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Front. Public Health | doi: 10.3389/fpubh.2019.00006

Decision-making in health and fitness

  • 1Auckland University of Technology, New Zealand

Cognitive Decision-Making

Denes-Raj and Epstein (Denes-Raj and Epstein, 1994) suggest that decision-making behavior is guided by two different cognitive processes, the first being an emotional response typical of interpersonal interactions, and the second an analytical response such as that used to solve a mathematical problem The theory was simplified further by Amos Tversky, with Stanovich and West naming the emotional process “System 1” and the rational one “System 2” (Tversky and Kahneman, 1982;Stanovich and West, 2000). Kahneman applied these ideas to economic behavior (Kahneman, 2003), with Tversky and Kahneman awarded separate Nobel prizes for their respective works.

The application of System 1 and System 2 decision-making behavior in the context of health and fitness can have wide-ranging potential personal and global public health implications. While the benefits of a better lifestyle are clear, poor choices, including neglecting to make a choice, can be a primary source of illness, chronic disease and physical impairment, and significant financial expenditure. Individuals who consider lifestyle choices more appropriately can become more fit and improve health using this decision-making process. This application of System 1 and 2 is described here as behavioral health and fitness. (Health is defined as all areas of the body working in harmony, while fitness is the ability to perform physical activity (Maffetone and Laursen, 2015).

Large numbers of people around the world attempt to regularly manage a variety of personal health and fitness routines. At its onset, this process can be strongly influenced by companies selling products and services (diets, books, programs, exercise equipment) through radio and TV, online and print media, health and fitness societies/agencies and from governmental recommendations, the latter two strongly influenced by politics and lobbying. The process is often void of individuality, encourages a one-size-fits-all notion, and can lead to dangerous herd behavior (Banerjee, 1992). These are associated with a System 1 response. Personalizing food and exercise choices require more thinking and is associated with System 2.

Characteristics of System 1 and System 2

Normally, both modes of decision-making are used in our day-to-day lives, and both have potential value. Consider System 1’s first impression, an often accurate assessment of another person, place, food and physical activity. This impression may correspond to one’s System 2 analysis over time. However, more often the use of images, words, sounds and other impressions in marketing, sway people by enlisting System 1 to help sell unhealthy products and services.

System 1

Involving simple everyday choices that are habit- and reaction-based, usually made with little thinking, attention, or information, System 1 governs the quick decisions such as which of several doors to use when entering an office building, lanes to take on a highway, or seats to sit in at an airport. However, important decisions that can impact on immediate and longterm individual and population health and fitness are influenced if not governed by System 1 as well (Kahneman, 2011).

The System 1 process is primarily an unconscious but natural reaction, such that one’s true underlying attitude or motivation for the decision is hard to come by, and the individual will likely provide one of several plausible rationalizations to justify how they made the decision. While this system is leveraged particularly well by marketers advertising products and services, it comes with the potential for strong bias and error referred to as cognitive illusions, making the potential for reduced health and fitness higher. Fleeting first impressions appear attractive to System 1 and predominate its thinking: Seeing a splashy colorful cover of a new diet book or a smiling lean person working out are common examples.

System 2

Relying on conscious intellect for lifestyle decision-making, System 2 requires more time to assess a particular eating plan or exercise program. In terms of self-care, it also provides an individual with the ability for ongoing monitoring of signs and symptoms that measure progress.
The more reliable System 2 decision-making can yield a more logical, personalized approach rather than a one-size-fits-all menu, and grants the ability to incorporate a planned, flexible program that can lead to improved outcomes (Chodosh et al., 2005). Requiring reasonable literacy, this approach offers greater autonomy, and can also reduce healthcare costs (Anderson et al., 2016).

Figure 1 lists some factors associated with System 1 and System 2 decision-making.

Health practitioners can also play an important part in teaching patients about the lifestyle habits associated with their particular needs, helping them avoid making irrational or poor choices (Adams, 2010;Polak, 2013). However, for the benefits of health education to succeed, a high level of engagement is required. This may be impaired by society’s System 1 dominance in the health and fitness arena, where consumers—patients and practitioners alike—are influenced. In addition, few practitioners provide details on decision-making and modification of behavior for several other related reasons: it’s time-consuming, most practitioners are not knowledgeable enough, and patients are given few strategies for maintenance. Likewise, governmental recommendations are extremely simplistic, not individualized, and without encouragement.

Costs of System 1

System 1 marketing deception has been a successful business strategy for decades, selling untold numbers of health and fitness products and services that promise quick improvement that System 2 thinks is too good to be true. For example, the diet industry in Europe and the United States alone has annual revenues in excess of $150 billion, yet up to two-thirds of any weight lost is regained within 1 year—and almost all is regained within 5 years, along with lost health (Dulloo and Montani, 2015).

Downstream healthcare costs continue to be high and are rising globally. In the US, 2014 health-care costs climbed to $3.2 trillion (Martin et al., 2016), with the Kaiser Family Foundation estimating a worldwide cumulative healthcare loss of $47 trillion between 2011 and 2030.

Examples and Misconceptions

Here, we provide two examples of how the reliance of a System 1 approach can lead to failure:
1. A person wanting to lose weight is attracted to a program claiming you can shed 10 pounds the first week. Whether initially successful or not, the diet usually fails to provide long-term results, and may cause side effects such as nutritional imbalance, metabolic impairment, and disordered eating.
2. A person wants to exercise to get into shape. Regular gym workouts encouraged by the no pain, no gain philosophy pushes the process. After a period of initial excitement, with some results realized—lost weight, more fitness—fatigue, soreness, injury and frustration may develop causing some to give up working out. Others may become addicted to exercise, and, despite pain or frustration, continue pushing through it, increasing stress hormones that impair health and fitness.

System 1-based marketing has spawned many misconceptions, trendy fads, and rally cries that become unhealthy social mantras. Below are two popular and very successful examples:
1. No pain, no gain. Perhaps the first social description of no-pain no-gain came from Benjamin Franklin in his writings on capitalism (Behr, 2001). But in the fitness arena, this rallying cry glorifies pain and the high rates of preventable injury. It overshadows the scientific consensus (System 2), considered more effective and healthy. Bill Bowerman, legendary sports coach and co-founder of Nike, said, “The idea that the harder you work, the better you’re going to be is just garbage. The greatest improvement is made by the man or woman who works most intelligently.”
2. Just do it. Ironically, this popular Nike ad slogan, which appeared later in the company’s evolution, communicates the System 1 message that it is enough to simply make a snap judgment to follow a certain exercise ritual without further consideration, encouraging a herd mentality (Banerjee, 1992). System 2 might think, don’t just do it, do it right.

The New Players

Mobile trackers are the relatively new players in the health and fitness arena, and enlist primarily System 1 due to their emphasis on gaming and gamification. As they collect largely irrelevant data, users tend to give up on them within six months (Michael, 2016). Despite this, analysts at Morgan Stanley believe these devices will become a $1.6 trillion business in the near future (Danova, 2014). Indeed, the System 1 slant of mobile trackers, in the absence of more substantive and sophisticated analytics that engage System 2 thinking, may contribute to their early abandonment and demise: there is little of substance to continue engaging the user through System 2 once System 1 thinking has run its course, at which point the user moves on to the next new device or program that captures the attention of System 1.

A Public Health Choice

The purpose of public health includes informing and educating the public, mobilizing community partnerships, developing policies to support health goals, and enforcing related laws and regulations (Stover and Bassett, 2003). Despite the reality that many consumers use System 1 thinking to make unhealthy lifestyle choices, public health officials, health practitioners, policy makers and others must work out how best to interact with an existing System 1 process to reverse this trend (Gardner et al., 2012;Polak, 2013). Exploiting System 1 can help make health and fitness habitual, a process accomplished many times with whole populations reducing health-related risks through public health actions. Consider these very successful examples that make use of System 1 habits: hand washing, tooth brushing and wearing car seatbelts.

When it comes to making lifestyle choices, large numbers of people around the world are guided by System 1 thinking primarily from corporate marketing of health and fitness products and services that may have unhealthy consequences. This may be influencing the corresponding rise of chronic disease, physical impairment, lowered mental health, reduced quality of life, and the significant rise in healthcare costs.

Keywords: Chronic Disease, Consumer choice behavior, Emotion Reactivity, System 1 and system 2, Health Education, Diet, Exercise

Received: 25 Oct 2018; Accepted: 08 Jan 2019.

Edited by:

Allen C. Meadors, Independent researcher

Reviewed by:

Junfeng Wang, University of Illinois at Springfield, United States
Sherry L. Edwards, University of North Carolina at Pembroke, United States
Irene P. Aiken, University of North Carolina at Pembroke, United States
Neil Garrod, Independent researcher  

Copyright: © 2019 Maffetone and Laursen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Paul B. Laursen, Auckland University of Technology, Auckland, New Zealand, paul.laursen@aut.ac.nz