revealed diabetic is given an arsenal of tools for mitigating the adverse health effects of diabetes,
all of which diminish utility.
One response to this package of information could be to strictly follow doctor’s orders: changing
diet and lifestyle, and taking medication. From the perspective of the public health community,
such a strategy is the only rational response. Anything else is more risky and more likely to
compromise health. That is, failing to make diet and lifestyle changes or failing to take
medication would be considered costly from a health perspective.
However, in an individual’s attempts to maximize overall well-being, desires for his familiar diet
and lifestyle may compete against his desires to mitigate health risks from diabetes. Diet and
lifestyle choices reflect preferences conditioned by a lifetime of habit as well as by family and
community traditions. Undoing the force of habit and tradition is unlikely to be easy. He may
consider the prescribed diet and lifestyle changes to be somewhat substitutable for medication in
reducing the probability of adverse health outcomes. He might think that medication lowers the
health cost (increased probability of an adverse outcome) of failing to make diet and lifestyle
changes. In this case, offsetting behavior is certain; the important question for forecasting a
health outcome is how much offsetting behavior will occur? If the protective effect of
medication is assumed large while the pull of the familiar diet and lifestyle is strong, major diet
and lifestyle changes are unlikely. Some individuals might enjoy a large protective effect from
medication. But others might simply overestimate the protective effect and be lulled into
believing that medication eliminates the health risks of diet and lifestyle choices.