The Crowding Out Strategy for Eating Healthier

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Healthy eating is something we all strive to do - but life and our yearning taste buds can make that challenging. So, what tactics prove successful? Well, we may be onto something with the “crowding out” strategy.

Unfamiliar with the term? The crowding out effect is the act of simply adding more healthy foods — like fruits and vegetables to your diet, rather than explicitly taking away “bad” foods. The idea or psychology behind crowding out is, by putting the focus on implementing more nutrient-dense foods into your diet rather than focusing on what you can’t have, you’ll naturally crowd out the bad stuff with good stuff, transforming your palate and your wellbeing via healthy eating. 

And while this method appears solid, there has been some debate.

Although promoting an increase in the consumption of healthy foods rather than a decrease of unhealthy foods may be more expedient politically, it may be far less effective when it comes to healthy eating.  

The World Health Organization has estimated that more than a million deaths “worldwide are linked to low fruit and vegetable consumption.” In my video Is It Better to Advise More Plants or Less Junk?, I discuss strategies to address this issue.

To “clean up” a diet, we can always appeal to vanity. A daily smoothie, for example, can give you a golden or a rosy glow, both of which have been shown to “enhance healthy appearance” in African, Asian, and Caucasian skin tones, as you can see at 0:24 in my video.

What about offering free opportunities for healthy eating? We were able to find out when a free fruit scheme was introduced at schools in Norway for children in grades 1 through 10. Fruit consumption is so beneficial to our health that school kids eating only an additional 2.5 more grams of fruit a day would result in the program paying for itself in terms of saving the country money. How much is 2.5 grams? The weight of half of a single grape. That cost-benefit analysis assumed the minuscule increase in fruit consumption would be retained through life though. While the program ran, it certainly appeared to work, as there was a large increase in pupils eating fruit. What about a year after the free fruit program ended? The students were still eating more fruit! And three years later? They were still eating about a third of a serving more, even three years after they had stopped getting free fruit, which, if sustained, is considerably more than necessary for the program to pay for itself.

In the United States, “if one-half of the U.S. population were to increase fruit and vegetable consumption by one serving each per day, an estimated 20,000 cancer cases might be avoided each year.”

There were also some additional happy benefits, including a positive healthy eating spillover effect where not only were the kids eating more fruit, but their parents started eating more too. And, although the “intention of these programs was not to reduce unhealthy snack intakes,” that’s exactly what appeared to happen. The fruit replaced some of the junk. Increasing healthy choices to crowd out unhealthy ones may be more effective than simply telling kids not to consume junk, which could actually backfire. Indeed, when you tell kids not to eat something, they may actually want it even more, as you can see at 2:20 in my video.

Do you think telling families to increase the plant intake or decrease the junk in their diets worked better? Families were randomly assigned to one of two groups — either receiving encouragement to get at least two servings of fruits and veggies a day, with no mention of decreasing intake of junk, or being encouraged to take their junk food intake down to less than ten servings a week, with no mention of eating more fruits and veggies. What do you think happened? Those told to increase their fruit and veggie consumption just naturally “reduced high-fat/high-sugar intake,” whereas the families instructed to eat less fat and sugar cut back on junk but didn’t magically start eating more fruits and vegetables.

This crowding out effect may not work on adults, though. As you can see at 3:12 in my video, in a cross-section of more than a thousand adults in Los Angeles and Louisiana, those who ate five or more servings of fruits and veggies a day did not consume significantly less alcohol, candy, chips, cookies, or sodas. “This finding suggests that unless the excessive consumption of salty snacks, cookies, candy, and sugar-sweetened beverages” – aka junk – “is curtailed, other interventions…[may] have a limited impact… It may be politically more expedient to promote an increase in consumption of healthy items rather than a decrease in consumption of unhealthy items, but it may be far less effective.” In most public health campaigns, “messages have been direct and explicit: don’t smoke, don’t drink, and don’t take drugs.” In contrast, food campaigns have focused on eat healthy foods rather than cut out the crap. “Explicit messages against soda and low-nutrient [junk] foods are rare.”

In the United States, “if one-half of the U.S. population were to increase fruit and vegetable consumption by one serving each per day, an estimated 20,000 cancer cases might be avoided each year.” Put another way, 20,000 people would not have gotten cancer if they had been eating their fruits and veggies. The U.S. Department of Agriculture recommends we “fill half [our] plate with colorful fruits and vegetables,” but less than 10 percent of Americans hit the recommended daily target. Given this sorry state of affairs, should we even bother telling people to strive for “5 a day,” or might it be better just to say “get one more serving than you usually do”? Researchers thought that “the more realistic ‘just one more’ goal would be more effective for healthy eating than the very ambitious ‘5 a day’ goal,” but they were wrong.

As you can see at 4:56 in my video, those told to eat one more a day for a week ate about one more a day for a week, and those told to eat five a day for a week did just that, eating five a day for a week. Here is the critical piece: One week after the experiment was over, the group who had been told to eat “5 a day” was still eating about a serving more, whereas the “just one more” group went back to their subpar baseline. So, more ambitious healthy eating goals may be more motivating. Perhaps this is why “in the US ‘5 A Day’ was replaced by the ‘Fruits and Veggies—More Matters’ campaign… in which a daily consumption of 7–13 servings of fruits and vegetables… is recommended.”

If the recommendation is too challenging though, people may just give up on healthy eating. Does this mean policymakers need to ask themselves questions like “How many servings are regarded as threatening?” instead of sticking with the science?

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Tags: healthy, Healthy Eating, Mindfulness, parenting

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Written By

Dr. Michael Greger

A founding member and Fellow of the American College of Lifestyle Medicine, Michael Greger, MD, is a physician, New York T... See Full Bio

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