By 1942, the American Medical
Association was already aware of the negative health effects of sugary soft
drinks, and warned consumers to limit their intake of sugar (1). A recent
meta-analysis of 88 studies found a clear, consistent association between soft
drink consumption and body weight (2). In particular, in a longitudinal study
of over 90,000 women, those who consumed at least one soft drink a day had over
twice the risk of developing type 2 diabetes compared to those who consumed
less than 1 serving a month (3). These findings are certainly no abstract
concern. Currently, 35.7% of American adults are considered obese, with an
obesity rate of 49.5% among non-Hispanic blacks (4). In adolescents ages 12-19,
obesity increased from 5% to 18% from 1963-65 to 2007-08, with especially large
increases among Mexican-American boys and non-Hispanic black girls (5). Given
these findings, it is no surprise that the Boston Public Health Commission
released a public health intervention called “Fatsmack” that focused on sugary
drinks, which was aimed at minority adolescents. Unfortunately, the
intervention fails to effectively utilize a group-level theory of health
behavior change, stigmatizes obesity, and uses an unconvincing health frame.
In fall of 2011, a series of brightly colored poster
advertisements appeared across the city of Boston, concentrated in public
transportation hubs. They starred four thin, minority adolescents drinking
various sugar-sweetened beverages labeled as “soda” and “sports drink.”
However, these adolescents are in the midst of dodging a gelatinous orange blob
about to hit them in the face, which is supposed to be a lump of fat. In some
of the advertisements, the portrayed teen has already been splashed by the fat
globules. All of the faces have expressions of fear, disgust, and shock. In
large text, the advertisement warns “Don’t get smacked by FAT,” followed by
smaller text that says “Calories from sugary drinks can cause obesity and Type
2 diabetes.” In addition, the website Fatsmack.org hosts several videos that
portray adolescents getting smacked, in slow-motion, by the orange blobs. Their
faces, shifting in frame to frame, reflect the horror and surprise of getting
“smacked by fat.” The intervention’s aim is to educate teens about how calories
from sugary drinks can result in weight gain by equating the calories from sugar
with fat – both precursors to obesity (6).
The associated website, Fatsmack.org, describes the
negative health effects of drinking sugar, and warns readers to “Be smart” and
not buy into the marketing by beverage companies. Website sections titled “You
are a Target” and “Marketing Tactics” give adolescents insight about the
in-depth market research conducted by food and beverage companies, describing
the audience being researched – the teens themselves –as like “a bug under a
microscope.” They also provide examples of the extensive reach of food and
beverage corporations, from billboards, to celebrity endorsements, to product
placements in popular media. This kind of perspective echoes the “truth” tobacco
cessation campaign, which was very effective in reducing percentages of youth
smoking in Florida (7). These materials emphasize not the health risks of
smoking or sugary drinks, but the duplicitous marketing of food corporations. The
Fatsmack website even offers tips about alternative healthy beverages in a
section of the website called “Do something.” In particular, water is cited as
an ideal alternative. Unfortunately,
none of these promising ideas were incorporated into the actual print or video
advertisements, the main focus of the intervention. Instead, they remain in the
background of the website (6).
Critique #1: Focuses on Individual as
Nexus of Change
The first major violation of the
campaign is that it relies on the assumption that an individual who gains
knowledge of the health risks of a behavior will necessarily change that behavior.
The campaign is in part based on an outdated model of human behavior: the
Health Belief Model (HBM). The HBM theorizes that behavior is based on six
components: perceived susceptibility, perceived severity, perceived benefits,
perceived barriers, cues to action, and self-efficacy (8). Fatsmack addresses
these points by portraying teenagers as the highly at-risk target population,
susceptible to the health consequences of obesity and type 2 diabetes. In a
very literal fashion, adolescents are warned that they will become fat if they
continue drinking sugary beverages. The desire for thinness is the perceived
benefit of abstaining from sugary drinks. The advertisement also assumes that
teens will have the self-efficacy to stop drinking sugary beverages by
themselves, and uses the threat of getting smacked by fat (becoming obese) as a
cue to action. Specific barriers to not drinking sugary beverages are not
addressed. Overall, this campaign relies on the assumption that if people know
the health risks of drinking sugary beverages, they will abstain, and secondly,
that health is important to teenagers. This assumption is flawed because there
is little evidence that increased knowledge leads to significant changes in health
behavior (9). Additionally, teens may be prone to the optimism bias with regard
to their health. Although they may learn that sugary drinks increase the risk
of obesity and type 2 diabetes in the overall population, they are not likely
to perceive these risks as applicable to themselves (10). Because the central
image of the advertisement is also so incongruous and unrealistic, and greatly
exaggerated for dramatic effect, it is easy for teenagers to dismiss the
concern of future health problems as equally exaggerated. Moreover, the models
in the ad are low-BMI individuals who in no way personify the stated health
risks—thus, the concerns seem even less likely, and an even more abstract
possibility of the future.
The HBM disregards the multitude of
factors that impact teens who are influenced by environmental and ecological
factors, social norms, and considerable levels of advertising and marketing. In
addition, the model – and advertisement – assumes it is equally easy for
everyone to just say no to sugary drinks, ignoring the obesogenic environment
of the targeted teens, and the inter-related factors that contribute to obesity
(11). The impetus is on the individual to change his or her own behavior – they
alone are responsible for their health. Unfortunately, the notion of personal
responsibility aligns perfectly with food corporations’ strategy of framing
obesity as an individual lifestyle problem (12). The advertising campaign
furthers the message of food corporations by emphasizing the individual as the
nexus of change.
Critique #2: Stigmatizes Obesity
The Fatsmack campaign also stigmatizes obesity, as its
central tenet is the idea of fat as gross, disruptive, and threatening. The
intervention relies on fear of obesity as its driving force. Stigmatizing
conditions are associated with a perceived sense of personal responsibility;
that is, conditions such as Alzheimer’s disease that are associated with random
chance tend to elicit pity and altruism from others, while diseases that are
associated with high levels of personal responsibility do not elicit such
sympathy (13). The prevailing public opinion and media regarding obesity
portray its etiology as a matter of personal responsibility and self-control,
which serve to justify the negative stereotypes and stigma that surround it,
despite scientific evidence about the importance of genetics, biology, and
social and environmental factors (14). However, evidence indicates that weight
stigma, and interventions that use weight stigma as a motivating factor, are
not successful. In fact, sometimes obese individuals may react to stigma by
engaging in even more negative unhealthy eating behaviors or lower levels of
physical inactivity (14).
At particular risk for the negative consequence of weight
stigma are overweight children. Overweight children who are victims of
weight-based teasing are more likely to engage in disordered eating or other
unhealthy weight control behaviors (16). Obese children are even at risk of
being stigmatized by adults by being rated as less favorable compared to their
normal-weight peers (17). The coping literature suggests that common coping
mechanisms for weight stigma include eating more food, or taking a stance on
refusing to diet, especially for those who have internalized the stigma (18). Finally,
given the increasing stigma against obese children from the years 1961-2001,
one would expect prevalence of childhood obesity to decrease if weight stigma
were an effective deterrent (19). Of course, as alluded to in the introduction,
prevalence has actually been increasing, especially among Hispanic and black
populations (5).
Thus, a campaign centered on weight stigma is likely to be
actively harmful to obese children. The Fatsmack campaign’s tagline “Don’t get
smacked by FAT” is intended as humorous. However, who exactly is the targeted
audience? If an obese teenager sees the advertisement, they can easily see
themselves construed as not the thin teenager, but the enemy – the gross, fatty,
blob. In fact, the tagline is so ambiguous that taken out of the context of a
public health campaign, it could be the cruel echo of a schoolyard taunt. If
the intended audience is a normal-BMI or underweight teenager, the
advertisement merely promotes already internalized weight stigma. Neither
target audience would likely have a positive reaction to such a tactless
campaign.
Critique #3: Ineffective Use of a Personal
Health Frame
Framing theory
suggests there are a number of facets to an effective frame. The most relevant
of these components are the ideas of a core position, catch phrase, visual
image, and appeal to principle (20). The Fatsmack campaign has a memorable
image – getting smacked by fat – as well as the catch phrase of “Don’t get
smacked by FAT!” Its core position is
that consumption of sugary drinks can lead to obesity and type 2 diabetes.
Correspondingly, the appeal to principle in this campaign is an appeal to
personal health. This links the core position to a widely valued ideal.
Unfortunately, the idea of personal health is actually not a particularly
valued ideal, and thus does not serve as a powerful, effective, or convincing
frame.
Initially, the notion of personal health might seem like
an obvious choice for a public health campaign. It educates and informs the
audience, and offers a clear message and instructions. Yet the goal of framing
an issue is not necessarily to assemble the most rational or logical argument –
frames are used to encourage national debate, become part of the political
process, and eventually, change policy. To do this effectively they must
capture the public imagination (21). The most important part of a frame is the
core value an organization’s message presents. For instance, tobacco companies
have historically been very successful in deflecting attention from scientific
arguments against tobacco to a debate about personal liberty and individual
autonomy. Within American culture and myth, freedom is among the most powerful
of core values – potentially much more important than health (21).
Not only is the Fatsmack campaign’s
core value of health potentially weak, the manner in which it is presented is
also ineffective. The audience is urged to not
drink sugary beverages in order to not
get smacked by fat or to grow obese. The focus is on preventing a problem that
doesn’t even exist yet. The ad is driven not by an aspiration towards a
positive state of health, but by a fear of obesity. Any kind of alternative to
sugary drinks, such as water, is not mentioned at all. Moreover, considering
the target audience, a health frame is an especially ineffective focus given
their relative youth.
More specifically, the intervention exemplifies many of
the early failures of anti-tobacco campaigns aimed at youth. As described by Hicks
in a discussion of Florida’s “truth” campaign, the focus groups with youth had
one consensus regarding anti-tobacco social marketing: “… they did not want to
be told what to do. … If we were to be successful, ‘truth’ could not preach.
‘Truth’ needed a message other than ‘don’t’.” (7) The Fatsmack campaign
violates this value precisely and laughably – its tagline begins with the word
“don’t.” The distaste teenagers feel towards being told what to do further
emphasizes the importance of core values like freedom and autonomy, which, when
violated, inspire distrust.
Proposed Intervention: Truth, Redux
The Fatsmack
advertising campaign’s target is fat. Hidden on its website, however, are the
promising beginnings of a possible alternative intervention that focuses on a
corporate target – the food and beverage industry. The parallels between Big
Tobacco and Big Food have been discussed by many (12). This intervention
attempts to utilize similar techniques as the “truth” campaign to inspire
outrage. The intervention will consist of a series of brief videos, which
target the food and beverage industry’s hypocritical practices. Although the
specific targets of the Fatsmack campaign are sugary drinks, in truth many of
these beverage companies are owned by corporations that oversee multiple food
and snacking divisions. For example, PepsiCo, Inc. owns Aquafina, Doritos,
Gatorade, and Frito Lay. Kraft owns Oreo, Nabisco, Tang, and Kool-Aid.
Coca-Cola owns Dasani, Fresca, Powerade, and Sprite (22). These corporations,
along with their respective trade associations and front groups, have built a
carefully constructed series of scripts that shape public opinion. They focus
on the role of personal responsibility, attack the government for encroaching
on personal freedom, and pretend to be engaged in the public interest. This
intervention aims to unveil that agenda (12).
One clip will begin with idyllic
images of children in school and on the playgrounds, then cut to dismal-looking
school lunches and a vast array of sodas and sports drinks that overshadow some
cartons of milk. Text will appear asking who or what would be more interested
in profits than adding even the simplest of food reform controls, such as removing
vending machines from elementary schools. Then, a long list of beverage company
names would scroll down the screen, along with the amount of money they have
spent blocking specific bills that regulate nutrition standards in schools (23).
Another clip will focus on the
restaurant industry by portraying a series of lavish chain restaurant meals
with huge portions. Then, a voiceover will directly quote Steven Anderson,
president of the National Restaurant Association, who stated “Just because we
have electricity doesn’t mean you have to electrocute yourself,” then flash his
name and affiliation on the screen (12). The clip will then ask about how the
restaurant industry must feel about you, the consumer. Then cut to an image of
a small child near a power outlet, with his hand hovering over the socket.
Taken from the real-life experiences
of Todd Putman, a former employee of Coca-Cola, another video would dramatize
his experience in trying to expand Coca-Cola’s branch internationally. He has
described the company’s marketing division’s main question as “How can we drive
more ounces into more bodies more often?”
This video would have a man standing in for Todd, clearly marked as an
employee of Coca-Cola, landing among the destitute favelas of Brazil, which are crowded urban slums that are the next
area of expansion for Coca-Cola. He would then look around, take a deep breath,
and start trying to sell 6.7-ounce bottles of Coke for 20 cents by going door
to door. This process would be undercut with images of poverty and lack of food
security, with a voiceover once again intoning the marketing slogan about more
ounces into more bodies (24).
Finally, one video could entail a group of businessmen who
appear to be visiting a school on a charity trip or volunteer organization,
with images of them reading and laughing with children. Then, segue to a
cafeteria scene where the camera would pan over the many snacks and drinks
available for purchase from the viewpoint of the businessperson. As the
businessperson’s perspective shifts to watching the schoolchildren sitting down
for lunch, various dollar signs and amounts pop up in bubbles over the
children’s heads. Some are not worth very much, while others – perhaps better
dressed or particularly demanding – are worth much more. When the camera is
focused on the children with high purchasing power, the businessman will smile
with satisfaction.
These clips, brief as they are, would create a link in the
public’s imagination between food and beverage corporations and their greed,
duplicity, and contempt for the consumer. The first and last videos would
emphasize corporations’ particular disregard for the health of young children.
The second portrays the consumer as foolish and unable to control himself, and
moreover, implicitly reflects the restaurant industry spokesperson’s
conceptualization of calorie-laden meals as electricity with the power to
electrocute someone—a genuinely dangerous product. With the third commercial,
Coco-Cola’s global power and reach are emphasized, along with its narrow
concern for profit margins despite humanitarian objections. The last component
of these ads would be a closing tagline that cements the enemy as “Big
Food.” One example could be “Big Food:
they’re your biggest fan.” This message
would emphasize both the profit-driven motivations of food corporations, as
well as add an allusive nod to their authoritarian, powerful methods of
dissemination.
Defense #1: Utilizes a Group-Level Theory
of Behavior Change
Because obesity
is a disease with a complex etiology that incorporates not just individual
biological, genetic, and lifestyle factors, but even societal and evolutionary
factors, an individual-level theory of change provides an unsuitable basis for
intervention (25). For example, several components of the HBM presume that
human behavior is completely rational in terms of assessing health risk. The
proposed intervention uses a group-level theory of behavior change to avoid discussion
of the negative health risks of sugary beverages altogether. Instead, it uses
an emotional appeal to focus on the negative practices of the food and beverage
industry. It shifts the focus away from an individual’s personal responsibility
to improve their health, to the large role food and beverage corporations have
in marketing unhealthy products.
By shedding light on the
unscrupulous practices of these corporations, especially with regard to
marketing sugary beverages or regulating nutrition standards in schools, this
intervention can increase public awareness by using Agenda Setting Theory. This
theory discusses how the media can set the agenda for public discussion by
bringing specific issues to light. In particular, within the context of advertising
theory, the emphasis is not on persuading consumers to think of products in a
certain way, but to simply focus their attention on a set of values or brands.
Thus, a link between media prominence and personal awareness emerges (26).
In recent decades, there has already been increased
awareness of food industry issues (e.g., the books Fast Food Nation, The
Omnivore’s Dilemma; films Super Size
Me and Food, Inc.). These have
raised awareness about factory farming and the environmental and health
consequences of food corporations. Yet there has not been a similar level of
outrage or knowledge aimed at the specific practices of food and beverage
companies, especially in their marketing towards children and teens. This intervention
can function like a series of advertisements that bring the hypocrisy of food
and beverage corporations into the public consciousness.
Defense
#2: Reduces Weight Stigma by Blaming Food and Beverage Corporations
The Fatsmack
campaign stigmatizes obesity, which is an ineffective tactic in reducing the
BMI of the target audience, and which is also associated with negative health
consequences (15). The proposed intervention utilizes Weiner’s attributional
theory of achievement motivation and emotion to educate the public about the
multiple factors that may impact obesity, such as the marketing techniques of
the food and beverage companies. This reduces the amount of personal
responsibility people feel is associated with obesity, by shifting some of the
responsibility onto corporate entities and environmental factors. If obesity is
perceived to be more similar to other kinds of illnesses such as cancer, which
are regarded as not in one’s control, this could lead to a reduction in weight
stigma (13).
In addition, because the campaign is
not focused on health, obesity, or fat in any way, high-BMI adolescents and
individuals would not feel as if they were being specifically targeted. This
might avoid some of the possible negative health consequences that are a result
of weight stigma or teasing. Instead, food and beverage companies would become
the stigmatized entities, much like how tobacco companies are now viewed as
malicious corporations (12). This could actually be an effective deterrent in
reducing the sales of these corporations’ associated products.
Defense #3: Empowers Audience Through a
Core Value of Freedom
Like the tobacco
cessation “truth” campaign, this intervention will aim to tell youth “the
facts” and then leave them “to make their own educated decision” (7). In framing theory, core values of freedom and
autonomy are among the most powerful and effective values to use, especially to
a young, rebellious American audience (21). By showing the audience images of
food corporations as powerful, sinister, and profit-driven, and prone to
manipulation of those with less agency (such as children and inhabitants of
global slums), they will react with a sense of betrayal and anger.
In particular, this intervention could induce psychological
reactance in the audience, when individuals feel their freedom of choice is
being taken away (27). In this case, they may feel manipulated by the food and
beverage industry. They may feel like the industry regards them as merely
consumers to be deceived, or pockets to be plundered. Consumers will look for a
way out of the corporate stranglehold on the food and beverage industry by
choosing alternative products for consumption.
Conclusion
The Fatsmack
campaign exemplifies the various well-intentioned flaws of a typical public
health campaign. It emphasizes health, encourages individuals to take on
personal responsibility, yet fails in understanding its target audience. It may
even result in some negative health consequences for obese individuals who feel
stigmatized by its message. The proposed intervention addresses these flaws by
using a group-level model that takes advantage of agenda setting theory. The
intervention also shifts the frame into one that targets the food and beverage
industry, and their hypocrisy towards consumers, instead of a health-focused
frame. Finally, it will empower the audience by providing a sense of freedom
and autonomy that allows them to escape from the omnipresent reach of the
powerful food and beverage corporations. By choosing to recognize these
companies as malicious and purely profit-driven, animus towards obese
individuals may shift towards the environmental factors that contribute to
their obesity. In viewing Big Food as the 21st-century equivalent of
Big Tobacco, we can learn from the strategies and mistakes of the past to
change current public opinion and policy.
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