Saturday, October 20, 2012

Candy at the Cash Register

Last week, the New England Journal of Medicine published an interesting editorial titled "Candy at the Cash Register-- a Risk Factor for Obesity and Chronic Disease."  This fits in well with our discussion of non-homeostatic eating, or eating in the absence of calorie need.

There are a few quotes in this article that I find really perceptive.


A basic misconception has stymied our response to the obesity epidemic: the belief that food-related decisions are consciously and deliberately made. Our reluctance to interfere with or regulate the food environment is a direct consequence of the belief that people's food choices reflect their true [conscious] desires....
The reality is that food choices are often automatic and made without full conscious awareness. In many cases, they may even be the opposite of what the person deciding would consciously prefer. What and how much people eat are highly influenced by contextual factors that they may not recognize and therefore cannot easily resist. A clear example of this influence is the placement of candy at the cash register, which is widely acknowledged to be a promotional strategy called “impulse marketing.” Impulse marketing encourages spur-of-the-moment, emotion-related purchases that are triggered by seeing the product or a related message. 
The authors then go on to describe the tactics that grocery stores use to catch your eye and drive purchase, such as placing certain products at the end of aisles.  This is so effective that vendors pay a fee to the retailer to have their products placed at the end of the aisle.
Even if many people acknowledge that food placement can attract attention, they think that those who respond to impulse marketing simply lack self-control and should learn how to resist such marketing strategies....
Even when people are consciously trying to make healthful choices, their ability to resist palatable foods in convenient locations wanes when they are distracted, are under stress, are tired, or have just made other decisions that deplete their cognitive capacity. Once cognitive capacity is depleted, automatic processing that relies on heuristics and other shortcuts dominates, and under these circumstances people are more likely to choose foods high in sugar and fat. Often people regret their purchases of candies, sodas, chips, and cookies. They may recognize that they were impulsive but have no way of avoiding being confronted with these goods, even if they initially went into the store seeking other products. 
Contrary to our favored perception of ourselves, we are not purely conscious beings; we're driven by many unconscious impulses that have a strong impact on every aspect of our lives, including food selection and consumption.  When a person is placed in an environment that promotes increased food intake, food intake will generally increase, often inadvertently.  That's how an obesity epidemic can result from changes in food culture without requiring a massive society-wide "moral failure".  Morality and willpower have very little to do with it.  It's simply a natural result of the food environment interacting with our hard-wired brain circuitry.

It's worth noting that this is multi-factorial.  No one would buy plain boiled potatoes and eat them in the car because they were placed next to the cash register.  We're eating more because highly tempting foods are marketed in ways that maximize purchase and consumption, often inadvertently.  I'll explore this concept a bit more as we proceed through the series "Why Do We Eat?"


29 comments:

psychic24 said...

Sometimes I wonder how great it would be to be able to go to a store and not have to worry about being cognitively "there" after a long day; how great it would be if food was food and not a prowler waiting for my head to be turned. Such a shame....and annoying as %@#!

=)

Anna said...

Having worked in advertising and marketing, I know about a lot of these tactics and it is of course all about getting people to buy more. Usually stuff they don't need.

I may feel "immune" to this influence because of my background, however there are many other ways in which my choices are restricted. The main one I find is in terms of availability of the types of food I choose to eat. There is an extremely poor selection of foods without added sugars, "natural" or otherwise, for example. The same goes for foods without added starchy thickeners, etc. Many of the things I eat are still considered novelty food items, while 99% of the food that is widely available is still just processed crap. Then there is culture to contend with - what my social circle, family and work colleagues consider "normal" food - and the pressure to partake. My choices are limited in these contexts all the time.

Danny Albers said...

Stephen I always said the lions share of dieters read Taubes first, the lions share of food marketers read Guyenette first. Sorry I hope you do not take that the wrong way as I happen to think you are both correct.

Food reward, at first, I was skeptical as a cause of obesity. But I am seeing how it indeed triggered me for so many years prior to gaining weight. As well I have studied marketing more in the industry and in the food industry the idea of food reward is not a theory, its a fact, and one they work very hard to exploit.

The issue you have is that people think this should be overridden by a strong mind or will power or that people are just weak.

This prejudice has followed obese people always. Most people I know got fat before they got lazier and tired and undisciplined.

I watched and read a few sources on "Addictive flavor profiles" and thought "ah hell, Guyenette was right too! And the food chemists are running with it!"

Gys de Jongh said...

"A basic misconception has stymied our response to the obesity epidemic: the belief that food-related decisions are consciously and deliberately made. Our reluctance to interfere with or regulate the food environment is a direct consequence of the belief that people's food choices reflect their true [conscious] desires"

Ten points !!

We are just passengers on an evolutionary fine tuned susrvival vessel. We are not the captain. We are not in charge of what is put in our mouth.

Lots of proof, no one believes it

Sara said...

I did a literature review on this topic recently - it was about how to change what people eat while they are at work or school. Summary: Changing knowledge does not usually change what people do (knowledge and behaviour do not always agree). But, you change what people do by manipulating their food environment, even if you don't address knowledge at all. This includes fiddling with things like ease, accessibility and expense. In NZ at the moment we are having a big issue with alcohol. In spite of massive public health campaigns, nuisance drinking, drunk driving and alcohol-linked crime is getting worse. Could it be because in the last decade alcohol has been allowed in supermarkets and the price has dropped to less than $10 a bottle on average? How about the fact that the drinking age was lowered to 18? Of course there is personal responsibility, but also the majority will always do the easy thing, not the thing that means they must always 'go against the norm'.

Reijo said...

Sara, is your literature review available somewhere? Sounds very interesting. We have very similar experiences with alcohol here in Finland. As Stephan states it's all about maximizing the sales in grocery stores, liquor stores, gasoline stations etc. Interesting thing about alcohol and candies is that they are both highly rewarding and addictive.

I love to see these kind of posts from bloggers like Stephan. Obesity is not only about biochemistry of ingested molecules. It's even more societal problem. Zealots in blogosphere offer easy answers, but there aren't any. Yoni Freedhoff, Andy Bellatti etc. are constantly reminding on the role of Big Food. It seems they are right. But it's also about the grocery stores as this paper concludess. A clearly neglected area.

Can you imagine how it was buying comfort food 60 years ago? Easy or difficult?

Obviously, very interesting series to come, "Why do we eat"!.

Ivan Nikolov said...

@ Anna. Right on! Foods that you (and I want to eat) are still novelty because there isn't enough demand for them to really take off. I - and my failed business (healthy bakery and smoothies - viitals.com) - are proof. Simply, foods nowadays have to be altered in a way of adding a lot of sugar (but don't tell the customer, don't advertise it, he/she doesn't want to know it and see it) and a lot of fat (same as above). If it is advertised as being otherwise or as high in protein, or (let us be helped) as "health" food, people outright avoid it. For the three years I was in the business of inventing, making and offering "healthy food" to the public I discovered that "healthy" actually has a negative connotation.

I know this will change but it will take time.

And, you are absolutely correct about the social circle and what they consider normal vs what you do. It makes you feel as if you have to make special efforts not to be seen as too different and outcast.

Michael Terry said...

"A basic misconception has stymied our response to the obesity epidemic: the belief that food-related decisions are consciously and deliberately made. Our reluctance to interfere with or regulate the food environment is a direct consequence of the belief that people's food choices reflect their true [conscious] desires...."

I don't think very many people think this. Food, just as with lots of other things, is subject to some unconscious influences. It's a pretty far leap to claim that you can't control it consciously by using the correct strategies, as I and lots of other people manage our diets just fine.

I may or may not support regulation of the food environment, depending on the regulation, but don't belittle your public policy opponents by pretending they're ignorant. Regulation has a long history of not achieving regulatory goals while having unintended consequences and costing lots of money. Until regulating bodies stop being captured by the industries they're regulating, and regulating bodies are allowed to lapse when their function is no longer necessary, and regulations start being weeded out quickly when they don't achieve the original goals, I'm going to be extremely mistrustful of regulation in general.

Robert Thorn said...

Dr. Guyunet,
Have you read any of Daniel Kanehmann's work, specifically "Thinking Fast and Slow"? He describes his body of work that touches broadly on the same cognitive challenges that you refer to here.

jd said...

I look forward to this series.

Also, I hope some of these researchers are giving credit to Brian Wansink, his food research, and his book, aimed at the layman, "Mindless Eating." While Wansink is not an obesity researcher, it seems that these obesity researchers are following his lead.

Dave said...

Back many months ago I bought into Taubes' nonsensical insulin theory because it alluded to the idea that I really had little control over my eating (I'm not obese by any means BTW, but eat too much to reach my desired body comp), and I have always believed that I really can't control it. I exercise a ton and usually do just fine during the day at work with no food around, but at home my wife buys so much junk food that I go on binges after a workout such as an hour jog on the treadmill. I will sit there and regret eating that junk before I've even taken it out of the wrapper, and then I proceed to eat it anyways. During these moments I really am powerless. Instead I always just rationalize that i'll make up for it the next day (which I never do), and start gradaually gaining weight until I hit a point where I gain enough willpower to diet down a few pounds and repeat.

Jane said...

@Dave
Is there any way you could persuade your wife to make 'junk' food for you that mimics the real thing but doesn't have any crap ingredients? Or make it yourself?

That's roughly how I got out of my addiction to sweet coffee. I had read The Saccharine Disease and was freaking out about refined carbs. I knew I could not go on drinking sweet coffee. I tried coffee without sugar and it was horrible, and went on being horrible for a month when I realised I had to do something different. So I started eating an apple whenever I had sweet-coffee cravings. For a whole year I ate a pound of apples every day, and then my addiction was over.

I think the problem was that my liver wasn't completely healthy and couldn't produce the sugar my brain needed fast enough. No doubt my pancreas wasn't in very good shape either, and this combination means fluctuating blood sugar. Obviously damage in my hypothalamus or other parts of my brain might have played a part too.

David Moss said...

"No one would buy plain boiled potatoes and eat them in the car because they were placed next to the cash register."

This is a minor practical point, separate from complete agreement with the statement that "we're driven by many unconscious impulses that have a strong impact on every aspect of our lives"... but plain boiled potatoes are clearly not completely innocent when it comes to mindless eating. There seems to be significant inter-personal variation on this point, but as many people have already commented on here, completely plain starches are often highly palatable and highly amenable to mindless over-eating, hence (based on anecdotal, but not personal, evidence) their commonly being selected as binge foods. I can see why people who don't find plain potatoes particularly tempting would find this almost inconceivable, because, as some-one with the opposite response to plain potatoes, it seems bizarre to me prima facie that there could be people for whom plain starches are filling. It's true (but misleading) that you'd never buy plain boiled potatoes at a checkout (because this would be highly inconvenient to eat- I'd never buy a pyramid of profiteroles at a checkout either), but I'm sure lots of people would mindlessly eat their way through some prepared boiled potatoes or plain bread in front of them on a table, in a way they wouldn't do with many other foods.

Jonathan said...

Stephan,

Have you looked into conscious inadvertent food intake (candy at a cash register) versus truly unconscious inadvertent food intake (ambien-induced refrigerator raids)?

I don't know anything about biochem but it looks like there are some interesting similarities there. Does stress/fatigue/obesity affect the receptors that benzodiazapine acts on?

Here's an interesting paper: Novel benzodiazepine receptor ligands: Palatable food intake following zolpidem, CGS 17867A, or Ro23-0364, in the rat www.sciencedirect.com/science/article/pii/0091305789905042

Thanks

@Jane
Add some chocolate protein powder to your unsweetened coffee (I like it iced). Tastes just like a mocha. Get your caffeine fix and some extra protein.

Stephan Guyenet said...

Hi Sara,

Absolutely.

Hi Michael,

I don't think anyone claims that you can't control food intake consciously at all. These researchers' position, which is also mine, is that food choice is strongly influenced by unconscious factors. Conscious efforts can obviously have some influence, but I think the implication here is that there are more or less smart ways to apply your efforts. Controlling the food environment requires less effort than using willpower to consciously detect and resist all these environmental factors that drive food intake.

Hi Robert,

I haven't, thanks for the recommendation.

Hi David,

I don't know where this idea came from that plain starches are a common binge food... I don't think they are. The most common binge foods are highly palatable energy-dense junk foods like ice cream, chocolate, pizza and chips. Bread is the only thing you might call an exception, but even that is quite palatable and energy-dense compared to a plain potato (and usually people put something on it like butter or jam, though not always). I'm sure you could find a few people who binge on plain potatoes if you looked hard enough, but I've never heard of it.

George Henderson said...

@ Sara,
and any attempt to limit alcohol content in Woodies (kiwi canned premix) will only increase fructose consumption...
sugar calories in alcoholic beverages are unlabeled and consumed largely unawares - because, how aware is a drunk of anything they do?
Does freedom of choice still apply to babies and drunks?
Are there papers on eating habits of drunks and the role of binge drinking in diet-health problems?
New Zealand would be the perfect place to do that research.

justjuliebean said...

On a very related topic, heard Dr. Kelly Brownell speak tonight, for M Pollan's Edible Ed class at Cal. and while he focused a lot on advertising, especially sugary cereal and soda bans, he also mentioned "optimal defaults", which, as you probably can figure, means the easy option should be the healthy one. In my opinion, it shouldn't take constant willpower and extraordinary effort to eat even moderately healthy. As Anna above mentioned, what's available and convenient isn't healthy.

So now, eating healthy takes willpower, restraint, education, planning, and willingness to tolerate inconvenience.

Jane said...

@jonathan
Thanks. Chocolate would have been a very good idea because it's high in copper, and I think I probably had copper deficiency.

Evelyn aka CarbSane said...

When I was a kid, Mom dragged us kidlets along when we shopped for food in the regular grocery -- which didn't carry the all-beef nitrate free hot dogs, sprouted grain bread and cold-pressed sunflower oil we used sparingly in salads.

In the 70's there was candy at the registers. Kids cereals were marketed by Tony the Tiger and housed on low shelves where they were at my eye level. This stuff is old hat, nothing new, though the invasion of the home with incessant advertising sure has increased over the years.

Someone mentioned on my blog a little while back how she had to walk around to get to the rice. And yet we hear folks talking about shopping the perimeter of the grocery.

EVERY grocery store in my area enters into the fresh produce department. Every one. Sure, in two of them the pre-prepared food and/or the entire deli area is right there alongside, but I walk past apples galore every time I go to a grocery store long before I encounter a candy bar. You actually have to go more out of your way to shop for processed foods. I'm mentally going through the stores I frequent now and I could be in and out in 5 minutes and get all my healthy stuff making one loop of the store. All my veggies (including starchy) and fruit, my eggs and dairy, my meats and fishies.

And if I had kids, I could go to the candy-free register and out.

Yes, there are the smells of on-site bakeries at times. Yes, there are the endcaps of on-sale crap I might have to navigate. But my point is THIS part is nothing new. If anything, it's better now than what my own mother faced.

George Henderson said...

Consistent with the theme of this post, it's snacking (number of eating/drinking occasions), not energy density or portion size that seems to have driven the increase in energy intake:

http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001050

Energy Density, Portion Size, and Eating Occasions: Contributions to Increased Energy Intake in the United States, 1977–2006

Between 1994–98 and 2003–06 changes in EO accounted for 39 kcal/d/y of increase and changes in PS accounted for 1 kcal/d/y of decline in the annualized change in TE.

Conclusions
While all three components have contributed to some extent to 30-y changes in TE, changes in EO and PS have accounted for most of the change. These findings suggest a new focus for efforts to reduce energy imbalances in US adults.

George Henderson said...

Here's a good analysis of that paper:
http://nutsci.org/2011/06/28/increase-in-number-of-eating-occasions-more-than-increases-in-food-portion-sizes-or-energy-density-per-meal-responsible-for-increased-energy-intake-at-the-population-level/

Sam Singer said...

Where I come from, the candies don't come free in our counters/registers. I think it's part of the marketing strategy made by these stores so that when kids see candies in great colored wrappers, they'd have to ask the parent to buy them at least 2.

Disposable medical gloves

jojopig.com said...

Thanks for the great read.

Jane said...

Thanks George, that's very interesting indeed.

Pleonard Leikoff said...

Oh, right, so the solution to the population's inherent inability to control themselves is to have them mindlessly wander around in a carefully-constructed, government-controlled healthy environment. Lets replace one (alleged) form of zombism with another. Brilliant.

Oh, and by the way, those government regulators: theyre lowly, helpless, urge-ridden human (automatons) too. Funny how we can use our volition to put the right ones in power so that they can protect us from our inability to put the right food in our mouths.

commercialanalysis said...

Hmmm, so human beings, biologically, are ultimately unable to decide for themselves what is and is not healthy, but somehow they are able to make the right decisions when it comes to the judgement of scientists' judgment by the politicians they elect as their proxies? We can't resist the urge to buy candy at the checkout counter, but somehow we can resist the urge to elect politicians who would go with the findings of scientists who declare truly unhealthy foods healthy in order to ensure that our candy supply is protected? And then the politicians we do elect, they themselves - somehow - can resist the urge to accept the findings of scientists who allow for truly unhealthy food (just because politicians, being humans aswell, want that candy too) and go with the other scientist who is correct? And finally, since scientists are people as well, how can our elected leaders - let alone ourselves - ever be sure that their "correct" findings are not simply mumbo jumbo rationalizations born from their urge for unhealthy food (ie: the food is actually unhealthy, but because they know their advice will be made into law, they want to be sure that they have will have access to the foods they "hopelessly crave" when they themselves go to the store)?

This is childish nonsense. It's fascism lite.

Healty Mai said...

Nice article.. >> That's how an obesity epidemic can result from changes in food culture without requiring a massive society-wide "moral failure". Morality and willpower have very little to do with it. ^_^

COW BRAIN

Jane said...

Well I think it's all the fault of the mindless masses. I'm a fascist, you see. They all WANT to be sick so they can fall about laughing at the scientists who spend their days trying to work out what's making them sick.

Megan Billard said...

This is very interesting. I know that I've been to a few stores lately where the candy at the cash registers in Calgary is minimal if there is any at all. But, this is a marketing practice that has been going on for how long? I think there is a reason the obesity rate is rising, but it's not because of candy at the register. It's because of a lack of self-control. Just because you see a candy bar doesn't mean you have to eat it. That's what people need to learn, self-control. Because for some of us, that candy at the check-out is a nice pick me up some days and is completely ignored other days.