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‘Candy at the cash register’ is putting our health at risk, say experts

“A basic misconception has stymied our response to the obesity epidemic: the belief that food-related decisions are consciously and deliberately made,” the authors write.

Sugary temptations in the checkout line exert a subconscious influence on our eating decisions.

We need to recognize “candy at the cash register” for what it is: a hidden risk factor for obesity and other chronic diseases, argue two health researchers in a provocative opinion article published this month in the New England Journal of Medicine.

“A basic misconception has stymied our response to the obesity epidemic: the belief that food-related decisions are consciously and deliberately made,” write Dr. Deborah A. Cohen, a senior scientist at the non-profit RAND Corporation, and Susan Babey, a senior research scientist at the University of Southern California-Los Angeles’ Center for Health Policy Research. “… 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.”

The ubiquitous placing of unhealthful snack foods at cash registers or at the end of store aisles is a clear example of this influence, say the two scientists.  Such placement is, of course, part of a well-known and highly successful sales strategy called “impulse marketing.”

When the items near cash registers or on the aisle ends are shampoo or magazines or batteries, any impulse purchase may put your weekly budget at risk. But when those items are snack foods, they present a risk to your health as well.

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“Placement of foods in prominent locations increases the rate at which they’re purchased; purchase leads to consumption; and consumption of foods high in sugar, fat, and salt increases the risks of chronic diseases,” write Cohen and Babey. “Because of this chain of causation, we would argue that the prominent placement of foods associated with chronic diseases should be treated as a risk factor for those diseases.”

“And in light of the public health implications, steps should be taken to mitigate that risk,” they add.

Not simply a matter of self-control

Research into how and why people make purchasing decisions supports the need to take such steps, the two scientists say:

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. Yet research using eye-tracking equipment has shown that the attention drawn by special displays, particularly on the ends of aisles, has more to do with the display characteristics than with the goals and capacities of individual people. Something about the arrangements and the edges of such displays compels a response.

Marketers carefully pretest their promotional displays and often use the same sophisticated eye-tracking equipment to make sure that customers cannot ignore them. People lack the capacity to fully control their eye gaze, and what they look at the longest is the strongest predictor of what they will buy. Furthermore, most purchasing decisions are made very quickly and automatically without substantial cognitive input, usually in less than a second. And choices of foods high in fat and sugar are made more quickly than are choices of healthful foods such as fruits and vegetables. For all these reasons, promotional displays of low-nutrient foods are both particularly influential and difficult to resist.

A hidden risk factor

It’s time to treat ‘candy at the cash register’ as a hidden risk factor, like cancer-causing chemicals in drinking water, Cohen and Babey conclude.

“We need to test new approaches to risk reduction that do not place additional cognitive demands on the population, such as limiting the types of food that can be displayed in prominent end-of-aisle locations and restricting foods associated with chronic diseases to locations that require a deliberate search to find,” they write. “Harnessing marketing research to control obesity could help millions of people who desperately want to reduce their risks of chronic disease.”

You can read the article for free online in the Oct. 11 issue of  NEJM.