Thursday, May 6, 2010

“Let’s Move” Away from Anti-Obesity Methods that Depend on the Individual and Rational Thinking – Katherine Reid

When First Lady Michelle Obama wore designer Jason Wu to her husband’s inauguration ball last year, overnight the designer was a success and a household name. It also showed the immense power of influence the First Lady had over the America public when it came to fashion choices. When Michelle Obama announced her new “Let’s Move” campaign to help fight obesity in America however, the American public wasn’t so quick to get off the couch and trade in their bag of Oreos for fresh fruits. Even with the her established influence the First Lady ran into the same scenario that many anti-obesity campaigns before her had – telling people to eat better and exercise isn’t always enough to motivate people to do it.
Like so many of its predecessor’s the Let’s Move her Michelle’s campaign was founded with great intend and a lot of good value information to help fight obesity, however we wouldn’t be in the middle of an obesity if those methods were enough to change unhealthy lifestyles overnight. Many current approaches to fighting obesity mistakenly rely on the assumption that people think rationally and are self motivated enough to change their lifestyle simply because you tell them they should. However despite all these campaigns with information about the importance of healthy lifestyles and the dangers of being obese, almost one third of adults and one fifth of children are still considered obese. Not only is obesity stealing years over the lives of children, its robbing tax payers who will spend about $150 billion to treat obesity related medical conditions this year (1)
Obesity is a serious growing problem and we need to develop a strong intervention campaign to fight it off. Current campaigns have good intentions but they’re not yielding the results we need to see. We can no longer rely on health campaigns that have hope individuals will do the right thing or believe that since our message is promoting healthy life styles we don’t need to market ourselves the way the food industry does. In order to win the battle of the bulge the public health campaigns need to be revamped to include strong public policies, strong and effective marketing campaigns with an overall population- based intervention method. Confronting the causes of this complex issue requires a multi-faceted approach and effort. Telling people to eat better and get more exercise places responsibility squarely on the individual, but fails to take broader environmental, economic, and age considerations into account. (2)
Critique 1: Relying on the Individual to Make the Right Decision
While it may appear that the main causes for obesity levels rising three fold in the last 30 years are a result of an individual’s decisions like increased consumption of more energy-dense, nutrient-poor foods with high levels of sugar and saturated fats, combined with reduced physical activity, attempting to reverse this behavior by relying on individuals to make the right decision is not an effective approach (3). Many anti-obesity interventions aimed at school aged children are based on calculating BMI of students and sending the results home in a report for parents. The hope is that parents upon seeing their child has a BMI considered obese will immediately take steps to radiate the issue. However, a recent study found that in one school where BMI report cards were handed out while the majority of parents with a child classified as obese agreed it was an issue, only 20% had developed a plan to address the issue. Of this 20% most of the parents believed a successful solution would be to put their child on a diet; however diets have been proven to be ineffective as a long term solution for fighting obesity (4).
A large weakness in the BMI report cards program is their strong reliance on the traditional Health Belief Model. It assumes that people will make a rational cost -benefit analysis about whether or not to change their health behavior. In this case once parents learn their child’s BMI classifies them as obese they will take actions to solve the problem and implement a healthier lifestyle for the child. While many parents had the right intention the plan failed to succeed because the individual parents weren’t successful in following through with their decision to develop healthy eating habits and instill the importance of regular exercise onto their children (5).
This model doesn’t take into consideration social or environmental factors that also contributes to the child’s lifestyle. Many overweight children have overweight parents who lead by example in eating poor diets and not encouraging physical activity. For many parents it’s easier to go through the McDonald’s drive thru than spend time preparing a healthy well balanced meal. Similarly it’s easier to place a child in front of a TV for three hours than to go outside and play catch. Their desire for convenience outweighs their immediate concern for their child’s well being. The Health Belief Model doesn’t take convenience into consideration and relies instead that people will make a rational decision in the best interest of their health. The BMI reports also doesn’t take into consideration self efficacy. For parents who are already overweight they may feel helpless, if they can’t control their own weight how can they control their children’s weight? They may feel instantly defeated before even trying. For many parents their may be guilt associated with their child’s obesity since they are ultimately the ones in control of their child’s diet and exercise routine. Many people would rather ignore the problem all together than take responsibility for their actions. Again the BMI report cards don’t take these aspects of social behavior into effect.
Obesity in school aged children is a serious health concern and we need to rely on strong and effective measures that will reverse the effects and no longer rely on the hope that parents will do the right thing and rationally choose what’s in the best interest of their child’s health.
Critique 2: Labeling Children as Obese Could Actually Worsen Their Condition by Lowering Self Esteem
Studies in children as young as five say they have developed a bias against fat people (4). After Michelle Obama’s “Let’s Move” campaign kicked off many people felt the First Lady had generalized overweight people as lazy and gluttonous and took personal offense. For most people they’re overall physical appearance is tied directly to their self-esteem and it’s a very sensitive subject and interpreting Obama’s message in that way can be very hurtful for them.
Again, using the example of BMI reports in anti-obesity campaigns while many children can’t quite comprehend the complexities of their Body Mass Index they can simplify a classification of obese into being “fat.” This labeling can actually cause damage by creating stigma’s for overweight children and have a strong negative effect on their overall self esteem. There self esteem however isn’t lowered because they are fearful of potential health risks instead its because of the early awareness that current social norms dictate that being overweight is socially unacceptable in our culture (4). A common side effect of labeling is that people start to identify with their labels and continue to perpetuate the stereotype. If a child is labeled as fat and they belief the social norm in their environment that fat people are unacceptable they may begin to identify themselves as “the fat kid” and act in the way society has depicted this stereotype to act. Many people even admit to intentionally treating overweight people differently because of the underlying stigma around obesity. Young girls are especially vulnerable to associating self worth with how they look and can be most affected by these labels.
The potential ramifications of labeling are dangerous and some reports cite growing concern that schools may be miscalculating BMI resulting in many average children being mistakenly labeled as obese. Considering this approach does more to hurt obese children than to help prevent obesity we should move away from labeling individuals and move instead to correcting social norms about obesity (4).
Critique 3: Weak Marketing Campaigns Are No Match for the Food Industry
In 2004 the Coca Cola Company alone spent nearly 240 million on advertizing while the national “5 a Day” campaign spent only 4 million. Assuming the ads cost the same amount that means for every 1 “5 a Day” advertisement a consumer saw they also saw 60 ads promoting Coco-Cola products (6). Ubiquitous advertising could be why the U.S. Department of Agriculture have said that even babies consume measurable quantities of soft drinks, and pediatricians say it is not unusual for overweight children to consume 1200 to 2000 calories per day from soft drinks alone (6). While the national “5 a day campaign” blazed new trail as a public health campaign that used marketing and advertising theories it pales in comparison to the those used by the competitors, like McDonalds and Coca-Cola. While “5 A Day” ads sell the promise of a healthy, fit, lifestyle so do Gatorade ad and they do it with a snazzy slogan, high profile celebrities and brightly colored bottles. Anti-obesity campaigns that aim to promote healthy eating habits and regular exercise need to step up if they’re going to overcome their competitors who sell the exact opposite product while inaccurately promising beauty, wealth and freedom from parents which are very valuable and enticing things to children especially.
Worse than a low volume of advertising though is anti-obesity advertising campaigns that are based on fear. While some fear campaigns can be effective all too often anti-obesity fear campaigns only help to perpetuate stigma and exaggerated stereotypes by unknowingly selling the promise that if you’re overweight then you are lazy, embarrassing and hopeless. It’s no wonder that children laugh and create spoofs of anti-obesity ads while at the same time adding Snickers bars and Fruit Roll Ups to their parent’s groceries list.
The anti-obesity ads, much like the BMI reports, are falsely assuming that people think rationally and telling them that obesity is dangerous will be enough to instantly cause them to change their habits. Obesity intervention ads need to follow the marketing theories that the food industry have perfected and sell their product, a healthy lifestyle, by promising the consumer their product will enable them to achieve or obtain something that is very important to them.
Proposed Intervention:
To successfully fight off the obesity epidemic we need to develop an intervention at the population-based that is based on prevention and establishing healthy lifestyle habits like eating well and regular exercise by making healthy choices easily accessible and convenient to everyone. The first step is to move away from relying on individual rational choices and instill changes at the population level since people are heavily influenced by their environment, peers and perceived social norms of both. The intervention will develop a counter marketing campaign to repel against the marketing of the food industry. The basis for the campaign would be to do for obesity what the Truth campaign succeeded in doing against the tobacco industries. Lastly the intervention will work to regulate change by enforcing public policies that will make it easy for people to make healthy choices by working to eliminate unhealthy options.
Defense of Intervention 1 – Focus on Population-Based Change
The proposed intervention acknowledges that people are greatly influence by their environment and by changing their environment individual behaviors will change. This herd mentality will be used to promote healthy lifestyle and prevent obesity. By using a population based approach you can make large widespread change that will effect a lot of people by implementing changes in the environment that make healthy lifestyle choices easily accessible.
School-based anti-obesity education programs have seen great success by integrating the keys to a healthy and active lifestyle into everyday lesson plans. No individuals are targeted to revise their habits and instead the entire population is taught how to succeed. The healthy eating habits and benefits of exercise become social norms in the school environment and children are positively model their behavior after their environment (7).
Programs across the US have worked to make physical activity available at the population- level. Cities invest in biking and walking trail and make them easily accessible and enticing to the entire population. They develop community gardens that allow people to grow their own vegetables and therefore again making fresh fruits and vegetables easily accessible. By removing previous barriers to healthy options people are more likely to succeed.
Defense of Intervention 2 – Use the Truth Campaign Model to Fight Obesity
In the same way that the Truth campaign utilized teenaged rebellion to exposure the Tobacco industry, this intervention would use the same model to fight against the food industry. It can expose the tricks of the food industry and how they specifically market their products to young children who can’t distinguish truth from marketing. The campaign will educate the consumer to the tricks of the food industry and empower them to make their own decisions and not be fooled into buying the products by simple gimmicks. To help build a strong foundation we’ll rely on involvement from at risk individuals, like people who are currently obese and or are highly at risk for become obese and determine what they like and what don’t like. Similarly, to the Truth campaign we’ll also work to brand the intervention with slogans and ads that people will recognize since repetition is effective (8).
Instead of pointing to an individual and assigning blame for their obesity, the marketing campaign will turn the blame onto the industry and make them responsible. The counter-marketing strategy of the Truth campaign worked to de-normalize smoking and in this case could also work to de-normalize unhealthy eating habits (9). A strong and competitive marketing campaign is a necessary defense against those of the food industry. IF we work to both undermine their campaign messages while increasing awareness for healthy lifestyles we’ll have a well rounded tactic for success.
Defense of Intervention 3 – Using Policy Changes and Corporate Restrictions
The easiest ways to help people make healthy food choices is to make the healthy choices the easy choices and whenever possible make them the only choices (9) and this can be done through successfully implementing policy changes and corporate restrictions. Already in the US with the help of FDA regulation on Trans Fat we have seen a significant decrease in products that contain them. Some states have even gone so far as to ban them entirely from restaurants (10). By pushing the responsibility back on the food industry they will become forced to change their methods and provide healthier alternatives. Many companies have already begun working on producing snacks that have lower sodium and fat content. While it will be hard to erase snacks and candy from memory it will help to have better options available for when they are consumed. The FDA can also help to enforce more upfront nutritional information on package labeling that clearly identifies any unhealthy ingredients.
Not only can we implement policy on what the food industry can sell but we could implement on how they go about selling it. Many countries like Sweden and Australia have begun to regulate television ads aimed at children by limiting the amount of commercials allowed with certain time periods or by preventing the use of cartoons to solicit candy or unhealthy snacks. Although such actions have not eliminated childhood obesity they may help to slow current trends (11). Additionally, legislative ban on marketing of unhealthful products in the schools would provide a needed respite for children and adolescents (6).
Putting legislation in place won’t be easy and the resistance from the food industry will be overwhelming since it threatens to limit their profits. For companies who fail to find healthier alternative or support the anti-obesity interventions they’re should be clear consequences. Many companies now are helping to endorse healthier lifestyles even while still selling a completely contrasting product but its helps PR. By continuing to bring companies into the news by lawsuits or penalties they will be forced to comply or suffer from high profile bad press.
A public policy needs to be in place also to provide funds for creating healthy alternatives, lawsuits against food companies similar to that of the tobacco industry could generate income to help supplement new research for anti-obesity campaigns. The “Let’s Move” campaign promised almost one billion dollars to improve school lunches however that would work out to less than 15 cents a student and with an apple costing almost 30 cents that money won’t stretch far enough to overcome the epidemic (1).
Developing successful public health campaigns, strategies and interventions for fighting and eradicating the obesity epidemic is essential. These campaigns need to be preventative and impact change on a population based level while making healthy eating and lifestyle habits easily accessible to everyone. This can be done implementing policies and corporate changes in addition to successful marketing campaigns that help to promote healthy lifestyle choices while undermining the ads of competitors in the food industry using the anti-smoking Truth campaign model. We’ve seen through less successful programs that people aren’t motivated enough at the individual level to change their habits and that rational thinking does not always drive the decisions they make about eating and exercise. Successful interventions need to keep this in mind and instead of asking the individual to do the rationale thing use ads, policies and population based changed to create an environment where decisions supporting a healthy lifestyle are abundant and convenient.
1) Let’s Move. America’s Move to Raise a Healthier Generation of Kids. Let’s Move.
2) California Health Advocates. The Obesity Epidemic Grows Among Medicare Beneficiaries: Examining the Who and Why California Health Advocates. disparities/2006/obesity-who.html
3) Global Strategy on Diet, Physical Activity and Health. Obesity and Overweight. World Health Organization. Switzerland:
4) Ikeda J, Crawford P, Woodward- Lopez G. BMI Screening in Schools: helpful or harmful. Health Education Research 2006; 21: 761-769.
5) Individual Health Behavior Theories (Chapter 4). In: Edberg M. Essentials of Health Behavior: Social and Behavior Theory in Public Health. Sudbury, MA: Jones and Bartlett Publishers, 2007, pp. 35-49.
6) Consumers Union. Out of Balance: Marketing of Soda, Snacks, Candy, and fast food. Consumer Union Publisher of Consumer Reports. San Francisco, CA, Sept. 2005.
7) Kumanyika S. Population Based Prevention of Obesity. American Heart Association, 2008; 118: 428-464.
8) Hicks JJ. The Strategy Behind Florida’s “Truth” Campaign. Tobacco Control 2001; 10:3-5.
9) Mercer S, Green L, Et all. Possible Lessons from the Tobacco Experience for Obesity Control The American Journal of Clinical Nutrition 2003; 77: 1073-1082.
10) Freudenberg N, Galen S. The Impact of Corporate Practices on Health: Implications for Health Policy. Journal of Public Health Policy, 2008; 29: 86-104.
11) Mello M, Studdert D, Brennan A. Obesity- The new Frontier of Public Health Law. NEJM 2006, 354:2601-2610.

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