Don’t buy into Britain's supermarket spying

Lib-Con plans to ‘nudge’ us into making healthier shopping decisions exposes how anti-democratic nudge theory is

Not content with already nannying and nudging us in various ways, and using sin taxes to regulate our consumption habits, Britain’s Lib-Con coalition government is now pursuing another policy of paternalism. It is aiming to gain access to the shopping habits of 25million people through the information saved on their supermarket loyalty cards, such as the Sainsbury’s Nectar card or Tesco Club Cards. That way, it can work out where we’re going ‘wrong’ in terms of what we buy and eat, and nudge us in the ‘right’ direction.

Supermarkets keep a complete record of all our purchases if we use a club card. But that information was traditionally only used to aim store promotions at customers, based on their previous purchasing habits. Now, prime minister David Cameron says he backs the idea that such information should be used to try to nudge people towards making better, healthier choices. Other senior Tories, however, including health secretary Andrew Lansley, are worried that this all adds up to government snooping.

By getting a glimpse into what people buy from the supermarket, right down to the last rasher of bacon and can of Carlsberg, the government hopes to devise ways to make our weekly shop healthier. People will be targeted with specific health advice. So presumably, those who purchase a case of Stella [beer] on a Friday evening will be subtly alerted to the dangers of alcohol and kindly asked to refrain from drinking too much, while those who regularly purchase white bread will be asked to consider the wholemeal option. Parents might also be chastised if their supermarket shop suggests they aren’t providing their children with a ‘balanced diet’.

An O-word, named after a certain Eric Arthur Blair, comes to mind. The idea of a government agency poring over the public’s shopping habits, and then suggesting healthier options, is a strange and paternalistic one. It assumes the public are too stupid to decide for themselves what to buy and eat. In the government’s eyes, the only reason someone’s Tesco Club Card might show up a lot of beer-buying is because that person is oblivious to the health implications of drinking, and therefore needs a friendly ‘nudge’ in the right direction. It couldn’t possibly be that, despite knowing about the relationship between alcohol and health, he has decided to get pissed nonetheless.

It should come as no surprise that this latest attempt to change people’s choices comes from the Cabinet Office’s Behavioural Insight Team (BIT). BIT, commonly known as the Nudge Unit, was set up two years ago to utilise behavioural economics theory to ‘nudge’ people into making what are considered to be the correct lifestyle choices. The Nudge Unit’s purpose is to find ways to ‘encourage, support and enable people to make better choices for themselves’ – though what qualifies these policy wonks to know what the ‘better choices’ are is unclear.

The Nudge Unit believes that small nudges and external stimuli can encourage people to become healthier. This means it hopes to change the way we perceive and see the world around us, and how we interact with it, too. To the Nudge Unit, the public are a bit like Pavlov’s dogs – ring a bell, provide some new stimulation to the brain, and everyone will unconsciously start salivating at the mouth to make new and improved eating, drinking and lifestyle choices.

The central idea is that people can’t be trusted to make decisions on their own, and so the government must get stuck into our day-to-day lives. But if the average person can’t be trusted to know what the right choice is, why is the Behavioural Insight Team any different? How is it that these people know what the right choices are? Perhaps they view themselves as an enlightened elite who must lord it over the feeble-minded masses, gently nudging us in the right direction, like shepherds herding the sheeple to the land of correct thinking.

This elite mindset is antithetical to democracy. The idea of democracy is that people are able to decide for themselves how to live their lives and also what the future of their society should look like. That is, democracy is, or should be, based on the idea that people know what is in their own best interests. And so we have the right to elect people who we believe will shape society as we would like it to be shaped. The ideas of the Nudge Unit negate this basic principle of democracy; in fact, they call into question the very idea of democracy, which can’t really exist if people are seen as incapable of making good decisions even in the supermarket aisles, never mind the voting booth.

The idea that the government knows what is best for us redefines the democratic relationship, the relationship between free citizens and those who govern. Rather than being viewed as active and conscious agents who should get to say what society should look like, we are turned into a mass to be manipulated by officials who believe they know best what we should look like. Elected politicians are turned from representatives of the demos into shepherds overlooking their fickle flock.

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Being overweight does not increase risk of death

An evaluation of national data by UC Davis researchers has found that extra weight is not necessarily linked with a higher risk of death.

When compared to those with normal weight, people who were overweight or obese had no increased risk of death during a follow-up period of six years. People who were severely obese did have a higher risk, but only if they also had diabetes or hypertension.

The findings, which appear in the July-August issue of The Journal of American Board of Family Medicine, call into question previous studies -- using data collected when obesity was less common -- linking higher short-term mortality with any amount of extra weight.

"There is currently a widespread belief that any degree of overweight or obesity increases the risk of death, however our findings suggest this may not be the case," said Anthony Jerant, professor of family and community medicine and lead author of the study. "In the six-year timeframe of our evaluation, we found that only severe obesity was associated with an increased risk of death, due to co-occurring diabetes and hypertension."

Based on the study, Jerant recommends that doctors' conversations with patients who are overweight or obese, but not severely obese, focus on the known negative effects of these conditions on mental and physical functioning, rather than on an increased short-term risk of death.

By contrast, Jerant added that it is important for doctors to talk with severely obese patients who also have diabetes or hypertension about their increased short-term mortality risk and treatment, including weight loss.

"Our results do not mean that being overweight or obese is not a threat to individual or public health," said Jerant. "These conditions can have a significant impact on quality of life, and for this reason alone weight loss may be advisable."

In conducting the study, Jerant used nationwide data from 2000 to 2005 of nearly 51,000 adults aged 18 to 90 years who participated in the Medical Expenditure Panel Surveys on health-care utilization and costs. The surveys include information on health conditions such as diabetes and hypertension.

Body mass index (BMI), or weight adjusted for height, was calculated for each respondent. The study categorized people as underweight (BMI < 20), normal weight (BMI 20 to < 25), overweight (BMI 25 to < 30), obese (BMI 30 to 35) or severely obese (BMI > 35).

Mortality was assessed using the National Death Index. Of the 50,994 people included in the UC Davis analysis, just over 3 percent (1,683) died during the six years of follow-up.

The investigators found that severely obese people were 1.26 times more likely to die during follow-up than people in the normal weight group. However, if people with diabetes or hypertension were eliminated from the data, those who were overweight, obese or even severely obese had similar or even lower death rates than people of normal weight. Consistent with a number of prior studies, underweight people were nearly twice as likely to die than people with normal weight, regardless of whether diabetes or hypertension was present.

The prevalence of overweight and obesity has increased dramatically in recent decades. An estimated one-third of all U.S. adults over age 20 are obese and another one-third are overweight. In addition to diabetes and hypertension, health problems associated with these conditions include heart disease, osteoarthritis and sleep apnea.

The relationship between weight and mortality is a controversial topic in public health. Although studies based on data collected 30 years ago showed that mortality risk rose as weight increased, analyses of more recently collected data, including the current one, call this assumption into question.

"Our findings indicate that the risk of having an above-normal BMI may be lower than in the past," said Jerant. "While this study cannot explain the reasons, it is possible that as overweight and obesity have become more common, physicians have become more aware of associated health issues like high blood pressure, cholesterol and blood sugar, and are more aggressive about early detection and treatment of these conditions."

Jerant said that the six-year period of his investigation limits the ability to make assumptions about the link between unhealthy weight and the risk of death over a longer timeframe.

"We hope our findings will trigger studies that re-examine the relationship of being overweight or obese with long-term mortality," said Jerant.

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