Thursday, May 6, 2010

Why the Fruits And Veggies: More Matters Campaign Fails To Induce Diet Change- Kahki Mealey

I. Introduction
The prevalence of obesity in the United States is disconcertingly high. Nearly 70 percent of adults in the United States are overweight or obese (1). The rate of childhood obesity in the United States has tripled since the 1960s, with one third of children now at risk for obesity based on their BMI (2). Obesity is a risk factor for cardiovascular disease, type II diabetes, cancer, stroke, and hypertension, and may be responsible for 300,000 deaths annually (3). Yet its deleterious effects extend beyond the physical, as it carries high medical, psychological, and social costs, and is difficult to treat through pharmacological and surgical interventions (4). Furthermore, obesity is often persistent across the lifespan. A four-year old obese child has a 20 percent likelihood of being overweight as an adult, while an overweight adolescent has an 80 percent chance of being overweight as an adult (2). Beyond adversely affecting people on an individual level, obesity burdens the healthcare system, as obese people incur greater healthcare costs. It is estimated that the annual cost for treating obesity-related illnesses in the United States is over 100 billion dollars, nearly 10 percent of the United States’ healthcare expenditure (3). Given the prominence of obesity, its effects on a reduced quality of life and health, and its high likelihood of enduring throughout one’s life, attention must be paid to prevention, particularly early in life. Obesity results from a chronic, positive energy imbalance, in that energy intake due to consumption of foods and beverages exceeds energy output due to metabolic and muscular activity. Therefore, the primary determinants of obesity are diet and physical activity. Because diet carries the most direct link to obesity and is universal among all people, this paper will focus on dietary patterns’ influence on obesity. Obesity is perhaps the second most avoidable cause of preventable death following smoking (3). And yet, while prevention of obesity has been an explicit goal of national public health policy since 1980, efforts have been largely unsuccessful, as its prevalence has been consistently rising in the past three decades (4). The majority of public health campaigns address obesity as a matter of individual responsibility and ignore environmental and social factors that fuel its development and presence. In examining the “Fruits and Veggies: More Matters” campaign, one can gain a sense of how traditional public health campaigns target obesity.
In 1991, the National Cancer Institute (NCI) and the Produce for Better Health Foundation formed a partnership and created the 5 a Day for Better Health program. The Center for Disease Control and Prevention (CDC) became the lead federal agency and national health authority for the National 5 A Day Program in 2005. In 2007, the CDC launched the Fruit and Veggies: More Matters initiative to adapt to new dietary guidelines that recommended more than five servings of fruits and vegetables for some Americans. Consumers are exposed to More Matters in stores, at home, on packaging, and online. The presence of the More Matters label on packaging and the online website seem to be the most apparent exposures of this campaign to the general public. Critique of this campaign will focus on the website portion, as this exhibits the essence of the campaign, and is the most comprehensive and easily accessible facet of the campaign for the American public. More Matters seeks to inspire Americans to increase their fruit and vegetable consumption by “showcasing the unrivaled combination of great taste, nutrition, abundant variety, and various product forms (fresh, frozen, canned, dried, and 100% juice)” (5) The primary focus of More Matters is education, including the relative nutrients in fruits and vegetables, the difference between whole foods and supplements, serving sizes, and tips for incorporating more of them in one’s daily diet (5).
To motivate people to increase their fruit and vegetable intake, More Matters emphasizes the benefits of eating fruits and vegetables, focusing on their positive health effects in reducing one’s risk for chronic disease as well as their potential aid in weight management. The program provides recipes for a variety of meals, including appetizers, salads, entrees, and desserts that are made with fruits and vegetables. Interactive tools to assess one’s current diet and a “recipe remix” to give one’s favorites recipes a “healthy new twist” by reducing the fat, calories, and sodium in foods further assist one in altering his or her diet to make it more nutritious (5). Commonly asked questions pertaining to nutrition and the More Matters program provide additional knowledge and tips concerning the composition of a healthy diet and how to attain one. Overall, the More Matters program uses education to sell the consumption of fruits and vegetables. More Matters seeks to convince the American public to increase their fruit and vegetable intake by raising awareness of the importance of these food groups for better health and providing tips on how to incorporate these into one’s diet on a daily basis (5).
II. Critique of Fruits and Veggies: More Matters
The Fruit and Veggies: More Matters campaign is ineffective in encouraging Americans to assimilate more fruits and vegetables into their diet and adopt overall healthier eating habits for three reasons. First, More Matters solely targets individuals in combating obesity, and neglects social and environmental factors that shape one’s diet. Second, More Matters fails to address the role of the corporate sector, mainly fast-food companies, in influencing one’s food consumption. Third, this campaign employs the traditional public health paradigm and uses education to appeal to a desire for health, but fails to appeal to core human values to sell people’s deepest aspirations.
A. Individual Level Approach
More Matters seeks to reverse the tide of obesity by approaching the epidemic on an individual level. The key message and focus of the homepage is “how many fruits and vegetables do you need? Every body is different. Enter your age, sex, and level of physical activity to find the amount that’s right for you” (5). A picture of one woman is placed next to this statement. Throughout the entire website, all pictures are composed of only one person. Once one determines the number of servings appropriate for him or her, he or she is given advice on how to consume these fruits and vegetables on a daily basis, based on recipes and serving sizes. Fruits and vegetables are promoted because they decrease one’s risk for obesity-related chronic diseases and aid in weight management. As one can see, the focus of the program is to convince people to eat more vegetables, and assistance in conveniently incorporating these into one’s diet is given. This program provides no support in changing one’s diet other than the actual food substitutions. More Matters implies that people are in complete control of their diet, and can successfully eliminate their risk for obesity on their own. More Matters isolates diet as solely an individual matter, and ignores all other social and environmental political factors that affect one’s intake. Access to healthy foods, particularly fruits and vegetables, limits food options for many people. Deception and lack of knowledge concerning the portion sizes and ingredients in food, especially that from fast-food chains and restaurants, factors into the growing rates of obesity. Family members and friends also play a role in a person’s food consumption. For example, children’s intake is largely dependent on the food their parents purchase. One study examining obstacles to consuming more vegetables found that household size, parental age, occupation, and education level, as well as race and ethnicity influence vegetable expenditures and the overall variety of food purchases (6). Perhaps most importantly, this individual level emphasis of obesity isolates weight from other risk factors, places all blame on a person for his or her weight issues, and implies that obese people lack willpower and self-control. This can stigmatize the overweight and obese and discourage them from the prospect of obtaining a healthy weight, and make them less likely to take steps to improve their health. Evidence suggests that obese people may be too ashamed to exercise and so avoid health-promoting behaviors. Studies also reveal that obese women may be discriminated in healthcare settings and may avoid or delay seeking medical care (7).
B. No Corporate Blame
The corporate sector has played a notorious role in creating an “obesogenic” environment. Food supply trends indicate that the composition of commercially prepared food has changed. The absolute grams of fat available per capita rose three percent from 1970 to 1994, while between 1970 and 1996 there was a 22 percent increase in fats and oils added to the food supply (8). Increasing advertising and availability of soft drink vending machines in schools and at work sites have contributed to more frequent soft drink consumption (8). Furthermore, foods away-from-home have a higher calorie and fat content and lower fiber content than foods typically eaten at home (8). Fast-food restaurants in particular market products especially high in fat, and these tend to be the most popular. For instance, a McDonald’s Big Mac and medium order of French fries fulfills half of one’s total energy requirement and over 80 percent of the recommended fat intake (8). Soft drink companies and fast-food restaurants both have successfully marketed larger portion sizes in the past few decades by increasing the number of larger-sized items available and selling these at a cheaper relative price. Television advertising has been cited as a contributing factor to higher caloric and fat intake (8). In 1999, the NCI spent one million dollars on the 5-a-Day campaign compared to $277 million and $571.7 million dollars spent by Coca-Cola and McDonald’s, respectively, in 1997-1998 (8).
Given these statistics, it is clear that the corporate sector contributes to a toxic food environment by expanding the accessibility and affordability of unhealthy food options. Yet More Matters fails to even address the corporate sector’s influence in fueling America’s obesity crisis. For most people, lifestyle factors require that some meals be eaten outside of the home. Unfortunately, fast-food restaurants offer many of the most affordable options, while simultaneously offering some of the unhealthiest ones. More Matters refers only to food prepared and consumed within the home, assuming that people have complete control over their food intake. More Matters mentions nothing about the quality of foods offered in restaurants, how this might affect one’s diet, and how to effectively deal with these issues.
C. Use of Education to Appeal to a Desire for Health
More Matters seeks to educate the consumer to appeal to a desire for health. By promoting the benefits of consuming fruits and vegetables, the specific nutritious qualities of each, and providing tips on how to incorporate these into one’s diet, More Matters sells health to increase intake of fruits and vegetables. More Matters is assuming that the desire for good health is a strong enough incentive to entice people to improve their diets. This program reinforces the value for health, but this conflicts with and ignores other, more powerful pulls towards maintaining one’s current eating patterns. “Although Americans certainly value health, they also hold other values that tend to be more important, more salient, and more influential on individual behavior” (9). These values include a desire for convenience, saving money, foods that are more tasty, immediate gratification in the form of food (i.e. food as a reward), and deeply-rooted patterns of food intake. For example, study results from the California Five-A-Day Campaign indicated that the program increased knowledge and understanding of the importance of eating more fruits and vegetables, but did not result in measurable dietary change (10). Additionally, the optimistic bias, a tendency for people to think they are invulnerable and possess unrealistic optimism about future life events, may play a role here (11). In preliminary data collection for the “Small Steps” campaign, a large majority of participants admitted their eating habits were inadequate, but few feared adverse health effects, as they believed they would eventually improve their diets (12). Moreover, in a recent survey of the American public, 78 percent of respondents reported that their body weights were not a serious health concern (12). These study results supporting the optimistic bias suggest that health itself may not be a strong enough motivating factor for dietary change.
Instead of researching what Americans want in terms of the benefits of a healthy diet and creating and packaging a product to fulfill these desires that are rooted in core human values, More Matters employs the traditional public health paradigm of using intuition to determine the product people should want, and thus uses education to appeal to a desire for health.
III. Proposed Intervention
A. Reframe Obesity to the Group Level
More Matters frames obesity as a behavioral, personal, and individual issue. To combat obesity, this initiative offers a set of limited strategies related to adjusting one’s diet that are unlikely to be successful. Rather than presenting obesity as a personal problem, More Matters should reframe obesity as a “normal response to an abnormal environment” (13). Individual behaviors should be put into the context of the external factors that inhibit or foster a healthy diet. “Framing in a way that promotes public health involves the expression of common societal values” (7). This includes shared responsibility between the individual and environment for the obesity epidemic. To employ this new frame, More Matters should empathize with people who are overweight or obese, acknowledge the social and environmental challenges these people face in maintaining a nutritious diet, then give them tips on how to deal with these. This should include recognition of the limited access and affordability of food that plagues many people from low-income and minority neighborhoods. Tips on obtaining food at a reasonable cost in food deserts, such as collaboration among families on meals, creating personal food gardens, and how to obtain alternate transportation to far-away supermarkets should be offered. Additional advice should be given on choosing healthy options from the food that is available. More Matters should include nutritional content of foods from popular fast-food chains and tips in the judgment of portion sizes.
More Matters must provide a supportive environment to enable individuals to make positive changes to their diet. Campaigns that encourage community involvement and change are more successful in reaching their intended outcome (14). More Matters should promote collaboration among community members to overcome obesity. This could start with the depiction of groups of people of varying weight (rather than the current pictures of one person) from different populations, united in the purpose of overcoming obesity, and gelled by a sense of camaraderie. More Matters should encourage people to tackle obesity with their family and friends. Forming support groups, sharing nutritious eating tips, and making healthy eating a social activity, such as the creation of dinner clubs, may make eliminate a sense of isolation, self-blame, and stigmatization obese people feel while providing the support necessary for them to attain a more healthy weight. In all, More Matters must impart advice that extends beyond individual eating patterns in order to enable people to attain a healthier diet.
B. Rebellion Against Fast-Food Companies
“We want to make health-damaging choices more difficult to make and health-promoting choices easier to make. It is true that many individuals need to take more responsibility for their behavioral choices. However, it is society’s responsibility to create an environment in which good choices are not only possible but are the easier choice to make” (7). Fast-food companies are failing to promote healthy food options, in fact, they are promoting consumption of the opposite. By continuing to purchase fast-food from these businesses, America is supporting and encouraging this harmful food environment. More Matters should advocate for a rebellion against the fast-food industry. To do so, this campaign should increase public awareness of the nutritional composition of fast-food, in particular the high fat and calorie content as related to portion size. This, in itself, will make people think twice about fast-food consumption. Second, More Matters ought to expose the public to the manipulative tools fast-food companies use to maximize profits, which include deceptively marketing certain products as healthy and pushing for large portion sizes by decreasing the unit price for these large quantities. More Matters should model this effort after the Truth campaign, which developed a brand for youth to identify themselves to the world by “attacking the duplicity and manipulation” of the tobacco industry (15). “A large body of sociological research has revealed that health is of value to the individual not intrinsically, but because it assures a certain degree of personal freedom, independence, autonomy, and control” (9). More Matters should similarly encourage people to take control of their life, their bodies, and their health by rebelling against the fast food industry which currently harms people’s health by selling extremely unhealthy food at large quantities for low prices. By selling freedom, independence, autonomy, and control, More Matters can allow people to separate themselves from the fast-food industry and refuse to let these businesses adversely affect their health.
C. Advertising Theory to Appeal to Core Values
The Advertising Theory is a group level model that typifies how marketers make a promise to consumers in return for purchase of their product. Imagery and social modeling support a promise comprised of the target audience’s deepest aspirations while core values, or concepts important to the consumer, anchor the promise and support (16). More Matters should apply the Advertising Theory to develop associations between the American public and a healthy diet that embodies a lifestyle. The More Matters campaign must be positive, supportive, and emphasize the benefits of a healthy diet composed of fruits and vegetables. In public health situations, there is rarely an immediate, explicit payback for the adoption of a healthy behavior. One of the reasons More Matters is ineffective is the fact that the campaign sells health, but this benefit does not override the desire for convenience, saving money, foods that are more tasty, immediate gratification in the form of food (i.e. food as a reward), and deeply-rooted patterns of food intake. Instead, More Matters should sell the values of family, longevity, and attractiveness that are truly valued by Americans. To sell family, More Matters should portray pictures of families including multiple generations, and market the idea that a healthy diet is important to maintain for both oneself and one’s family. Similarly, More Matters must persuade the audience that nutritious eating habits are worth it, because they enable one to have a long, fulfilling life filled with family, friends, and positive experiences, such that a healthy diet enables one to live each day to the fullest. Finally, More Matters must sell the concept that a healthy diet results in an attractive, sexy body, as appearance is so valued by Americans. Evidence suggests that attractiveness may be a strong motivator to attain a healthy diet. In a study focusing on obesity in African Americans, young women stated that their attractiveness to boys was a stronger incentive to eat healthy than weight regulation, health, or fear of weight gain (17). Taglines and pictures that promote longevity and attractiveness must be incorporated into the campaign.
More Matters must increase campaign exposure among children, adolescents, and adults alike. Currently, More Matters is promoted through the website and packaging on foods, and this fails to target segments of the population most in need of dietary adaptation. Internet usage is correlated with socioeconomic status, whose education and resources decrease the risk higher-income people will be obese in the first place, and allow them to more effectively treat obesity if it is present. Furthermore, advertising for More Matters partly relies on labels (Fruits and Veggies: More Matters!) on produce, but this is flawed in that those who actually see the label are already likely to buy the particular food item. This is echoed in typical public health campaigns, as there is evidence that those who participate in mass-media health campaigns tend to be from high socioeconomic groups and already engage in better health practices (18). Advertising in venues such as malls, schools, supermarkets, concerts, boardwalks, skate parks, health and fitness clubs, at athletic events, in magazines, and on television, including those which are frequented by those of low-income levels, will increase exposure among the American public. Presence of the campaign at skate parks, health and fitness clubs, and athletic events in particular will facilitate the association of the campaign with an overall healthy lifestyle.
IV. Conclusion
Given the prominence of obesity, its effects on a reduced quality of life and health, and its high likelihood of enduring throughout one’s life, prevention and treatment must be a public health priority. The Fruit and Veggies: More Matters campaign seeks to increase fruit and vegetable consumption by advocating the health benefits of these food groups. Yet this campaign is unlikely to be successful because it addresses obesity solely on the individual level, fails to assign corporate blame for the issue, and sells health, a desire that is not compelling enough among most Americans to persuade them to alter their diet. Instead, More Matters should reframe obesity to the group level and integrate its environmental and social causes into the campaign, stimulate a rebellion against the fast-food industry, and use the Advertising Theory to sell family, longevity, and attractiveness.


REFERENCES
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