Of Nannies and Nudges:
Current State of Obesity Policymaking
“Who’s Afraid of the Nanny State?”
Rogan Kersh
Wake Forest University, USA
April 2014
Plan of Presentation
O ‘Nanny State’: pejorative frame
O Extended case study: Obesity politics/policy
O State responses
O Retreat: Laissez-faire
O Submerge: Invisible policies
O Divert: Libertarian-paternalist nudges
O Advance: Use state’s coercive powers
O Reframe: Emphasize ‘nanny’ positives
Obesity:
Policy
Issue?
Slow-Motion Epidemic
1990
1998
2010
No Data
<10%
10–14%
15–19%
20–24%
25–29%
≥30%
Laissez-Faire State
 Philosophically familiar
 “Consumer sovereignty”: frequent US variant
 Obesity-politics context: personal responsibility
 Dominant US Political Frame: 2000-06
 Still powerful: Lusk/Ellison (2013)
What Causes Obesity? (US, 2013)
"Primary Cause"
90
80
70
60
50
40
30
20
10
0
Laissez-Faire State
 Philosophically familiar
 “Consumer sovereignty”: frequent US variant
 Obesity-politics context: personal responsibility
 Dominant US Political Frame: 2000-06
 Still powerful: Lusk/Ellison (2013)
 Competitor, 2007-present: toxic food environment
Obesity: 2 Primary Frames
Average Soda Size, USA: 1970s-Today
16 oz: late 80s
• Personal Responsibility
– Dominant, 2000 to ~2006
34 oz: 2000s
20 oz: 1990s
8 oz: 1970s
• “Toxic Food Environment”
– Increasing post-’06
12 oz: 1980s
• More Subtle Variations in recent years
Typical Sandwich Size, USA
1980
320 calories
Difference: 535 calories
Howlong
to burn
calories:
How
would 535
you have
to bike
hour 32 minutes
toBike
burn for
5351calories?
2013
How
calories are in
855 many
calories
this turkey sandwich?
Laissez-Faire State
 Philosophically familiar
 Obesity-politics context: personal responsibility
 Dominant US Political Frame: 2000-06
 Still powerful: Lusk/Ellison (2013)
 Competitor, 2007-present: toxic food environment
Submerged State
 Submerged State: Mettler (2012), builds on others
 Obesity-politics example: Reformulation
Psychological State
 Libertarian Paternalism: Thaler & Sunstein
 Canvass of Behavioral Changes: Jones et. al.
 Obesity-Politics example: Menu Calorie Labeling
Menu Calorie Labeling
Our Evaluation Study
• Does NYC labeling influence fast-food choices of
individuals in low-income areas?
• “Difference-in-Difference”
• Examine calories purchased before/after labeling, in
NYC & control city (Newark, NJ)
• 2 NYC Studies, 2008: Adults and Children
• Follow-up, 2011: Philadelphia (Baltimore/control)
Results: Calories Purchased
Regression Adjusted Calories
• No differences
1000
825.87
600
823.40
Calories
700
846.12
800
824.81
900
500
Pre
Post
seen in response
to labeling by:
• Race/Ethnicity
• Age
• Sex
400
300
• Education
200
100
• “Noticed Info”
0
NYC - Full Sample
Newark - Full Sample
City
But What If…
ACA/“Obamacare”
Active (Coercive?) State
 US: interest-group politics (PRFC Act)
 Elsewhere: more legislative success
 Which polic(ies) to choose under constraints?
Ireland, 2009 obesity-policy recs (as of 2013)
 Impact/Feasibility Studies
Nanny State…Reframed
 Pejorative…
 …to Positive: Shift Political Culture
 US: Millennials/Gen Y



Unusual ‘peer networks’
Highly adult-supervised/curated lives
Responsive to vital cultural messages/change