Projects and Implementation

Research that improves lives (interview with Prof. Aleksandra Łuszczyńska)

01 February 2023

We talk with Professor Aleksandra Łuszczyńska, an acclaimed health psychologist from SWPS University, about groundbreaking research in the field of health sciences, illnesses of the future, and the role of researchers.

Urszula Korman-Hollanek: Professor Łuszczyńska, you are the Head of the CARE-BEH Center for Applied Research on Health Behavior and Health, which operates under the auspices of SWPS University’s Institute of Psychology. Together with a team of scientists, you research health-related behaviors, such as diet, physical activity, preventive measures, and the quality of life concerning people suffering from chronic illnesses. I would like to begin with some hard data that is very meaningful: over the last three decades, the number of overweight and obese Europeans has quadrupled, cancer is the second leading cause of death in Poland, and diabetes has been dubbed an epidemic of the 21st century.

prof. Aleksandra Łuszczyńska: Please note that obesity, which underlines many illnesses, only recently has been officially classified as a disease.

And how was it treated before?

As an outcome of various social and genetic processes and behaviors or as a symptom rather than a disease. This is significant, because the change in classification has been instrumental in the development of systems that support the prevention of and dealing with this problem, such as new sources of financing treatments, which are now covered by health insurance systems.

It is even more shocking as the data indicates that the majority of these diseases, including cancer, could be prevented if only people changed their habits, behaviors and lifestyle. Has your research center been founded to meet these social needs?

The Center was established because a group of young researchers, including myself, wanted to focus on psychology and health sciences – an area that straddles applied and basic research, also called Pasteur’s quadrant. This area of research, on the one hand aims to understand certain principles and mechanisms, and on the other hand assumes a speedy application of solutions, so that they could benefit the society as soon as possible. For example, these research problems include the implementation of interventions that are conducive to behavior change and an assessment of their efficacy. We are keen on research that explains how we can influence health-related behaviors, modify them and maintain the change, and how to implement strategies, which allow people to have a satisfactory quality of life during illness, and how to prevent diseases.

Perhaps we can talk for a bit about an important aspect of wellbeing, which is the quality of life of persons living with various conditions. Does the Center carry out research concerning solely obesity and its consequence or does it study other diseases, too?

Our research also includes cancer. Generally, our main research focus has always been health behavior. Over the years, we have carried out numerous projects of this kind. Some of them concerned behaviors conducive to early cancer diagnosis, such as cervical cancer. Recently, we have been researching health-related behaviors, which determine other types of cancer, where obesity is a crucial risk factor. Apart from cancer, there is also a well-documented correlation between obesity and cardiovascular diseases. The related behaviors that we are interested in include physical activity, sedentary behavior, and eating habits, i.e., diet. On the one hand we try to understand the mechanisms underlying the problem, and on the other hand, we want to develop a plan of interventions that could be implemented in different populations. Currently, we are working on two large projects concerning this area. In on of them we are investigating to what degree health-related behaviors, attitudes, and emotions of partners or close relations, influence the beliefs and behaviors of overweight persons. What’s interesting, it turns out that if the relationship between these people is good, than even the so-called negative social control, in other words a method relying on inducing guilt, brings positive results. Please note, we are talking about rare instances of using that type of tactics.

In this case, does the “negative social control” mean limiting access to food, or colloquially, locking the fridge?

Yes, that’s one of the methods. Although, it mostly means verbal remarks or comments addressed to the obese persons by their partners.

Nevertheless, it sounds like abuse.

Still, in a situation when a person dealing with obesity perceives his or her relation with the partner as very satisfying, the negative social control in small doses can positively impact the lifestyle, such as sedentary behavior. In other words, it can encourage the obese person to become more physically active.

Were these results surprising to researchers?

To a certain degree, because it transpired that behaviors usually regarded as a negative influence may bring positive results, provided they occur in certain circumstances. We carried out similar studies for parent-child relationships, with children 6 to 11 years old. It turned out that it was not particularly important how the children perceived the restrictions imposed by the parents, but whether the parents clearly communicated their intentions and consequently implemented the restrictions, such as the amount of sedentary time permitted. This type of strategy employed by parents brings positive results, changes children’s behavior according to the expectations, and finally, leads to fat burning. However, I must emphasize once more – we mean using such strategies only from time to time, not all the time.

What research methods did you use? I assume that conducting these types of observations requires rather strong invasion of privacy of the research subjects.

We use traditional psychological research strategies, i.e., various types of questionnaires. In this case, the questionnaires were sent to the participants 8 to 9 times in 14 months. They were sent to both persons from a given dyad (parent-child or adult-partner), who then described their own behavior and observations concerning themselves and the other person. Moreover, we measured behaviors of the participants in an objective manner, i.e. by using accelerometers (ed. professional devices that record physical activity and vital signs), which allowed us to monitor physical activity and its intensity at different times of day. They also allowed us to detect body position (e.g. vertical, horizontal, sitting, etc.).

How long do the study participants must wear these devices and how do these instruments look like? Are they similar to smartwatches that are popular these days?

Participants must wear the devices for at least three days. They are attached to a belt that you wear around your waist, because measurements taken from that location on the body are much more accurate than from a smartwatch worn on your wrist. Hand movements are not sufficiently reliable.

Our recent interventions were also related to different approaches to fitness planning and outcomes resulting from these approaches. In the first version, we focused on individual planning (each participant planned his or her own activities), while in the second version, we focused on collaborative planning, which meant that both partners in a dyad were tasked with developing a joint plan, which would require them both to get physically active and support each other. Our third intervention was a so-called dyadic intervention, where the obese person or a patient with a cardiovascular disease, developed their own plan, while the partner was tasked with helping them to adjust this plan to their actual lifestyle. The intervention was carried out for two months and during that time, it was repeated seven times.

And what were the results of these interventions?

I must be honest, the results did surprise us. We assumed that the collaborative planning (i.e. where both persons developed a joint plan) would bring the best results. Meanwhile, the most effective approach was the dyadic planning. In this group, we have observed an actual change manifesting as the patients’ increased physical activity by 10 minutes a day.

Is it a lot?

In comparison to the control group, yes. It adds up to 70 minutes per week. I must stress that we are talking about moderate to intense activity, such as exercises resulting in an increased heart rate and sweating – an effort that increases cardiovascular fitness, not just a slow walk. Interestingly, the amount of physical activity did increase not only among the patients, but also among their partners.

Was the collaborative planning doomed from the start, because it lacked a clearly designated “project manager”?

Collaborative planning is more tasking, hence more difficult to implement. Working out a compromise is a more complex process, which requires both parties to invest larger cognitive and time resources.

How are the results of the studies carried out by the Center used later? How do they translate to real life?

The results of our research are used by international institutions, national and local governments that formulate guidelines and prevention programs for communities and whole societies. They include: The World Health Organization (WHO), United Nations Children’s Fund (UNICEF), the United Nations (ONZ), the United Nations High Commissioner for Refugees (UNHCR), the National Cancer Institute (NCI), and the Division of Cancer Control and Population Sciences (DCCPS). One of such organizations is also the National Institute for Health and Care Excellence (NICE) in Great Britain and the Center for Disease Control and Prevention (CDC) in the United States, and also smaller organizations in Scotland and Canada that work with patients at risk of cardiovascular disease and cancer. Moreover, institutions that train experts in preventive medicine and designers of physical fitness policies are also interested in research carried out by our Center.

Which means you have a real impact on shaping lifestyles and health parameters not only in Poland but also internationally. The results of your work quickly spread beyond the walls of your “laboratory”.

After all, this is what it is all about

Does the Center collaborate with other research institutions around the world?

Of course. We usually enter into two types of collaborations. The first one includes institutions that carry out research in similar fields, with whom we have had long-standing working relationships encompassing mutual support, auditing, and consulting. These include Freie Universität Berlin (Free University of Berlin) and the University of Zurich. We regularly consult with the researchers from these centers, at all stages of research, such as the development stage (including the whole project, tools and interventions), participant selection, and finally the results review stage. Thanks to this cooperation, we are able to avoid research mistakes and our interventions become much more useful. This type of collaboration has been ongoing for the past two decades.

The second type collaboration is related to European projects that were initially financed by the 7th Framework Porgramme for Research, then by Horizon 2020, and recently by Horizon – Europe programs. As part of that last program, we have recently been working on a project LIKE A PRO (From niche to mainstream – alternative proteins for everybody and everywhere), which is a pan-European project of social change concerning the consumption of protein alternatives.

Do you mean proteins other than meat proteins?

Yes. Considering the huge consumption of energy and water, and emission of CO2 emissions associated with meat production (especially beef), and thanks to the fact that technologies for the production of alternative digestible proteins exist, we have undertaken initiatives aiming to reduce meat production by providing consumable alternatives. Our team is tasked with identifying psychological, social and environmental factors that would facilitate or hinder an introduction of alternative proteins into regular diet.

What do you mean exactly by “sources of alternative proteins”?

For example, proteins produced by certain types of bacteria or fungus as well as proteins obtained from insects or krill; and, obviously, a production of lab-grown meat has been developing for a while. Together with a group of European manufacturers, consumer organizations across Europe, and an international team of researchers, we are working towards shifting the products derived from the above-noted sources from a total niche to the mainstream. We are thinking about the ways that would convince consumers, manufacturers and most of all, vendors to use and regularly consume these products. We are brainstorming how to make these products sufficiently attractive and available for all stakeholders in the food chain.

I assume that overcoming habits and shifting the way people who represent the above-mentioned groups think about food is the biggest challenge.

Yes, it’s true. Therefore, one of the initiatives intended to achieve that goal, are workshops that we want to organize in 13 European countries. The workshops are aimed, on the one hand, at defining the main barriers, and on the other hand, at identifying key social factors supporting the introduction of protein alternatives.

How exactly will these workshops look like?

In every one of the 13 countries, stakeholders representing the food sector (e.g. persons from consumer groups and vendors) will meet and jointly create a map of personal, political, cultural, and community-related factors that are conducive to maintaining the status quo. They will also be asked to identify the elements of the system, which would be helpful in convincing consumers to reach for protein alternatives more frequently.

Where do researchers expect to encounter the strongest barriers to the introduction of protein alternatives? Would it be consumer mentality or socio-cultural factors or perhaps political ones, such as the meat manufacturers’ lobby.

Taking into consideration other research results, we can definitely say that a triangulation, that is a simultaneous influence of three factors, which I will talk about in a minute, is required. Were we to focus solely on popularization and education, we would need to accept that the impact of our initiatives would be limited. They would not reach marginalized social groups, such as people with lower level of education or lower socio-economic status. That way, we would contribute to social inequalities.

So how can you reach everyone?

In this case, local or regional strategies seem to be the most effective and most egalitarian. For example, the initiatives could include local regulations rooted in higher-levels, i.e. national or EU directives that would need to be implemented over a decade. A unified strategy concerning packaging, labelling and display of these products, so that they are placed on the so-called “first choice” shelves, should be developed. Appropriate regulations should also include catering in public institutions, such as schools, public health institutions, universities, and public administration. It would be one of the fundamental solutions with a large reach and equality factor. Easily accessible and appropriately marketed products would constitute an excellent start of shifting social beliefs in this matter.

How long, in your opinion, will the legislative process and the shift in social awareness take? When could we expect a significant change in this matter?

If you are asking how long does the process of implementation, from the completion of research in the lab to reaching every Johnson and Kowalski, take then, in case of health sciences (including psychology, which often is included in this discipline), it takes from 17 to 20 years. It is a multi-stage and multifaceted chain of gradual changes.

In that case, let’s go back, for a moment, to the “lab” or to the research process itself. I know that the CARE-BEH Center for Applied Research on Health Behavior and Health also researches the problem of child obesity and the impact of advertising on children’s food choices. What conclusions do you draw from that work?

You probably mean our CO-CREATE (Confronting Obesity: Co-creating policy with youth) project, which is carried out in cooperation with four other countries, including Norway, the Netherlands, Portugal, and Great Britain. In this participatory research project we analyze the situation of young people from big and small municipalities of different levels of affluence. Together with the adolescents, and then with stakeholders, such as representatives of local governments, businesses and public institutions, we analyzed factors conducive to child and youth obesity. We wanted to develop such methods of preventing obesity, which would be recognizable, effective, but most of all acceptable for both young people and these institutions. Therefore, these young people from the participatory countries, have co-developed with us maps of systems that contribute to obesity among children.

And what seems to be the main contributor?

Well, the young people themselves often indicated advertisements and marketing strategies as important causative factors. They also emphasized the impact of advertising on mental health. It is well known that a straightforward correlation exists there – when one experiences problems such as anxiety or depression, one’s resources supporting behavior regulation diminish, including self-regulation of eating behaviors, which makes people more prone to the effects of advertising. It even happens when you are aware that the adds do not reflect reality and that advertisements are only aimed at selling products. It is interesting that the young people from various European countries, whom we had invited to work with us on this project, were well aware that advertising could have huge influence on kids 11 years and younger, when cognitive skills are not yet sufficiently developed to recognize manipulation used in marketing of products. So, young people themselves acknowledge strong negative impact of advertising presented on television, streaming platforms, and in social media, and they are of an opinion that these ads should be regulated to a larger degree.

The CO-CREATE project will end next year, so it is a bit too early for the final conclusions, but since you mentioned social inequality, I would like to talk about one more topic recurring in research, which is a correlation of obesity and poverty.

In the past this correlation was indeed very visible. When your basic needs are not met, you engage all your cognitive, emotional and behavioral resources in solving these problems. People from lower socio-economic social groups struggle with many problems in daily life. It is much harder for them to manage their budget, therefore they may become less discerning targets for advertisers. Personal skills in those groups are delegated to other areas related to basic and social needs.

But these days, the correlation of poverty and obesity is not that obvious because an increasing number of people from a higher socio-economic or better educated groups also struggle with excessive weight and obesity.

Why?

We must remember that food manufacturers invest huge amounts of money to ensure that their advertising is effective. They make their products attractive in taste and appearance, so that everyone would try them, buy them and repeat the behavior many times. This way they create market conditions conducive to increased food consumption, highlighting also exclusiveness of some highly processed and high-energy products.

Getting back to the collaboration with other research centers around the world, do you also use each other’s research infrastructure and participate in mutual exchange of researchers while working on certain projects?

Yes, definitely. Members of my team, which happen to be mainly female, regularly participate in research fellowships abroad that are funded by granting institutions, such as the National Science Centre (NCN). Last year, one of our researchers, Zofia Szczuka, for several months collaborated with the lab at the City University of New York, a leading research center specializing in dyadic processes. Apart from the centers I mentioned earlier, we also collaborated with the University of Newcastle in Australia, University of Colorado in the United States, and Peking University.

What are your short- and long-term research goals?

If I was to be realistic, I would have to say that a lot is riding on accessibility of funding.

But if, for a moment, we could fantasize and assume that you have access to an unlimited budget, what would be your research dream?

If this was the case, for sure we would like to focus more on the research topic I talked about earlier, that is on alternative proteins, because these types of projects allow us to extend our expertise beyond the “healthy for individuals” to “healthy for the planet” area. At the same time, I am aware that this type of change is very complex and it requires the balancing of human behavior in many dimensions. It is a change that is as much complicated in its implementation as it is indispensable. In this area, collaboration with manufacturers and consumer organizations presents itself as a very interesting challenge, enabling us to shorten the amending process by going directly to the source of potential changes.

Another research area that we would like to develop is prevention of obesity, also in the context of genetic risk factors, that is certain predispositions encoded in one’s DNA.

What are these predispositions?

For example, a predisposition to reward dependence, which makes it harder for some individuals to avoid temptations of food as a source of pleasure at the physiological or psychological level.

You once used a metaphor that “genes are a gun, but it is the society that pulls the trigger”. Is it still valid?

Yes, I still stand behind this claim. Of course, the debate on the importance of genetic versus societal, public policy and psychological factors is still ongoing? Although the knowledge about the importance of these individual factors is constantly expanding, we still tend to treat them as acting separately. An interaction between some of these factors is still not well known, which means we still do not know for certain how and in what circumstances the society “pulls the trigger”, activating the genetic switch.

In your opinion, what is the main role of researchers in today’s world? How do you see your own role? On the one hand the rapid technological development presents endless possibilities for research, and on the other hand, it seems to place an even greater responsibility on the shoulders of researchers.

The threat I see in the context of research and its role in social development is that the world of science is increasingly closing itself in silos or in “bubbles”, where research results are communicated and applied only in narrow areas, related to a given scientific discipline. If we work on psychological solutions, we often omit the issue of public health, or vice versa – we concentrate on the analysis of organoleptic characteristics of food and we do not look at acceptability and accessibility of the product from the consumers’ point of view. Therefore, I think, that diligent development of interdisciplinary or transdisciplinary knowledge, and collaboration on making the results of basic research implementable and socially valuable, are the biggest challenges researchers face nowadays. This is a task for us, researchers specializing in social sciences and humanities.

What can we expect in the next 10 to 15 years in the field of health and quality of life? What changes are coming our way?

For a while now, science has been working towards not only extending human life, but also improving the quality of life. As a psychologist, I know that the concept of the quality of life depends, to a large degree, on the place where individuals see themselves in relation to social norms and culture on the one hand, and on the other hand, how they perceive their own goals and expectations (not only in somatic terms, but also in social, mental health, and external environment terms). A good quality of life is the main challenge for many scientific disciplines. We have been observing clear and growing demands from young people, whose political power is especially visible in the Scandinavian countries. That power is directed towards changing people’s behavior, limiting the use of resources, and concern about the natural environment. Individual quality of life is not possible without the planet's quality of life. I think, that the efforts of scientists around the world will focus on these issues in the nearest future.

Should we expect any groundbreaking discoveries concerning health? Will we be able to stop the wave of cardiovascular disease, cancer, and problems arising form obesity? We have been waiting for a miracle cure for cancer, while many of us have it within reach in the form of daily lifestyle decisions.

In my opinion, we won’t be able to stop the wave, but we will be able to shrink it. Simply because of the fact that the accessibility of interventions supporting prevention of these problems will be increasing, and I do not just mean pharmacological interventions, but also cognitive and behavioral ones, those that improve patients’ quality of life in the social domain. Interventions that allow people to realize their professional and social potentials despite illnesses.

To conclude, if you allow me a personal question, I am curious how the acclaimed expert in health psychology and proponent of healthy lifestyle takes care of her own health?

I try to be physically active. I meet WHO’s recommendations in that regard. For the past several years, I have been devoting 250 minutes a week to physical fitness (from intermediate to intense). I believe it makes a huge difference not only to my wellbeing and physical stamina, but also to a stable release of various neurohormones. After all, all these factors are crucial for the quality of my work.

Thank you for taking the time to talk with me.

Urszula Korman-Hollanek