Thursday, May 6, 2010

Jamie Oliver’s Food Revolution: A Critique – Caitlin Hall

Childhood obesity has become one of the hot-button issues of this generation. According to the Centers for Disease Control (CDC), in 2008 an estimated 17% of American children and adolescents between 2 and 19 are obese [1]. From 1980 to 2008, preschool obesity rates doubled from 5-10.4% [1]. The numbers are startling and disheartening since there are so many illnesses associated with overweight and obesity. Incidence of coronary heart disease, type II diabetes, hypertension, certain cancers and stroke tends to be high in the overweight and obese population [2]. Overweight and obese children are facing more health problems earlier and later in life. It is predicted that, for the first time, the average American lifespan will decrease due to obesity [6].
Celebrity chef Jaime Oliver (AKA the Naked Chef) has long been a proponent of healthy eating as a way to reduce childhood overweight and obesity. In his native England, Oliver was influential in garnering support and funding to revamp school lunches by bringing in healthier food [4]. Oliver hosted “Feed Me Better” and “School Dinner” documentary series which highlighted the poor food choices at public schools and offered healthy, home-made alternatives. The two campaigns were successes in England, resulting in health and educational improvements in the students who ate Chef Oliver’s meals [5].
Recently in the United States, Chef Oliver was an integral part of our TV line up. In his six part series on ABC, Jaime Oliver’s Food Revolution, the chef tried to improve the eating habits in one of the most unhealthy areas in the country, Huntington, West Virginia. Much of his time was spent bringing home-cooked and nutritious meals into the public schools, trying to replicate the success of his programs in England. However, he also offered services like free cooking lessons to families in the area. His goals were to rid the school cafeterias of overly processed and unhealthy food and replace it with fresh, homemade fare while encouraging healthier eating in the greater community. During the series, though, the viewer experienced a number of set-backs. The children did not like the food, the food did not meet national nutritional guidelines, the community resisted him, he could not come in on budget, etc. At the end of the series, Oliver portrays his experience as generally successful. Yet, research showed otherwise. Student participation in the school lunch program dropped, labor and ingredient costs increased, and milk consumption dropped [10].
From a public health perspective, this is a worthy cause. High childhood obesity rates are almost certain to shorten the lifespan of the younger generations. Preparing fresh food could help reduce unhealthy eating, and when paired with exercise and other lifestyle changes, could reduce obesity rates. Yet for all the good intentions, it appears that his current intervention – his food revolution – will ultimately fail. The program, has three major flaws; little regard for psychological reactance, use of fear tactics and reliance on the outdated Health Belief Model.

1. Outsider Status and Psychological Reactance
Oliver’s revolution was in trouble before he even made it to Huntington. The arrival of the multi-millionaire celebrity chef from England was probably already a lot for this West Virginia town to handle. But it was that Oliver, for all intents and purposes, scolded the community for supporting bad food habits that led to widespread psychological reactance. In his book in 1966, Jack Brehm outlined his theory of Psychological Reactance. In lay terms, psychological reactance occurs when people’s inherent behavioral freedoms are undermined or threatened. When this reduction or threat becomes imminent, people will be motivationally stimulated to hold on to those freedoms with great force [7-9].
When Mr. Oliver came to town with a promise to change Huntington’s eating habits, residents reacted as Brehm would have predicted. Rather than embrace Oliver for promoting health, it appeared that many in the community stood against him. Newspaper articles illustrated worry of the city’s image and the local radio host disparaged the premise of the show, saying that he did not want to sit around and “eat lettuce all day” [6]
Because the threat of reactance is so real when proposing behavior change, it is important to protect the freedoms of the target population. Avoiding an authoritarian style and offering choices instead of demands are likely to result in lower levels of resistance[8-9]. In Huntington, Oliver did not always protect the freedoms of his population. With the threat of reducing kids’ choices in the elementary school lunch line, some parents pulled their kids out of the school lunch program. The parents could then regain the freedom to choose what kind of food their child would eat for lunch [10]. Had Oliver been more aware of this psychological reaction, he could have approached the situation from a different starting place.
Jamie Oliver’s status as an outsider was also problematic for acceptance of and participation in his new food program. In his research, Paul Silvia found that interpersonal similarity can actually reduce reactance while boosting rates of compliance[11]. Oliver was not at all similar to the general population in Huntington. He was a foreigner who came to town to “fix” them, he is a celebrity, a millionaire, etc. Oliver tried, somewhat unsuccessfully, to align himself with the community by painting himself as a caring parent. Even though he had this similarity, his many differences were difficult to overcome, which may be why the community in its entirety was never fully on board with his plans.

2. Fear Appeals
With any public health intervention, marketing is important. Proper use of social marketing techniques allows for programs to be planned in such a way that the target populations want to take on positive behavior change [12]. During the show, much of Mr. Oliver’s time was spent trying to “sell” his program to the immediate Huntington community as well as to the nation at large. Yet, he fails at this project because he tries to sell good health by appealing to fears about obesity and weight-related diseases.
In one episode, Mr. Oliver and a local pastor flip through the member list of the congregation and note how many people have died from diseases associated with unhealthy diets. In another episode, Oliver and a local radio host speak with a funeral director about the difficulties of cremating an obese body and view the extra large coffins that people must buy for the deaths of obese relatives. In yet another episode, Mr. Oliver filled a dump truck with a year’s worth of fat from school lunches, and unloaded it in front of parents, kids and teachers to show how much fat their kids consume at school [6]. These images are designed to appall people to the point that they change their behaviors.
Fear appeals have long been a part of public health intervention strategies. Some believe that shocking images will result in motivation change, leading to better behaviors [13]Research shows that fear appeals do not drive a successful health intervention. Research by Hastings et al discusses the mistake of engaging in fear campaigns for public health interventions. Fear messages, and other that cause dissonance can be easily tuned out [12]. For example, if a health campaign is being promoted through use of television advertisements, people will be able to change the channel if they do not like what they see. In Oliver’s case the same is true.
Research suggests that appeals based on positive emotions (i.e. sex, love, hope, excitement and humor) are effective[14-15]. Rather than use fear as a motivator, public health interventions need to re-frame their issues into something that people seek out. While some of the images were probably just television theatricals, the fear-based techniques could have seriously reduced program effectiveness.

3. Reliance on the Health Belief Model
The Health Belief Model (HBM) is often used to propose and analyze public health interventions. Developed through the works of Godfrey Hochbaum, Irwin Rosenstock, and Stephen Kegels, the HBM explores how perceived susceptibility, perceived severity, perceived benefits of action and perceived barriers to action influence intention and behavior change [16]. The HBM is an individual-level theory, meaning behavior is a rationed process, so responsibility is placed solely on the individual [17]. A major critique of the model stems from the direct link between intention and behavior [17]. In other words, if a person believes they are susceptible to some sort of poor outcome which could be fairly severe, and the perceived benefits from behavior change outweigh the costs, then the theorists believe that a person will intend to change. Because the model directly links intention and behavior, theorists would argue that if a person intends to change, they will always follow through [17]. From experience with health interventions, it is clear that people’s intentions do not always result in behavior change. There are other factors such as self efficacy (if you think you can make the change) as well as structural impediments (organic food is much more expensive than processed) that affect whether behaviors are changed [17].
Jamie Oliver’s intervention strategy in West Virginia relied on the assumption that intention leads to behavior change. It is well known in the US that high fat diets lead to poor health effects [1]. Yet, heart disease is the number one killer in the United States [18]. Unlike what Jamie Oliver and the HBM assume, the link between intention and behavior is more complex.
Part of the intention of the show was to highlight national issues in regard to nutritional standards in school lunches. The hope was that the Huntington model, as seen on TV would motivate other areas of the country to adopt change as well – hence, the food revolution. But again, Oliver did not regard the complexities between intention and behavior.
Mr. Oliver’s show was likely to arouse disgust or anger in the viewership, but he never gave information on what people could do with their reactions. In other words, a mother in San Diego may have watched the show and been concerned about her child’s health, but without guidance, she may not know to write to her representative, talk to the school board or mobilize a grassroots movement.

Revised Intervention Strategy
It is important to understand that much of Mr. Oliver’s show was to provide entertainment. Yet, the issues he addresses are important to public health. Again, healthy eating at home and in school should be encouraged as a way to improve health. The intervention I suggest draws from a number of social science perspectives and addresses the three critiques of “The Food Revolution”.
I first propose that this new innovation is started as a pilot program in ten or so US school districts. I would encourage communication among participating districts. A pen-pal program could be introduced so that students at one school can see how the students at another school are using the program. The different locations will also allow researchers to address problem areas and play with unique community characteristics so that the plan can later be rolled out more efficiently. Just as Oliver’s original intervention, mine will be composed of school-based and home/community-based approaches.
In the elementary schools, I would like to use a social norms framework rather than the Health Belief Model. The Social Norms Theory (SNT) was introduced by H. Wesley Perkins and Alan Berkowitz [19]. The theory attempts to explain individual behavior by exploring norms and perceptions of norms that exist in the surrounding environment [20]. In other words, the theory suggests that people participate in certain behavior because they perceive others’ expectations and values to be congruent with that activity. In using this framework with younger children, the hope is to change the norms from unhealthy eating habits to healthy eating habits as the kids grow. Based on the Early Sprouts program, I would encourage students in elementary schools learn about food from the seed up [8]. This program has preschoolers growing their own vegetable gardens and learning how to make food with what they grow. The children also take recipe cards back home to try and reinforce the healthy eating habits learned at school [8]. By fostering a sense of achievement and empowerment, the children are more likely to enjoy what they are eating. Because all the students would participate in this program, eating fresh, healthy food instead of junk will become normative.
I recommend a similar program introduction for middle schools and high schools. I would encourage the introduction of vocational classes in which students learn to grow and cook their own food. This homemade food should be a meal option during lunches. Again, the students will take ownership over their work and may be less likely to turn away from healthy alternatives. For all schools, I would like to eliminate overly processed and fatty foods. It is important to maintain menus that are appealing to students (such as pizza, spaghetti, etc), but more wholesome ingredients could be used to make the various dishes.
Instead of using the shocking publicity stunts shown in Mr. Oliver’s program, I think that the importance of healthy foods need to be brought into the home in a more constructive way. First, I recommend local individuals to have activist roles in each community. This would make it a community revolution instead of “Jamie’s” revolution. Having well-known individuals promoting the program will limit reactance. Rather than sending out fear-messages, organizers should instead be promoting their new habits in a fun way. For example, rather than dumping a truck-load of fat it would be more beneficial to host a food festival with tasty, healthy meals and local performances.
It would also be necessary for local organizers to have information to help navigate the system. Mr. Oliver ran into problems with nutritional guidelines set out by the federal government. There needs to be a place where people can go to find this information and to use it to either build the program or build coalitions to request changes in the requirements. One of the main reasons I believe his intervention will prove ineffective for the Unites States is that Oliver did not provide helpful information to viewers who may have wanted to create change in their own towns. By having a local source who holds this information, interested activists can get in contact with the right people, thus pushing change forward.

Reducing Reactance
My intervention really tries to reduce the psychological reactance of the target population. Instead of using an out-of-touch celebrity advocate, I would like to use real people as promoters. By recruiting community members with insider status into the intervention, the population may be less likely to fear losing freedoms.
It is also important to address the framing of the intervention. To many in Huntington, it seemed as though Mr. Oliver was there to “change them” or “scold them”. Even if they had less intense reactions, there was a feeling that Mr. Oliver was telling them that their way was wrong. To avoid reactance backlash, organizers must highlight the positives rather than the negatives [14]. For example, rather than being angry at the fat content of one meal, the interventionists should focus on the tastiness and local origin of a comparable meal.
Avoiding Fear Appeals
Obesity is a very serious public health issue plaguing America. Even though the rates of overweight and obese people are very high, most people are quite aware of the risks that go along with those conditions. To remind people of this with shocking scenes is uncomfortable and ineffective. Instead of focusing on negative and frightening imagery to invoke change, the new intervention will focus on positive and optimistic scenes. Community gardens and food festivals promote a better way of eating without causing people to ignore or react against the message.
Trashing the Health Belief Model
The most important change was to move away from the individual-level health belief model and towards the group-level social norms model. I like the social norms model for a few reasons: it does not place blame on individuals for poor behavior choices. Instead, it encourages people to change behaviors and reinforce new habits as a community. It also allows for examination of social complexities between intention and actual behavior change. The model allows for community interaction in creating and maintaining healthier norms regarding food choice. I think that long term change is more sustainable when a whole community is supporting the effort.

Jamie Oliver’s revolution, while well-intentioned, is most likely destined for failure. Poor intervention-planning led to a product that was not well suited for Huntington or the United States as a whole. If an intervention is to work well, target community needs to be involved their unique social situations must be considered. My own approach targets different aspects of community and positivism, so as to avoid the three major mistakes in Oliver’s approach. With the problem of childhood obesity looming, I hope that new interventions will make a positive difference.

1. CDC. Childhood overweight and obesity. 2010.
2. CDC. Health consequences: Overweight and obesity. 2010.
3. NIH. Obesity threatens to cut U.S. life expectancy, new analysis suggests.
4. BBC News. TV chef welcomes £280m meals plan
5. ANI. Jamie Oliver’s healthy school dinners help kids achieve better results.
6. ABC. “Jamie Oliver’s food revolution”. Television series. 2010.
7. Behm, JW. A Theory of Psychological Reactance. Oxford, England:Academic Press. 1966.
8. Rains, SA., Turner, MM. Psychological reactance and persuasive health communication: A test and extension of the intertwined model. Human Communication Research 33(2), pp 241-269. 2007.
9. Whitehead, D., Russell, G. How effective are health education programmes – resistence, reactance, rationality and risk: Recommendatinos for effective practice. International Journal of Nursing Studies 41(2), pp 163-172. 2004.
10. WVU Health Research Center. Jamie Oliver’s food revolution in West Virginia: Initial evaluation of school-based meal changes. 2009.
11. Silvia, PJ. Deflecting reactance: The role of similarity in increasing compliance and reducing resistance. Basic and applied social psychology 27(3), 227-284. 2005.
12. Grier, S., Bryant, CA. Social marketing in public health. Annual Review of Public Health 26, pp 319-39. 2005.
13. Guttman, N., Salmon, C. Guilt, fear, stigma and knowledge gaps: Ethical issues in public health communication interventions. Bioethics 18(6). 2004.
14. Hastings, G., Stead, M., Webb, J. Fear appeals in social marketing: Strategic and ethical reasons for concern. Psychology and Marketing 21(11), pp 961-986. 2004.
15. Lewis, IM., Watson, B., et al. Promoting public health messages: Should we move beyond fear-evoking appeals in road safety?Qualitative Health Research 17(1), pp 61-74. 2007.
16. Individual health behavior theories (chapter 4). In: Edberg M. Essentials of Health Behavior: Social and Behavioral Theory in Public Health. Sudbury, MA: Jones and Bartlett Publishers, 2007, pp. 35-49
17. Siegel, M. Lecture: Health belief model. 21 January 2010
18. CDC. Heart disease is the number one cause of death.
19. Berkowitz, AD. The social norms approach: Theory, research and annotated bibliography.
20. Perkins, HW. A brief summary of social norms theory and the approach to promoting health. 2006.

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