To Enable Healthy Decisions, Limit Your Options

Mar 6, 2013
People value having options. But having too many options can prevent us from making the best choices for our health. Precommitment techniques can help.

Modern life is full of options, and for the most part, that’s a good thing. 

But sometimes a multitude of options gets in the way of our making the best choices for our health.

Adam Davidson, who writes the weekly “It’s the Economy” column for The New York Times Magazine, noted yesterday that after a lifetime of trying and failing to lose weight, he recently succeeded by committing to a program that left him no options.

Davidson noted that most diets and other good intentions fail because there’s always a third option – an easy way out – that allows us to tell ourselves we tried even while undermining our own success. But when we make a firm commitment that eliminates these escape routes, we are more likely to get results.

Behavioral scientists call this precommitment: the intentional imposition of penalties or restraints to ensure better behavior.

In his landmark book, Mindless Eating, Brian Wansink offers several examples of precommitment: using smaller plates, eating in a room outside the kitchen while leaving the leftovers behind, eliminating leftovers by buying food and preparing dishes in smaller quantities. 

Classical Origins of Precommitment Strategies

The concept is nothing new. In Homer’s Odyssey, Odysseus needed to sail his ship past the Sirens, whose enchanting song tempted sailors to their deaths. So before entering those waters, he lashed himself to the ship’s mast so he could resist. His precommitment helped him stay the course.

Applying Precommitment to Enable Better Pharmacy Decisions

Express Scripts employs precommitment in several ways to help patients make better health choices. One example is Worry-Free Fills®, a program that enables patients to precommit to having refills of their maintenance medication delivered right to their home just in time for when they need them. We have similar solutions around generics that allow members to precommit to future savings opportunities; when a generic becomes available, we don’t have to reach out to the member in advance to substitute a more cost-effective medication.

I’ve yet to hear of a diet guru taking Odysseus’ approach literally (e.g., lashing our arms to the dining-room chair). But some companies are working to make it easier for people to impose big financial penalties on themselves if they fail to meet their weight-loss goals, and precommitment strategies in the tradition of Odysseus offer a good way to navigate through modern life’s multitude of options and temptations to arrive at a healthier place.

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