Natalie Digate Muth, MD, MPH, RD, is the ACE senior consultant for healthcare solutions, a practicing pediatrician and registered dietitian. Recognized as a Certified Obesity Specialist, Natalie has written for more than 50 publications and, in 2012, published her first book, 'Eat Your Vegetables' and Other Mistakes Parents Make: Redefining How to Raise Healthy Eaters.
Coaching Behavior Change: Nudge Design
Consider this scenario: Your client wants to lose weight. Her husband does not. The house is stocked with soda, chips and ice cream. Your client just got home from a stressful day at work and is really hungry.
Now consider this one: Your client wants to lose weight. Her husband does not. The house is stocked with fruits and vegetables, and she has a rule that desserts and sugary drinks are not stored in the house. Your client just got home from a stressful day at work and is really hungry.
What happens next? The outcome is less about willpower or motivation. It is a matter of context. In one scenario, the client is bombarded with poor choices, while in the other scenario a healthy choice is the easy (only?) choice. In the first scenario, regardless of willpower and motivation, it would be difficult to choose healthfully, whereas in the second example a gentle nudge may be all it takes to shape healthier habits.
In their bestselling book, Nudge: Improving Decisions about Health, Wealth and Happiness, authors Richard Thaler and Cass Sunstein coin the term “choice architect,” which they define as a person who “has the responsibility for organizing the context in which people make decisions.” While they refer mostly to policy makers, health and fitness professionals interested in helping people make difficult behavioral changes can improve their effectiveness by becoming “choice architects.” They also can help to train their clients to do the same for their own families. In essence, being a choice architect combines two important concepts. The first centers on the idea of making the healthy choice the easy choice. The second is an understanding that a person who relies too heavily on willpower—available in finite amounts, even to the most disciplined among us—to make healthy choices is likely destined to fail.
This can be done quite simply through nudge design. Here’s how:
- Identify a target outcome or behavior. Break it down into the very simplest, smallest action possible.
- Make it really, really easy to do the behavior—so easy, in fact, that you might do it without even thinking.
- Remove or minimize barriers that make the behavior more difficult to do.
For example, you have a client who wants to eat healthier. She narrows it down to wanting to eat more fruits and vegetables. She makes sure to buy fruits and vegetables at the grocery store. She cleans and cuts them right when she gets home and places them front and center in clear containers in her refrigerator.
Another client wants to be more physically active. He would like to start with walking. He has a very hectic work schedule and little free time. At work he is on two to three conference calls per day. He handles this by leaving a pair of tennis shoes and headphones at work and gets his exercise by turning most of his conference calls into walking meetings (at least for him).
In both cases, the healthful behavior is more likely to occur when the environment supports it and systems are in place to offer a gentle nudge to make it happen. Helping clients identify opportunities in which their environment can support them in making a desired change and then setting up systems to nudge them toward that change is a critical component to any behavior-change intervention.
For more information on choice architecture, take a look at this ACE ProSource article on how you can help clients optimize their environments for success. And for more on the power of nudges, check out the Slim by Design, which features key discoveries from Brian Wansink’s work at the Cornell University Food and Brand Lab.