Background Information
Currently
in the U.S approximately 68% of adults and 17% of children are overweight, in the
state of Minnesota the obesity rate is expected to double if this pattern
continues (1). The health insurance company Blue Cross and Blue Shield of
Minnesota has taken a controversial approach to the obesity epidemic. The insurance
company started tackling this growing health issue in Minnesota in a more
serious manner by running new commercials in September 2012 that will run
throughout 2013. The commercials depict overweight and obese parents promoting unhealthy
eating behaviors for their children. In the past, the company had successfully used
comical commercials to promote healthy behaviors such as one showing an old man
dancing to hip hop song in a doctor’s office waiting room. Blue Cross/Blue
Shield claims they have spent over a decade working on prevention related
advertisements and believe these particular ads are stronger (1). Dr. Marc
Manley, chief prevention officer for Blue Cross, believes a more serious campaign,
finger pointing and all, is what Minnesota needs (2). The company calls the ads
a “reality check” for parents with the hope that the advertisements will
seriously motivate adults to make a change in their eating behaviors and set a
better example for their children (1). One of the commercials being aired
depicts two young, overweight boys bragging about how much food each of their
dads can eat when one of the father’s walks up with a tray overflowing with
fast food. The advertisement concludes with the overweight father looking
guilty and the words “Today is the day the set a better example for our kids”
on the screen. The anti-obesity ads have received national attention, both
criticism and praise. Articles and blogs writing about the new ads received
various comments from readers, most of the commentary focused on the idea that
as a society we already do enough finger pointing and maybe its time to help
individuals solve the problems.
Overview of the critique
The
Blue Cross/Blue Shield of Minnesota commercials regarding obesity are
questionable in their overall effectiveness to change people’s behaviors. The
public health campaign continues to stigmatize obesity, which further alienates
individuals who are overweight or obese. The commercials will also induce
psychological reactance in their audience. Viewers of the commercials will
likely be provoked to ignore the message and continue to participate in
unhealthy behaviors. Although the commercials end with telling parents to act
as an example to their children, they do not guide parents on how to lead by
example. The commercial lacks concrete educational resources and words of
encouragement for the audience.
Further stigmatizes obesity
The
commercials further stigmatize obesity with their message. The advertisement targets overweight
people by placing them in the spotlight. Not only do the commercials only
utilize overweight actors but also they focus on fast food and unhealthy
snacks. Although some may argue that using overweight actors in advertisements
is a visual image for change, this is not true when the advertisements further
stigmatize overweight people. The director of obesity research at Yale
University, Rebecca Puhl, PhD, stated, “by
stigmatizing obesity or individuals struggling with their weight, campaigns can
alienate the audience they intend to motivate and hinder the behaviors they
intend to encourage (3).” This
Yale study also concludes that a stigma in a public health campaign is the
enemy because it prevents any type of positive progression (3). In America’s
history stigmas have been shown as detrimental to people. For example, the
HIV/AIDS stigma become so problematic that it became a obstacle when the
epidemic was addressed (3). The HIV/AIDS stigma was counterproductive; it
became noticed as a root cause to an individual’s susceptibility to the disease
(3). With evidence from past experiences such as the HIV/AIDS epidemic it is
crucial that the commercials stop promoting the negative stigma attached to
overweight individuals. These stigmas produced in the commercial include;
overweight people mainly buy junk food, overweight people mainly eat junk food,
overweight people set bad examples, and overweight parents cannot care for
their children. These mentioned stigmas are just a few that the commercial has
the capability to promote and stimulate in the audience.
Another
study published in Social Science and Medicine found that subtle forms of
stigma were most effective on impacting an individual’s health and social well
being (4). The commercials produced by Blue Cross/ Blue shield are in no way
subtle. The study also found that individuals rarely challenge stigma and often
blame themselves for the stigma attached to obesity. The commercials can induce
this blame game by promoting the obesity stigma. If these advertisements do not
change to become more positive and encouraging, it is likely that more
advertisements will continue on this negative path.
Induces Psychological
Reactance Theory
The
commercials will trigger psychological reactance in their audience. Simply
stated the basis of psychological reactance theory is that people do not like
to be told what to do, this commercial concludes by telling parents what to do.
The commercials are condescending to parents; they shame parents and make them
feel guilty. In the second Blue Cross/Blue Shield commercial the young girl is
following her mother, both of whom are overweight, around the grocery store. At
one point the mother turns around to check on her daughter and sees she has the
same junk foods in her grocery carts. The mothers face turns into sadness and
guilt when she looks at her daughter’s groceries. These commercials induce
feelings of guilt, shame, and embarrassment on parents in a condescending
manner; the ad is trying to tell parents what to do by saying what not do.
Although the commercials do attempt to reduce reactants by using overweight
actors to relate to the audience this can induce anger in the audience. Researchers at Yale University in Connecticut
found that negative messages “instill less motivation to improve health (3).”
The study concludes that a message, which induces shame or guilt onto a person,
will not help create a change but may backfire. This supports the idea of
psychological reactance.
The commercials also attempt to pressure parents
to choose different foods and lead by example, this pressure may cause the
parent to adopt the opposite attitude and allow their children to eat anything.
Another study done at Yale University had over one thousand participants view
current public health obesity campaigns in the United States. The study found
that participants were more likely to provide the campaign a better rating if
it was motivational (4). Comparatively, the negatively rated campaigns shamed
the participants and created a negative environment where change was unlikely
(4). This study supports idea that the negativity in the commercials will
induce psychological reactance in viewers. Overall, the commercial threatens a
parent’s personal freedom, which in turn could cause them to continue with the
undesirable behavior.
Provides No Concrete Solution
to the Problem
The commercials do not provide any
educational solution to the obesity problem. At the conclusion of the Blue
Cross/ Blue Shield Minnesota commercial the only resources and information
given is the company website with the words “obesity affects us all.” Dr. Marc Manley, BCBS chief prevention officer,
stated that the intent in creating the ads was to show good parents having
moments of realization that they needed to change their own behavior in order
to send the right message to their kid (6). Viewers did not respond well to the commercials, on a blog one
viewer commented, “ I think that we do a lot of finger pointing in our society
instead of trying to help individuals solve challenges (7).” The reaction was
common among respondents that the commercial failed to provide the tools to
actually help the audience.
The commercial brings the audience to
the contemplation stage of the transtheoretical model behavior theory where
they will begin to think about making a change. A study on adolescents done by Laura Mauriello found the
stability of the action and maintenance stages of the model were key in
promoting healthy behavior (8). The more resources provided in the previous
stages the more stable the action and maintenance stages (8). The problem is
that the commercial does not help induce people into the preparation stage,
which is where an attempt will be made to take concrete steps for a healthier
lifestyle. The commercials do not adequately prepare the audience; it does not
guide towards a specific plan.
The American Dietetic Association
concludes that media messages need to include an active and behavioral focus on
choosing the rights foods (9). The association goes on to say that half of
American shoppers are searching for nutrition information and education within
their media and social outlets (9). The commercials do not help these
American’s on their search for information; therefore Blue Cross/Blue Shield is
failing to actively help society. The obesity
Action Coalition also had something to say regarding the ads: CEO Joe
Nadglowski’s stated, "The vast majority
of people understand that they struggle with their weight, actually are trying
to do something about it, but unfortunately for all of us that have ever
struggled, we know that it is challenging (7)" This highlights the notion
that people are aware they are overweight, but they need the tools to make the
change. In the Minnesota
Blue Cross/Blue Shield commercials no concrete resources are provided. The
company is perpetuating the obesity epidemic by failing to educate the audience
with positive, informational messages.
Proposed alternative
intervention
The
campaign to prevent childhood obesity should be an educational approach focused
on motivating and guiding both adults and children. The commercials would
encourage parents and children to lead active healthy lives. A change to the
commercials would depict children and parents together participating in
physical activity while eating and drinking healthy snacks such as carrots or
water. At the conclusion of the advertisement resources could be provided, not
to benefit a particular company, but to benefit the individuals health.
The
actors in the commercial would come from every background and be of every shape
and size to decrease the obesity stereotype. The parents would be actively
helping their children participate in the games as well as eating behaviors.
This would promote the theory of planned behavior, the behavior would benefit
both parent and adult therefore the behavior will take place. The conclusion of
the advertisement would recommend resources for physical activities, food
recipes, and other educational tools. The goal of the commercial would be to help
families obtain a healthy, happy lifestyle.
Reducing the stigma of
obesity to benefit public health
Stopping the obesity stereotype in the
commercials with a positive, motivating message would reduce the stigma
attached to overweight people. The stigmatization attached to obesity is not
beneficial for the health and psychological development of individuals (10). A recent study shines light on a frightening
statistic: as obesity rates continue to climb weight discrimination has also
increased over 50% in the past ten years (11). The Yale Research study found that the stigmatization of obese individuals threatens
health, generates health disparities, and interferes with effective obesity
intervention efforts (3). The problem is that society regards overweight people
personally responsible for their weight problems; society assumes it is the
individual’s fault. Mass media campaigns that label children as overweight or
fat spur a movement of body hatred and food fear, eventually making them even
more susceptible to negative media messages. A more effective approach would be
to focus on positive self-images and include self esteem building components
(3). By including these factors and reducing the emphasize of personal
responsibility the negative views of society can be reduced and the overweight
individuals have been shown to have more positive attitudes (3).
Instead of utilizing the negative weight stigma to
change behaviors the commercials should first address the weight stigma, to
alleviate any negative thoughts, and then move forward with the goal of the
commercial. For example, fit families could be playing in the park when an
overweight family walks by, instead of taunting them the other families could
ask them to join in the game. This could decrease the stigma that overweight
people are unable to enjoy physical activity, this is especially important for
vulnerable young children to see in the media. Also as the Yale Research study
determined, unhealthy eating behaviors should be discouraged for all people (3).
The commercial should feature all of the families refusing unhealthy snacks
such as soda instead reaching for healthy alternatives. To decrease the stigma appearance based
media efforts should be avoided, instead replaced with health focused, positive
messages.
The usage of the theory of planned
behavior
The campaign to help combat obesity in
children and adults must promote self-efficiency to be successful. The target audience
must believe they are capable of changing their habits and behaviors before the
change actually occurs. In the case of this campaign, the parents need to
believe they are capable of making a change in their family’s food habits. The
theory of planned behavior simply states that individuals are rational decision
makers who consider the implications of a behavior before engaging in it. The
intent to actually do the behavior predicts whether the future behavior will
occur or not. The factors impacting the behavioral intent include attitudes,
subjective norms, and perceived behavioral control.
A study published in the Journal of
Health Communication by Andrews, Eneli, and Silk (2010) examined the theory of
planned behavior in preventing childhood obesity specifically focusing on
parents as health promoters (12). The study utilized mothers and children ages
2-5 as participants (12). One finding was that positive attitudes from parents
in regards to healthy meals and nutrition could decrease children’s obesity (12).
An effective ad would, “inspire behavioral change by highlighting the
effectiveness of small actions (12).” Andrews, Eneli, and Silk found that subjective
norms promoted by health associations influenced a parent’s behavior. Blue
Cross/Blue shield would need to directly present their approval of healthy
foods for parents to be receptive to the message. The study also determined
that parent’s need to feel in control of their own weight as well in control what
they feed their children (12). The commercials need to make parents feel
capable of changing their own weight and show that it is possible for anyone to
make healthy food. The findings of the study concluded, “it is critical that
future health campaigns emphasize the ability of healthy eating to decrease
childhood obesity (12).”
Another study evaluated the
effectiveness of a theory of planned behavior based intervention program to
change children’s BMI’s. The study
split the participants into two groups: the control group and the intervention
group (13). The intervention group focusing on overcoming barriers, increasing
availability of healthy foods, and increasing parent support (13). The results
found that the intervention group had a higher consumption of healthier foods
and a lower consumption of unhealthy foods (13). By using the theory of planned
behavior the study was able to identify behavioral beliefs and attitudes of the
children (13). It found that negative messages resulted in lower levels of
excitement and receptiveness for the children (13). This study determines that
using the theory of planned behavior has advantages. By determining the
associations children make media campaigns can work to change these attitudes
and promote healthier messages to children and adults.
These findings from both studies
demonstrate that parents do need to be targeted but to change behavior not to
chastise and shame. Blaming won’t change a parent’s behavior, instead its
crucial to instill to parent’s the importance of health and nutrition.
Provide a structural approach
Educational resources would be provided
to encourage the commercial viewers to learn about healthy habits. When
“prevention of obesity in children” is typed into an Internet browser search
bar the search results include various government websites providing education
tools. The educational tools range from recipes, risk factors, and simplified
overview of obesity. For example, The Center for Disease Control and Prevention
outlines ways to help a child combat obesity including help kids stay active,
remove calorie rich temptations, and encourage healthy eating habits (8). It is
tools similar to the CDC that should be promoted when implementing a campaign
to change eating behavior
In an investigation into home and
school intervention strategies for children the findings support the necessity
of educational resources (14). The investigation looked into fifteen intervention-based
studies over the past twelve years and determined that seven studies were
effective based on their usage of behavioral change techniques. The results
determined that intervening in all aspects of a child’s life in an educational
manner is the most effective (14). Essentially, this means that public health
measures should involve school, home, and community settings. Also along with
educators, parents should be involved in raising awareness about obesity and
promoting educational resources for their children.
The
review of interventions study also determined specific ways to educate children.
One approach was to help children set goals for themselves, this helps change
their behavior in a gradual and long lasting way (14). Another approach is to
target the right behavior in the right setting (14). This entails targeting
physical education in schools and healthy food choices at home. In general, it
is crucial that the health nutrition information be introduced and maintained
over time.
Another
investigation looked at the overall prevention and treatment of obesity in
children (15). An expert committee compromised of individuals from various
professional organizations did the investigation. The committee determined that
supportive efforts to address the problem along with strong positive obesity
prevention messages (15). The committee stressed the importance of messages in
schools and communities to revolve around prevention, assessment, and treatment
(15). Numerous times the expert committee recommends “actively engaging
families” and the importance of “making information and suggestions available
(15).”
The
findings from both of the investigations demonstrate the importance of
educational resources. The review of interventions and the expert committee
study both supported the notion that education is needed on all levels. A mass
media campaign is an easy way to reach a wide audience; it should incorporate
tools to help people achieve their goals. The previous conclusion to the
campaign “obesity affects us all” with the company’s website provides an
inadequate source of information. The company website will lead individuals to
health care providers and the goals for the company. A more effective message
would include something similar to “ we can work together to reach our goals”
with educational tools available on listed websites. This phrase sends the
message of hope and goal setting, which the intervention based study concluded
was important. Also by providing concrete educational tools the audience can
easily explore their options.
Conclusion
Instead
of criticizing the choices and appearance of overweight parents a statewide
media campaign should focus on motivating and supporting parents. A more
effective approach to reducing rising obesity rates in children as well as
adults would include a multi-layered commercial. First, the public stigma
attached to obesity would need to be reduced. Instead of focusing on overweight
parents and children the commercial could depict families of all shapes
interacting with one another, showing that being overweight does not make you a
bad or different person. Also on a behavioral level the commercial should
refrain from inducing psychological reactance in the audience. Based on
psychological reactance the commercial trying to tell parents exactly what to
do could cause them to continue their bad health habits and even further induce
these habits. The theory of planned behavior would be appropriate to use for
this media campaign. Parents need to feel confident in their ability to change
behaviors in order to change their own as well as their children’s and
surrounding family. Following this theory the commercial should include
positive, empowering messages for parents and show parents succeeding in
helping their children achieve health goals. Lastly, the current commercials do
not provide adequate resources to help the audience achieve the desired goals. The
lack of resources allows the audience to contemplate the behavior, but does not
help them to prepare to tackle the change of behavior and habits. Educational
resources are crucial to creating a successful mass media health campaign.
The ideal commercial from Blue
Cross/Blue Shield of Minnesota would include various types of people
participating in a health conscious activity such as cooking or a physical
game. Each person would demonstrate the activities in a motivational and
encouraging manner. The commercial would conclude with a positive phrase and
tools to further learn about working together to achieve health goals. Public
health campaigns run by organization such as Blue Cross/Blue Shield have the
ability to send a powerful message. It is crucial that organizations become
involved, in a helpful way, in the fight to end childhood and adult obesity.
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