Employers need simple, low-cost ways of helping employees make healthy choices. The effects of poor health and obesity cost U.S. companies $225 billion every year, according to the Centers for Disease Control, and this number is quickly rising. Although some employer-sponsored wellness programs have yielded high returns - Johnson & Johnson reported a 170% return on wellness spending in the 2000s - the employee wellness industry as a whole has struggled to prove its value.
Wellness initiatives often fail because they rely on outdated methods of engagement, placing too much emphasis on providing information. Extensive evidence from behavioral economics has shown that information rarely succeeds in changing behavior or building new habits for fitness and food choices. Telling people why and how to improve their health fails to elicit behavior changes because behavior often diverges from intentions. This is particularly true for food choices because our self-control is taxed by any type of depletion, including hunger. And the necessity of making food decisions many times a day means we can't devote much processing power to each choice, so our eating behaviors tend to be habit- and instinct-driven. With a clearer understanding of the influences on choice - context and impulsivity, for instance - companies can design environments that reinforce employees' healthy choices, limit potential lapses, and save on health care costs.
Jointly, the Google Food Team and the Yale Center for Customer Insights have been studying how behavioral economics can improve employee health choices. We've run multiple field experiments to understand how small "tweaks" can nudge behavior toward desirable outcomes and yield outsized benefits. To guide these interventions, we distilled scattered findings from behavioral science into a simple framework, the four Ps of behavior change:
The framework helped us structure a portfolio of strategies for making healthy choices easier and more enticing and making unhealthy choices harder and less tempting. Below, we present a brief example of each point of intervention.
One of the major contributions of behavioral economics to our understanding of behavior change lies in the application of small nudges in "choice architecture," that is, the presentation of available options. Small changes in the choice context can direct attention toward healthier options or make those options easier to choose. For example:
- Order: Sequence matters. The privileged position in a visual set (such as a buffet line or menu) is the first item in a pair or the middle item in a set of three. The privileged positions in an auditory set (such as a recited list of daily specials) are both the first and the last items.
- Defaults: Due to a bias toward the status quo and to the ease of not making a decision, defaults exert a strong pull on choices. They can make the "better" choice the easy choice.
- Accessibility: People tend to eat food that is easy to see or easy to reach.
A small difference in accessibility can have a major impact on snacking. We sent undercover observers to one of Google's large and busy "microkitchen" break rooms, which are stocked with free drinks and snacks. The observers recorded the number of people who took both a drink and a snack. One beverage station was 6.5 feet from the snack bar; the other was 17.5 feet from the snack bar. Each beverage station had a refrigerator containing cold drinks and a brewing station for hot drinks. The snack bar offered nuts, crackers, candy, dried fruit, chips, and cookies. Observations of more than 1,000 people found that people who used the beverage station near the snacks were 50% more likely to grab a snack with their drink. For men, the estimated "penalty" in increased annual snack calorie consumption for using the closer beverage station was calculated to yield about one pound of fat per year for each daily cup of coffee!
Persuasion interventions can make healthy options more appealing and unhealthy options less appealing through the fine-tuning of message delivery, from framing and timing to the leveraging of social norms. These are the least invasive and lowest-cost ways to nudge people toward better choices. The key is communicating the right message, the right way, at the right time - when the individual will be most receptive to it. Here are the three essential factors:
- Vividness: Vivid messaging and imagery grabs the attention of the intuitive, emotional mind. Vividness - triggering delight or disgust, for example - can help the gut instinct make the best choice.
- Comparisons: The right message might frame relevant trade-offs or quantify the effects of behavior, e.g., "It takes two hours to walk off the calories in a can of soda." Losses or pain can sometimes be more motivating than gains or pleasure.
- Moments of Truth: The Moment of Truth is the time and place when people will be most receptive to persuasive messaging that relates to the goal.
Although another study had predicted that advertising widely disliked vegetables wouldn't get people to eat more of them, we found the opposite. In one high-traffic cafe where Googlers eat free meals, we promoted an unpopular vegetable (beets, parsnips, squash, Brussels sprouts, or cauliflower) as the "Vegetable of the Day!" with displays of colorful photos and trivia facts next to a dish containing that vegetable as its main ingredient. By placing the campaign posters at the Moment of Truth, right next to the dish - rather than, say, emailing an article about the health benefits of vegetables - we increased the number of employees trying the featured dish by 74% and increased the average amount each person served themselves by 64%.
Possibilities refers to the set of choices being offered. This is the most obvious lever of change, but it's often overlooked. When changing possibilities, be mindful of maintaining freedom of choice, since negative reactions against perceived paternalism could outweigh the benefits. Tempting but unhealthy options could perhaps be reduced or made less available without eliminating them altogether. You can try changing:
- Assortment: Variety is a powerful stimulant of consumption: more options generally means more consumption, since people have a tendency to eat what's in front of them. However, behavior is affected by perception, not reality. For example, people will eat more M&Ms from a bowl containing many colors than from a bowl containing only one color - despite all M&Ms having the same flavor. One way to reduce consumption without restricting choice altogether is by rotating variety over time, serving, say, a different dessert each day rather than five different desserts for the whole week.
- Bundling: To encourage healthier behavior, healthy options can be strategically paired with other healthy options, or even with less-healthy options.
- Quantity: People tend to believe that an entire portion is the appropriate amount to eat, however "portion" is defined. Tweaking quantity can influence consumption.
In a field experiment in another Google microkitchen, we targeted the most popular snack item: bulk M&Ms. They had been self-serve from bulk bins into four-ounce cups; most employees filled the cup. After taking a baseline measure of consumption, we replaced loose M&Ms with small, individually wrapped packages. This simple intervention reduced the average serving by 58%, from 308 calories to 130.
With process, persuasion, and possibilities, you can influence behavior in a specific context. It is only through the person, however, that behavior can be influenced across contexts over time - and outside the workplace. Influencing the individual is the most challenging lever of change. Most attempts fail to change behavior even when they succeed in changing attitudes and intentions, because behavior often deviates from intentions. So motivation is not enough - tools are needed. A few well-established interventions can help support people's best intentions. These include:
- Goals: Setting and tracking goals is an essential strategy for improving behavior over time. Goals should be personal, motivational, and measurable, and supported with tools to help along the way.
- Precommitment: Willpower is a depletable mental resource: when people are tired, hungry, stressed, or focused on something else, they are less likely to perform actions requiring willpower. Planning and committing in advance - preplanning healthy meals, for example - allows reasoned decision making and helps prevent impulsive choices that could be regrettable.
- Habits: The majority of our actions are automatic, which means that habitualizing healthy behaviors is the ideal way to sustain them. The following experiment was designed to help Google employees turn goals into healthy eating habits.
Volunteers set personal diet and body goals and were randomly assigned to one of three groups. The first received information on the link between blood glucose and weight gain. The second also received tools for using that information: blood glucose monitoring devices, data sheets, and advice on measuring glucose, weight, BMI, and body composition. The third was the control group, receiving no information or tools. Weekly surveys showed that those who had received tools in addition to information made the greatest progress on their goals. After three months, there was no difference between the information group and the control in achieving personal goals, but for those who had received the tools, 10% more people reported making progress on their body goals, and 27% more reported making progress on their diet goals. By the end of the study, those in the tools group found healthy choices were becoming more habitual. Information was not enough to facilitate change, but tools and measurement made the healthy choice the easy choice.
The 4Ps approach allowed the Google Food Team and the Yale Center for Customer Insights to experiment our way toward a comprehensive program to help employees make better food decisions at work and at home. Our results so far present a compelling glimpse of how human resource and leadership teams can use behavioral economics to boost employee health and performance while reducing companies' health-related costs.