"Food impacts us in so many ways: biologically, psychologically, socially"

Lili Kókai is a second-year PhD candidate at the Department of Public Health of the Erasmus University Medical Center in Rotterdam, supervised by Professor Johan Mackenbach and Professor Hans van Kippersluis. She is conducting research in the Smarter Choices for Better Health Erasmus Initiative, in the Action Line 'Prevention'. The goal of this Action Line is to identify sustainable and cost-effective ways to induce healthy behaviour. Kókai says: "My project specifically aims to design an innovative intervention to induce healthy behaviour in populations with elevated cardiovascular disease risk."

How are you creating this innovative intervention to induce healthy behaviour?
"We are collaborating with a team of scientists coming from different fields: public health, psychology and economics. I am a health and medical psychologist and am currently following post-initial training to become a public health epidemiologist. These fields provide me with a very interesting combination of knowledge on the individual and environmental determinants of human behaviour. 
My main interest is how psychological well-being impacts cardiovascular health both directly – for instance, stress impacting heart and blood vessel health – and indirectly through health behaviours, such as dietary behaviour. I hope to report interesting findings on these relationships in the coming years. 
Our first results will be based on survey data from the Lifelines cohort, followed by focus group interviews with patients with elevated cardiovascular disease risk. Based on these results, we will fine-tune the design of our intervention, which will combine insights from psychology and economics, before rolling it out in the fall of 2020."

What do you think is the relation between 'food' and psychology as well as medical studies? 
"The media and vendors tempt us with foods with high fat or sugar content at every corner, and we tend to think of food as a 'treat' or 'comfort'. At the same time, we are told by the same media and vendors that we need to 'detox, reset, and eat pure', and we feel disappointed in ourselves for giving in to unhealthy temptations. 
Society indeed has a complicated relationship with food, and psychologists and medical doctors have a special role in it as credible sources of information about the impact of diet on our mental and physical health. Unhealthy dietary habits are one of the most important modifiable risk factors for non-communicable diseases, such as cardiovascular disease. Furthermore, you have eating disorders like anorexia, bulimia, as well as rising phenomena such as 'orthorexia nervosa' (which is loosely defined as a pathological fixation on eating 'pure'). Society is incredibly pre-occupied with food, whether it is about eating it, or not eating it. Dietary habits affect both our mental and physical health and vice versa. In my opinion, medical doctors and health and medical psychologists should cooperate even more to provide integrated advice and care to those who struggle to lead healthy lifestyles."

"In my opinion, medical doctors and health and medical psychologists should cooperate even more to provide integrated advice and care to those who struggle to lead healthy lifestyles"

In what way does your research match or supplement Hans van Kippersluis' research
"Professor Hans van Kippersluis is one of my supervisors. He is a health economist, which adds a fascinating perspective on the way we design our intervention to induce healthy behaviour. Behavioural economics is somewhat of a meeting point between health economics and health psychology. While the fields of health economics and health psychology have the shared ambition to contribute to better health and healthcare, sometimes it is not entirely clear where the disciplines parallel or differ in their approach. We think that it is an important achievement in itself to find a common 'intervention language' between the two disciplines that can make the design of interdisciplinary interventions easier." 

How will the intervention contribute to better health and healthcare? 
"The goal of our intervention is to help people eat healthier and exercise more. Specifically, the intervention will include various behaviour change techniques that have previously been found to be successful in decreasing fat- and sugar intake and increasing physical activity. These behaviours are a causal link in the development of cardiovascular disease. Additionally, we would also like to decrease stress, negative affect and fatigue in our participants through positive psychology techniques, thereby improving their heart and blood vessel health both directly and indirectly. We are designing a scalable intervention, which means that it will be simple enough that it could be implemented in other and bigger populations in the future."

What is your personal interest in this subject? 
"I love food, both to cook it and to eat it. I also think that diet is a crucial subject for research, as food impacts us in so many ways: biologically, psychologically, socially. Some even say that the invention of cooking is what led to the rise of humanity. I recommend, in this regard, the book 'Catching Fire: How Cooking Made Us Human' by Richard Wrangham."