motivation.

Group support is powerful not only because of the boost you get from the group (and the accountability), but also because people in the group share their experiences and concrete how-to examples of succeeding in behavior change and overcoming barriers.

Besides, nobody likes the word willpower. Willpower and motivation may be enough if the spark that initiates behavior change attempt is the result of a huge event or epiphany (such as loved one dying). But we can’t rely on people having epiphanies. We need to provide them tools and how-to tips to make the change easier and effortless; break big goals into small steps. And we need to care about them, not just because of healthcare costs, but because everyone has a right to be treated as a fellow human being with feelings and dreams.

David Sobel from Kaiser Permanente (in preventive medicine: has been trying to prevent medicine for more than 30 years) held a powerful presentation about empowering people. In chronic disease management, the best way to help people has been to let them help other people so that they can find solutions together and gain confidence. He also told a story about a diabetic patient for whom nothing seemed to work, until one day he asked the patient: “What do you really enjoy doing?” At that moment, the patient smiled and answered “trout fishing”. For a while, they could both be somewhere else than in the world of ailment – they could stand in the stream and feel the breeze of a soft wind on their face. At that moment, the doctor stopped seeing his patient as a diabetic and started looking at him as a trout-fisher. And that was also the moment after which they started having progress in lifestyle changes.

So, three steps to personalization:

1. Find people’s passion: what do you really enjoy?
2. Discover their solutions: what would work for you?
3. Celebrate their success!

Stress

Services should be designed to minimize the stress they cause to users, says Neema Morajevi from the Stanford Calming Technology Lab. Makes sense. They’ve created a draft of Design Cards intended to help designers choose strategies to make the user experience stress-free. It’s good to be reminded about this side of things, but we’ll see how applicable those cards are in practice.

In the spirit of small trials, they did a little SMS study during the conference. Basically, we first practised deep breathing   and then got text messages during the rest of the day day asking us to take a few deep breaths or express gratitude to someone. We replied to the message by telling how many breaths we took, how many people we thanked, or how these actions made us feel. It’s a pretty good way to deliver small interventions, as long as the number of messages doesn’t grow too high.

Other tidbits

Some other stuff that stuck with me:

• Not only can you now use your smartphone to measure heart rate and stress, you can also use it to analyse urine samples. Lab in your pocket!
• Hemi Feingarten, Fooducate, about processed food: “The longer the shelf-life of the product, the shorter the shelf-life of humans.” I totally agree. Also: junk food has 90% profit margin, whereas it is 10% for vegetables. If you were a greedy food industry person, which one would you want to sell?
• One person or a handful of people can nowadays use technology and social media to create large changes. Examples: Egyptian revolution, pink slime petition.

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Good conference. One of my small steps was the decision to stand up during the second day – sitting kills.

The presentations and slides should be on the conference website soon, so check them out when you have a chance!