On The
Issue of Obesity
Over the past two
decades, the number of obese and overweight individuals has increased
dramatically. More than a third of adults in the United States and
approximately 17 percent of children and adolescents under the age of 19 are
obese (1). The growing number of obese and overweight individuals in the United
States and around the world has become an incredibly pressing issue in the
sphere of public health. Extensive research has shown that being overweight or
obese can cause conditions such as cardiovascular disease, type II diabetes,
cancer and other major health complications (2,3). Future projections predict that
in fifteen years, 80 percent of the adults in the United States will be
overweight or obese (4).
The
Updated 5-A-Day Program: Fruits and Veggies-More Matters
With eye-opening
statistics and projections an overwhelming number of initiatives have been taken
in public health to promote healthy eating and living. Intake of fruits and
vegetables can potentially prevent chronic disease and aid in weight
management. But despite the number, the
actual effectiveness of these programs has fallen below expectations (5). One
such program that falls in this category is the “Fruits and Veggies-More
Matters” campaign.
Fruits and
Veggies-More Matters is an initiative that was started in March 2007 to reflect
the recommendations provided in the 2005 Dietary
Guidelines for Americans (6). Fruits and Veggies-More Matters replaced the
“5 A Day for Better Health” (5 A Day) campaign, which recommended individuals
to eat at least five fruits and vegetables everyday. The goal of replacing the 5
A Day approach was to re-brand the campaign’s message and persuade consumers to
eat more fruits and vegetables by eliciting emotional responses. With the new
campaign, individuals are encouraged to eat at least 7-13 servings (3½-6 ½ cups)
of fruits and vegetables a day (6). However, even with the increased
recommendations and the impact of social media and branding in mind, the effectiveness
of the Fruits and Veggies-More Matters approach has failed to make any progress
from its predecessor. In a study conducted two years after the program’s initial
release, over 50 percent of individuals reported that they did not know the
current recommendations for fruit and vegetable intake (6), let alone the name
of actual campaign.
Criticism
of Intervention 1: Overemphasis of Education and Lack of Progression of
Intended Behavior
From the start of the 5 A Day Program, awareness
of dietary recommendation for consuming at least 5 fruits and vegetables a day
went from 8 percent to 40 percent in a 10 year period (7,8). Although the awareness
of the dietary recommendation was clearly evident, the actual proportion of
individuals eating five fruits and vegetables everyday was virtually unchanged
(9). The results showed from 1994 to 2005 the change of prevalence of
consumption of fruits and vegetables per day went from 24.6 percent to 25.0
percent.
One of the major flaws of the 5 A Day
program, and what continues to be a problem with the Fruits and Veggies-More
Matters campaign, is that it puts too much emphasis on education. The message
of healthy eating is dispersed through a variety of different outlets such as
grocery stores, printed media and public schools to reach as many people in as
many influential spheres as possible (11).
By giving individuals nutritional information
and stressing the benefits of a healthier, more varied diet, public health contends
that individuals will naturally be more inclined to more fruits and vegetables.
However, this is an oversimplification and its basis of the belief stems from
the health belief model. The health
belief model is an individual-level model addresses a person’s perceptions of
the threat posed by a health problem, the benefits of avoiding the threat and
the factors influencing the decision to act (10). In the application of this
model, it is key to understand how the target population feels about health
problem (i.e. obesity, coronary heart disease, or etc.), whether they feel the
threat is serious and if they believe action can reduce the problem at a
reasonable cost.
It cannot be
assumed that simply providing education and cold, hard facts regarding
nutrition will lead to change in an individual’s behavior. Even when
individuals are given the facts and the figures regarding the prevalence of
obesity and overweight individuals and the risks associated with being
overweight or obese, many do not take these advisory messages as a perceived
threat to their health in the short term, and thus the benefit of eating
healthy will not be their first priority. It cannot be assumed that
individual’s are completely rational in their decisions and will forgo any
external factors that can influence the promotion of unhealthy behavior. If the
Fruits and Veggies-More Matters program continues to provide the same educational
approach similar to the 5 A Day Program, the success of nutritional education
from this program will be continue to fail. There must be a shift from the
education regarding benefit of the individual to benefit of the individual’s
family and community. Education focuses solely on the individual and his or her
action alone cannot be the only channel of intervention.
Criticism
of Intervention 2: The Messenger Fails to Relate to the Audience
In 2005, research was conducted to
develop Fruits and Veggies-More Matters. The individuals who put this campaign
together had the framework of social marketing in mind during the program’s
creation (7), but failed in specifying certain aspects of the campaign’s
branding strategy. Branding refers to names, symbols, designs and core values
that represent an idea or movement with the objective of creating a
relationship of trust between the product or service and its target population.
A major component
in the success of a brand is the messenger. The messenger is the conduit that
delivers the message from the organization to the target audience and is key in
attracting attention to the idea, personalizing and simplifying complex
concepts through modeling as well as reinforcing belief formation through reliable
and credible sources. The credibility of the messenger is key to have in order
to promote the initiative and communicate the idea of health-promotion
initiatives (16).
In a public
service announcement PSA titled “More Matters” the Tacoma Pierce County focuses
on the growing, buying and eating more fruits and vegetables and addresses
mothers and families as their target audience. The message itself has a good
foundation and specifies the particular population they want to address.
However, the messenger used to deliver this message is completely ineffective.
In the commercial, images of middle-aged women and/or families are shown
partaking in healthy choices while an adult male or female dressed up as a carrot,
apple and head of broccoli delivers the message. A giant talking vegetable talking
in a clearly staged environment is not effective in delivering the message of
healthy eating at all. There’s nothing relatable between mothers and families
to giant advise-giving vegetable people. The messenger of the campaign should
be one that is reliable and can be trusted to convey the core message. The real
success lies in communicating real, believable and uplifting human messages. Without
this key player, the message of eating healthy will not be taken in seriously
by the target audience and will fail to bring about change in behavior.
Criticism
of Intervention 3: Overly Dramatic Messages Lead to Opposite Reactant Effect
Another reason
that may have lead to the failure of this program lies in the theory of psychological reactance. This
theory explains how people become psychologically aroused and when their
freedom is threatened by incredibly persuasive messages. After seeing these
messages, a reactant behavior results in an attempt to restore the threatened
freedom, and is usually the exact opposite of that which was intended in the
original message (12).
All of the public
service announcements (PSA) provided by Fruits and Veggies-More Matters are
prime examples of overly dramatized messages that induce psychological
reactance. In a PSA titled “School Daze” a gloomy-toned adult voices over the
commercial and addresses how parents should talk to their kids about healthy food
choices. The voice-over is accompanied by video clips of three teenagers who
sneak out of school to eat food such as a significantly large pizza slices,
fries and nachos at a questionable-looking fast food shack. The mood quickly
changes and images of fresh fruits and vegetables are shown on the screen along
with positive and encouraging words to “eat at least 5-9 servings a day of colorful
fruits and vegetables.” The last words that the voice-over says are “Get
healthy, America” (13).
The way the PSA
was sequenced does not promote positive behaviors. Showing these three
teenagers sneaking out of their school portrays this group in a negative light
and assumes that teenagers are rebellious and will not listen to their elders.
If adults continue to hold this preconception, teenagers will not change their
behaviors. In fact, more teenagers will probably consider idea of sneaking out
and possibly get fast food as a result of watching this commercial. Thoughts
that may occur in a teenager’s mind after they have seen this PSA fall along
the line of “who has the right to tell me how to eat?” and may revert to eating
unhealthy, yet convenient foods once again. This psychological distress and
reactive response is caused by the threat upon the teenager’s freedom to choose
whatever what he or she wants to eat.
If the goal of the PSA was to promote healthy
eating habits among teenagers and their parents, a more dynamic approach must
be made in which a more positive message is elicited in a way that does not
offend individuals. A more practical and meaningful approach would be to show
both the parents and the teenagers together eating or preparing a meal together
as a family. The PSA would portray the
benefits of not just eating healthy and making good choices as an individual
but rather as a family. This approach would emphasize previously held beliefs
regarding family importance and reinforce these values in a way that is
beneficial to their dietary health.
The messages of
the Fruits and Veggie campaigns do not have to be so grim and focus on telling
people what they should do and how they should eat. If anything, the campaign
should emphasize ways to incorporate healthy eating messages in their everyday
lifestyle in more innovative and active methods.
One campaign that
did this approach very successfully was the VERB campaign. Center for Disease
Control and Prevention’s Youth Media Campaign created a branding strategy
called VERB that promoted physical activity among children aged 9-13 years old
(14). Instead of pushing the ideas of getting active through exclusively
educational methods, framers behind this campaign brand created an identity and
a positive outlook for the issue. With VERB, the organizations created what is
called an “aspirational brand”, which elicits high emotional desires of the
target population. The brand was not just a name; it represented a lifestyle
that inspired “tweens” to go out, to find new ways to be physically active and
to identify themselves as a “VERB kid.” Evaluation of the VERB brand showed
that there was an increased positive attitudes associated with physical
activity (14).
Fruits and
Veggie-More Matters should learn from this aspirational branding model. To be
able to find a way to incorporate the core values of the nutritional education
and package them in a way that makes the individual identify themselves
positively with will lead to major health improvements in the field of
nutrition.
Recommended
Advice for Program Improvements
Although the
Fruits and Veggies-More Matters campaign was designed to increase the promotion
of eating at least 7 to 13 fruits and vegetables everyday through the use of
social marketing strategies, the campaign falls short in its efficacy
especially in its foundation of having an effective frame. A frame is a method
of packaging and presenting an issue so that it conveys a particular message (18).
The foundation of the Fruits and Veggies campaign lies in an education frame
that promotes healthy choices. Although health is an important core value in
the eyes of the public and policy makers, there are other core values that a
more compelling and emotional effect on individuals (17).
A strong value
that the Fruits and Veggies-More Matters campaign can take advantage of is the
core value of family. Rather than simply educating the family and warning them
about issues and complications related to obesity and overweight, the idea of
the family preservation should be expressed. Catch phases such as “A family
that eats together stays together”, “Eat five a day with the fam” or
“Connecting with your kids, one meal at a time” (19) paired images such as
families cooking together and eating together can be used in this frame. This
framing strategy will in promote healthy eating using a positive and more
dynamic approach rather than simply educating families and scaring kids into
eating healthier foods.
A successful
frame is not complete without an effective brand messenger. Currently, PSA
messengers for more matters consist of wide range of spokespeople from
professionals in the field of nutrition to adults dressed up in vegetable
suits. But each messenger fails to meet the mark of ideal messenger criteria. Two
major target populations that the Fruits and Veggies campaign focuses on are
parents, particularly mothers, and children. Finding the ideal messengers is
key in persuading both populations.
Using celebrities
as messenger is one effective way of spreading awareness of a campaign.
Celebrities who are familiar faces to the public can endorse health messages
and greatly influence the effects of the message on the target population (20).
Effective uses of this strategy can be seen in the Let’s Move campaign, which
is spearheaded by First Lady Michelle Obama. Let’s Move is a campaign that
promotes of healthy eating and exercising to fight against childhood obesity. Obama
puts a face to the campaign and immediately makes a personal connection to the
target audience by portrayer herself as a mother who, like many mothers in
United States, is concerned with their children’s health. In an interview on
the NewsHour with Jim Lehrer, Obama said, “This issue [childhood obesity] is
critically important to the me for the health and success of our kids, and of
this nation.” (21)
Another useful
brand messenger could be peer counselors or group leaders in promoting the
recommendation to children or young adults. These individuals are respected and
trusted by their peers. This particular tactic was designed and used by the
5-4-3-2-1 Go! intervention. This campaign has a similar theme to the Let’s Move
campaign in that it also promotes healthy lifestyle choices for children and
their parents. The strategy behind the creation of the “5-4-3-2-1 Go! Teams” and
the team leaders was to engage individuals to embody the value of healthy
lifestyles through individuals such as high school sports stars and other
stellar student leaders from diverse ethnic backgrounds. The leaders of these
“Go! Teams” were aimed to serve as positive role models for younger children
and were “living mascots” who would build awareness for the 5-4-3-2-1! Go brand
(22).
The success of
these strategies can be explained through the social cognitive theory. This
model of social behavior is essentially the idea individuals learn from the
behavior of others (10). Using strong messengers that make the audience believe
that these role models (i.e. celebrities, group leaders and etc.) can relate
personally to them is a useful tactic in changing an individual’s behavior. The
program should affirm one’s already held beliefs from a source they can trust
and empathize with. This is vital for the success of the campaign.
Additionally if
the campaign reaches the right people in the community and uses them as
messengers, the results will be greatly beneficial to the campaign. If the
campaign reaches and persuades very influential people in the community, the
positive behavior elicited will spread to those in their social network and
branch out from there on. This phenomenon is explained by the social network
theory. This group-level model holds that people do not live isolated lives are
very much influenced by the social networks in which they are in, especially with
groups such as family, close friends, classmates and coworkers. Eating habits
is a behavior that is greatly influenced by the people we are around. A study
using data information from the Framingham Heart Study found that individuals
who were obese and those were thin, respectively, tend to cluster around the
their own groups (23). If the campaign could hone in and change the behavior of
an important or central individual in the obesity cluster, behavior can be
altered and spread among those in the group.
Conclusion
Previous dietary
campaign promoting consumption of at least five fruits and vegetables per day
increased awareness of the dietary recommendations by approximately 40 percent
within a ten-year span (7,8). But despite the rise in awareness the actual
behavior change of eating more healthy fruits and vegetables barely changed
(9). With the idea of social media and branding on their side, the makers of
the Fruits and Veggies-More Matters campaign hoped to provide a better idea and
increase healthy fruit consumption than their predecessor (7).
However, the
Fruits and Veggies-More Matters campaign and its basis in the health belief
model falls short in its approach and has a number of areas to work on before
real success can be made in its part. The campaign must shift away from the
health belief model and individual models of behavior and focus on framing
their issue in a manner that elicits positive emotional responses using family
and community values. By understanding and stressing these core values and affirming
prior beliefs among influential individuals in the community, the success of
Fruits and Veggies-More Matters may stand a chance in inducing behavior change
and improve upon the poor campaigns that preceded it.
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