Changing one’s health habits may be difficult for various reasons. People need concrete support, not to be preached at.
Most Finns are familiar with the basics of healthy habits: they ought to eat less fat, salt and sugar and more vegetables, fruit and fish. Of course, some people know even more, for example, the differences between healthy and harmful fats and white and wholemeal bread, and that we should take at least 10,000 steps per day.
In spite of all this knowledge, the weight of Finns has steadily increased since the 1970s. According to the National Institute for Health and Welfare, sixty-six percent of Finnish men and forty-six percent of Finnish women are overweight. Furthermore, about twenty percent of both men and women are obese. The body mass index of children and young people is also increasing. According to the Adolescent Health and Lifestyle Survey (AHLS), the prevalence of excess weight among 12–18-year-olds has nearly tripled in the last four decades, and the severity of obesity has also increased.
Up to half a million Finns are estimated to suffer from type 2 diabetes. In 2011, the total cost of treating diabetes and other illnesses related to excess weight was about 330 million euros.
How is this possible at a time when Finns have access to all sorts of health information, there is a gym on nearly every street corner and healthy foods await us in the supermarkets? Why don’t we just start following the advice on healthy living?
Academy of Finland Research Fellow Nelli Hankonen, a university lecturer in social psychology at the University of Tampere, says that information in itself is not enough to change people’s behaviour. This is especially true of health behaviour.
“Lifestyles are complex amalgamations of various behaviours. If you want to influence people’s lifestyles, you should take into account much more than just knowledge. Among other things, people need actual skills, such as the skill to cook healthy meals and the ability to regulate, plan and schedule their behaviour,” Hankonen says.
One must also take into account competing behavioural patterns that are encoded in us by evolution. Our bodies are programmed to store fat and salt and hold on to the body’s energy reserves. We must be highly motivated to resist this predisposition in our current environment, which requires little exercise and contains a lot of food. People must really want to act in healthy ways.
“However, healthy behaviour may often feel unpleasant. Both the risks related to unhealthy behaviour and the benefits of changing behaviour may seem distant and hard to take onboard. Therefore, people easily replace healthy behaviour with more instant types of gratification,” Hankonen says.
Tipping the balance in favour of healthy behaviour requires high motivation and a belief that one can actually start to exercise regularly or quit smoking or drinking, for example. If people do not have the self-confidence required or do not believe they can succeed, they will not be very likely to try.
A physical and social environment conducive to change is also necessary. For example, when we talk about children not getting enough exercise, we may ignore the fact that children are frequently driven everywhere and that sports played during free time can be costly.
“All of these factors increase the likelihood of unhealthy behaviour,” Hankonen says.
The basic conflict in our social environment is that at the same time as one form of media after another talk about how we should live healthily, we pick up a different message from our immediate environment.
“Other people do not seem to exercise so much or eat healthily. Every family has an uncle who smoked all his life and still lived to be ninety years old. Because of cognitive biases, we tend to pay attention to the special cases that support our current behaviour and make it easier for us to accept what we are doing,” Hankonen explains.
There is a whole gamut of influences. When researchers measured the various factors that had an effect on the exercise levels of 15–19-year-old Finns, the result was that most of the eighteen measured factors were associated with excercise. Surprisingly, the clearest single factor that was not related to exercise was information.
“Knowledge about recommended physical activity was not significantly associated with exercise. How people chose to behave was determined by completely different matters,” Hankonen says.
The research results also show that there is no one trick that would make the whole population behave more healthily.
“No lifestyle application can solve this problem. Not even Pokémon Go can permanently make everyone exercise,” Hankonen says.
Segregated bicycle lanes or a sugar tax are also not much of a solution. Instead, we need several different means that form a comprehensive whole and help us make better choices.
Information campaigns still also play a role, but they should be wisely planned.
“The campaigns should take into account the different styles of influencing people and the psychological mechanisms that can help people perceive and absorb things. The information provided by behavioural and motivational sciences is not currently fully used. A lot of preaching still occurs, even though it is not often very efficient,” Hankonen says.
Preaching often results in resentment. According to a recent research report, as many as a third of Finns make a serious attempt to lose weight every year. The Finnish Broadcasting Company YLE commissioned a study that showed that every third woman starts a diet several times a year. Unsuccessful dieting attempts repeatedly result in anxiety and feelings of guilt.
“People may think that everything about them is bad, not just their weight. This is what goes wrong with health education. People should accept themselves as they are and simultaneously acknowledge that it is in their own interest to change their lifestyle,” Hankonen says.
What should we do? How can we talk about healthy lifestyles so that the talk does not harm or discourage people or bore them to death?
According to Hankonen, we should be able to speak to people who need to change their lives in ways that empower and motivate them. We should first abandon the focus on how people look. Many people have the mistaken belief that bikini fitness competitors are the epitome of health. However, real health does not require extreme training or dieting or unreasonable physical goals.
“Using fitness competitors as role models only alienates those who are not so familiar with exercising. Such attitudes build an unnecessary divide and polarisation between ‘health fascists’ and ‘others’,” Hankonen says.
However, the current vogue for fitness has also resulted in some good things. It has made sports clothes and trainers part of an acceptable wardrobe in cities and made walking easier. Such small things add up and help to increase the amount of daily exercise.
In the recent years, “nudging”, which entails positive reinforcement and indirect suggestions by altering the choice architecture but not removing any behavioural alternatives, has aroused international attention. Nudging may support desired healthy choices by indirectly influencing the motives, incentives and decision-making of groups and individuals. For example, research has shown the positive effects of changing the placement of products on supermarket shelves so that soft drinks can only be found at the back of the stores. Another well-known example is removing tobacco products from view.
However, Hankonen points out that nudging is just another tool that does not transform things on its own.
“Nudging can be applied in places where small changes can make a difference,” Hankonen says.
In a research review published by Hankonen and Sini-Tuuli Hynynen in 2015, the promotion of children’s and young people’s sports by supporting their autonomy was found to be beneficial. In this approach, young people’s own wishes and needs are recognised, and they are offered a choice of exercises and opportunities to exercise.
A similar approach could be applied to adults. One of the three basic psychological needs is the need for self-determination. It is closely connected to internal motivation, which is of primary importance when people seek to make great changes.
According to Hankonen, health care professionals should forget their expert status and be more cooperative when they talk about lifestyle changes with their patients. Among other things, motivational interviews have proven to be beneficial.
• Academy of Finland Research Fellow (2015–2020) and university lecturer of social psychology at the University of Tampere in Finland.
• For over a decade, she has researched changes in behaviour and how behaviour can be influenced with a special focus on well-being and related behaviours.
• Hankonen is currently investigating what is known about the strategies people use to regulate their motivation and how those means are associated with fluctuations of motivations at work or in sports. She is also working on a randomised field trial encompassing more than one thousand young people on how they can be motivated to being physically active in order to stay healthy and to reduce extended periods of sitting down in schools and colleges.
Text: Hanna Hyvärinen
Photograph: Jonne Renvall