CHILDHOOD OBESITY August 2013 j Volume 9, Number 4 ª Mary Ann Liebert, Inc. DOI: 10.1089/chi.2013.9405 GUEST EDITORIAL Convenient, Attractive, and Normative: The CAN Approach to Making Children Slim by Design Brian Wansink, PhD ducation is overrated when it comes to changing eating behavior. This is as true for children as for adults. There is a very unreliable link between knowledge and behavior, and relying only on education and knowledge to change the eating behavior of children will continue to be frustratingly unsuccessful. Fortunately, there is an alternative. Most children of all ages have a choice of what and how much they eat. Even if given only a bowl of gruel from the Oliver Twist cookbook, they have the choice of whether to eat any of it or whether to eat it all and ask for more. The key to changing their behavior is not in convincing a child that an apple is better for them than potato chips—that does not work for adults, let alone defiant 7 year olds. Instead the key is to make sure that the apple is the more convenient, attractive, and normative food to grab. Even though the typical person thinks that they make about 20–30 decisions about a food each day, we make closer to 200 food decisions.1,2 We are not fully aware of about 90% of these decisions because they don’t involve reason and deliberation. They involve quick, instinctive actions. The same is true with children. They are not aware of why they choose the foods they choose. This gives us a great opportunity to set up our child’s eating environment so their quick, instinctive actions are biased toward the healthier foods—toward the apple rather than the cookie. E The CAN Approach and Behavioral Economics In 2009, the New York State Department of Health called and asked my Cornell Food and Brand Lab, ‘‘How much would the government need to subsidize whole fruit in school lunchrooms so that children would take 5% more fruit?’’ A quick visit to five schools showed that price wasn’t the problem. These fruits were being sold in metal chafing dishes, under sneeze shields, in a dim corner of the line. We told the Department of Health that price wasn’t the problem and it wouldn’t be the solution. Instead, the fruit needed to be put in nice bowls and placed in a well-lit part of the line. When this was done, fruit sales increased an average of 103% for the entire semester.3 Putting the fruit in an attractive bowl in a well-lit part of the line accomplished three goals. First, it made the fruit convenient to select. Second, it made the fruit appear more attractive. Third, it made it appear normative, typical, or reasonable to take fruit—partly because it was convenient and attractive. It was the CAN approach to changing behavior.4 In thousands of homes, schools, and restaurants with thousands of kids, we have found that using this CAN approach—making healthy foods more convenient, attractive, and normative—is much more effective than taking favorite foods away from children or telling them what they can’t have.4 The key, however, lies in doing this creatively. Convenient The healthy choice needs to be made to be the convenient choice—convenient to see, to find, to grab, and to eat. Consider what happens in schools with our program called the Smarter Lunchroom Movement.5 In one study, when one of the food lines in a school cafeteria was redesigned to be a convenient line that only offered prepackaged healthy entrées and foods (such as salads), sales of these healthy foods increased 18% within 2 weeks.6 Convenience can relate to the way food is offered. If you were to ask children why they don’t eat more apples or pears, 5- to 9-year-old children say it is too big for their mouths or it gets stuck in their braces. Adolescent girls say they don’t eat more fruit because it is messy and it looks unbecoming or unladylike. One solution to both problems would be to provide children with cut fruit. Indeed, when we put fruit sectionizers in school lunchrooms, children took 70% more fruit.7 Attractive The second principle of the CAN approach is that the healthy choice needs to be made to be more attractive relative to what else is available. Fruit that is served in a steel chafer pan or stored in the bottom drawer of a refrigerator is not as attractive as fruit in a colorful bowl. Even simply Charles H. Dyson School of Applied Economics and Management, Cornell University, Ithaca, NY. 277 278 WANSINK Table 1. From Can’t to CAN: Convenient, Attractive, and Normative 1. Make it More Convenient 2. Make it More Attractive 3. Make it More Normative Parents who want their kids to eat better at home. Put precut vegetables on the middle shelf of the fridge and the bread out of sight. Buy more tempting salad dressings with cool names and less tempting bread. Set salad bowls on the dinner table every day, even if they aren’t being used, and get rid of the butter dish. A school lunch manager who wants to get more kids to take and eat fruit. Puts it within easy reach in two different parts of the line— beginning and end. Puts it in a colorful bowl and/or gives it a colorful sign. Puts it in front of the cash register with a sign saying, ‘‘Take an extra one for a snack.’’ giving food a descriptive name makes it more attractive and increases a child’s taste expectations (and enjoyment) of it.8 Dinosaur Trees are more exciting and taste better than broccoli, and a Big Bad Bean Burrito tastes better and is more exciting than when it is called a Vegetarian Burrito. Even putting an Elmo sticker on apples led 70% more daycare kids to take and eat an apple instead of a cookie.9 Normative Last, children like what is popular—they like what they think is normal. Efforts that make the healthy choice appear to be the more normal or normative choice make it more popular with children. When 50% of the milk in a cooler is white (versus chocolate), kids are nearly three times as likely to take a white milk than when only 10% is white. It seems like the normative choice. The same applies at home. When cheese sticks or cut ‘‘veggies’’ are on the front shelf of a refrigerator, it seems like the more normal food to take—otherwise it wouldn’t be so convenient (Table 1).10 Moving from Can’t to CAN We often tell children what they can’t eat. We typically don’t think in terms of enticing them with what they can eat. Let us challenge ourselves to focus on changes that make healthy foods more Convenient, Attractive, or Normative for children to choose. When we put the fruit in a nice bowl in a well-lit area, we make it more convenient, attractive, and normal to grab a banana than the chocolate chip cookie dough in the far back of the freezer. Why not just get rid of the ice cream? It is a fine line between removing temptation and removing a favorite choice. Removing temptation is okay with things we like but don’t love. However, if the food is something kids really love, removing that food choice usually backfires. It might prevent them from eating ice cream today, but tomorrow then becomes their personal All You Can Eat Ice Cream Thanksgiving Day. Instead of banning chocolate milk, make white milk more convenient (place it in the front of the cooler), more attractive (sell it in a pretty plastic bottle), or more normal (give it 50% of the cooler instead of 10%). In one middle school, simply making these choices increased white milk sales by 38% and decreased the sales of sugary beverages by 18%. Instead of telling them what they can’t have, the CAN approach led children to what was healthier.4 This CAN approach represents an evolution in how to change how children eat. Instead of focusing on educating them, it is a focus on directly changing their behavior without solely relying on education to do all the heavy lifting. It is a change whose time has come. Author Disclosure Statement No competing financial interests exist. References 1. Wansink B. Mindless Eating—Why We Eat More Than We Think. Bantam Dell: New York, 2006. 2. Wansink B, Sobal J. Mindless Eating: The 200 daily food decisions we overlook. Environ Behav 2007;39:106–123. 3. Just DR, Wansink B. Better school meals on a budget: Using behavioral economics and food psychology to improve meal selection. Choices 2009;24:1–6. 4. Wansink B. Slim by Design—Mindless Eating Solutions for Everyday Life. William-Morrow: New York, 2014 (in press). 5. Smarter Lunchrooms Movement. Available at www.smarterlunchrooms.org. Last accessed June 27, 2013. 6. Hanks AS, Just DR, Smith LE, et al. Healthy convenience: Nudging students toward healthier choices in the lunchroom. J Public Health 2012;34:370–376. 7. Wansink B, Just DR, Hanks AS, et al. Pre-sliced fruit in school cafeterias: children’s selection and intake. Am J Prev Med 2013; 44:477–480. 8. Wansink B, Just DR, Payne CR, et al. Attractive names sustain increased vegetable intake in schools. Prev Med 2012;55:330–332. 9. Wansink B, Just DR, Payne CR. Can branding improve school lunches? Arch Pediatr Adolesc Med 2012;166:967–968. 10. Wansink B, Shimizu M, Brumberg A. Association of nutrientdense snack combinations with calories and vegetable intake. Pediatrics 2013;131:22–29. Address correspondence to: Brian Wansink, PhD Charles H. Dyson School of Applied Economics and Management Cornell University 100 Warren Hall Ithaca, NY 14853 E-mail: foodandbrandlab@cornell.edu