The current health care crise du jour – obesity, and its evil cousins diabetes and heart disease – are crippling health care systems. I know it. You know it. Everyone who hasn’t been living under a rock for the past 10 years knows it.

The obvious remedy (for most of the population)? Stop smoking, get more exercise, and eat fewer but more nutritious calories. It’s not rocket science, so why don’t we do it?

According to Sandra Ahten, a weight loss coach and founder of The Reasonable Diet, much of the answer lies in preparation and planning, in other words controlling our environment to reduce moments of choice (Should I have dessert or not? I know I should take the stairs, but I don’t feel like it.)

By controlling what we can of our environment, we help to set ourselves up for success (ie, weight loss, more exercise). She cites the statistic from Mindless Eating by Brian Wansink, PhD, that we make more than 200 food decisions each day. As Ahten notes, that’s “entirely too many for our willpower to handle.” You can say ‘No’ only so many times.

But beyond controlling our own home, work, and social eating environments, what about the bigger picture – retooling our societies for healthy living? Such large-scale changes are termed ‘structural interventions’ and Caitlin Rothermel discusses a recent article in JAMA on the benefits of structural interventions, their economic implications, and the role of health economists in making those calculations.