It’s Time to Stop the Childhood Obesity Epidemic: Flaws of the UK’s Change4Life Campaign Overcome by the Activ8 Campaign – Molly Vaughan
Across the world, there has been an explosive
increase in lifestyle-related diseases resulting in premature mortality and
chronic morbidity. In the U.S., three of
the top ten killers are cardiovascular disease, diabetes, and stroke(1); while
there is a genetic component to these diseases, lifestyle and obesity play a
major role as well. Diet, smoking,
sedentary lifestyles, and increased alcohol consumption are the most common behaviors
that lead to chronic disease and poor health(2).
Despite public health initiatives to
decrease these unhealthy behaviors, people continue to be unhealthy(3). In the UK, 23% of adults consume more alcohol
than is recommended and 60% do not reach the recommended physical activity
guidelines(2). Adults’ unhealthy
behaviors are affecting our country’s children as well. Childhood obesity has become an epidemic, due
to its presence in wide age ranges, socioeconomic groups, and various ethnic
groups. In the U.S., the overweight and
obesity rates have increased from 2.3 to 3.3 times over the last 25 years; in
England, the rates have climbed from 2.0 to 2.8 in only a decade(4). These children are unfairly being set up for
a lifetime of chronic illness, stigma, and even pain, as with increased obesity
comes a number of co-morbities, such as diabetes, high blood pressure, chronic
pain, to name a few.
The issue of childhood obesity has
been far from ignored by Public Health advocates. A number of campaigns have been enacted over
the past 10-15 years, with varying levels of success. These range from changes at smaller scales,
such as decreasing soda machines in schools (5), to larger multi-component
programs that address nutrition, physical activity and other factors, such as
First Lady, Michelle Obama’s “Let’s Move!” campaign (6).
With the UK
being fourth in the world in terms of obesity and with 61% of adults and 28% of
children aged 2-10 overweight or obese, the British government launched the
Change4Life Campaign in 2009 as the social marketing companion to the larger Healthy Lives, Healthy People campaign. The Change4Life campaign was initially created
to target parents and children ages 5-11 who were at high risk of obesity. With a budget of 14 million pounds for the
2011/2012 year alone, it is a multi-component marketing campaign intended to,
by 2020, create a sustained decrease in excess weight amongst children and
adults(2).
The Change4Life: Eat Well. Move More. Live Longer
campaign not only has a multitude of information on their website regarding
physical activity recommendations, health recipes, and information for parents
and families, but also has formed partnerships with businesses and neighborhood
communities(2). There have been a large
number of commercials created by the brand, discussing how unhealthy behaviors
(inactivity, poor nutrition, or alcohol overconsumption) can lead to poor
health(7). It has branches that have
been formed by other groups, such as Cook4Life, Walk4Life, and Start4Life that
are associated with the campaign.
Additionally, it has hundreds of thousands of members and has spread to
other countries, such as Ireland(2). Studies on Change4Life have shown that it has
good brand recognition and has a positive message without stigmatizing
overweight or obese individuals(2,8).
Critique Argument I
While there are some good initiatives within the
Change4Life campaign, it is flawed in the use of an individual-based behavior
change model, the Transtheoretical model.
In the most recent Change4Life marketing strategy document, the authors
discuss how the campaign is loosely based on the Transtheoretical model of
behavior change(2). This model
encompasses the idea that individuals move through six different stages
(pre-contemplation, contemplation, preparation, action, and maintenance) to
overcome a behavior, with each stage requiring different interventions in order
to move the person to the next consecutive stage(9). As individuals move toward the later stages
of Action and Maintenance, they develop self-efficacy in overcoming a
behavior(10). Individuals may regress
from one stage to the previous or become “stuck” at any phase along the
way. The Transtheoretical model was
developed and is used often to treat addiction, such as smoking or alcoholism.
One of the Change4Life campaign’s goals is to move
people from either pre-contemplation or contemplation through the phases until
they reach the maintenance phase, for both behaviors of health eating and
physical activity. They created 4 stages
(Motivate, Activate, Monitor, and Recognize) based on the original six
Transtheoretical model’s stages(2,10), however they do not provide specific
interventions for people in the different stages of the model or enable people
to figure out in what stage they are currently(2).
The flaw with using a social cognition model, like
the Transtheoretical model, for reducing obesity is that these models are
focused on the individual and do not always consider the social context or
environmental barriers to behavior change.
Obesity is a challenging construct, influenced not only by individual
behaviors, but also social stigma, socioeconomic status, geographic location,
school programs, and much more.
Additionally, studies have shown that social cognition models are not as
effective as theories of group behavior change, however the public health world
continues to use them in ineffective campaigns(11). The Change4Life campaign tries to influence
individuals or individual families, assuming (like social cognition models)
that if they are given the correct information they will be able to move
through the stages of behavior change.
The Change4Life Marketing Strategy states that it “will provide
information, products and tools for individuals and families who are seeking to
improve their lifestyles(2).” However, a
person’s beliefs/education about a subject do not necessarily dictate their
behavior. Newer models of behavior
change focus on changing the behavior first (such as unhealthy eating) and then
a change in beliefs will follow(12,13).
Critique Argument II
Whereas the developers of the
Change4Life marketing campaign sought to utilize current social marketing
theories, they failed to incorporate a core value other than health(2). The backbone of a strong advertising campaign
is to 1)provide a promise (Change4Life’s promise can be summed up in their
subtitle: Eat well. Move more. Live longer)(2), and 2)support the promise with
stories, images, and music, and 3) utilize strong core values(14,15). The support for the Change4Life’s
advertisements is adequate, as they use characters (created by the claymakers
of the popular British Wallace & Gromit series) that are familiar to
British audiences, but the information conveyed in the stories are not
memorable for their target audience as they are based on health. For example, one of their television ads
bombards consumers with information about inactivity leading to clogged
arteries(7).
Advertising and Marketing theories insist that what
audiences want to see in a brand or campaign are strong core values with which
they identify. These might be freedom,
control, or family, unlike Change4Life’s core value of health, which is less
important to most people. The core value
of health has been used in previous public health campaigns and has failed miserably;
one example is the ineffective Surgeon General’s warning on cigarette boxes
that “Smoking kills(16).” Another example is the $1 billion National
Youth Anti-Drug Media Campaign, which was paired with organizations and equally
widespread, similar to the Change4Life campaign. The National Youth Anti-Drug Media campaign
used similar marketing strategies of health, in this case discussing the
negative side effects of drug use. Both
Change4Life and the National Youth Anti-Drug Media campaigns were able to have
high exposure levels (due to high levels
of funding), but because of their use of health as their core value, they have
not been able to elicit behavior change in their target audiences(17,18) It is clear that powerful campaigns, such as
Make Your Move: Nakanjani!(19), Live Up campaign(20), or Kind bars(21), have
utilized more powerful promises, support, and core messages than health, which
have enabled their success.
Not only does Change4Life use a flawed social marketing strategy
through the use of health as a core value, but also by having an unclear target
audience. Looking at other successful
youth campaigns, such as the anti-tobacco Truth campaign, it is clear that a
media campaign is strongest when they have a specific audience they want to
impact(14). This allows for detailed
research as to what core value will be most memorable and the most effective
methods to affect change in the population(16).
Change4Life targets both young children, their parents, and middle-aged
adults in their advertisements. In a
6-month, cluster-randomized trial of 1,419 families with children ages 5-11
recruited from across England, Croker et al. found that parents in the
intervention group that received the Change4Life’s Family Information packet
(marketing materials) were not engaged in the program and felt that it was for
their children. Croker et al. stated, “Given
that ultimately parents are being asked to implement change, being more
explicit about this in the campaign messages, and measuring proximal targets of
parental behaviour change, may increase the likelihood of success(17).”
Change4Life’s lack of a clear target audience may have led to the
conclusions by parents with higher socioeconomic status that the information
packs were “patronizing,” with lower SES families giving higher ratings overall
for the packets. Surprisingly, the
intervention group rated the importance of physical activity significantly lower at six months, as compared to the
control group; there was no significant difference between control and
intervention groups regarding levels of TV watching or diet at 6
months(17). The intervention group might
have been undergoing psychological reactance, which commonly occurs if a
campaign tells its audience what they should do (as in eat 5 fruits and
vegetables per day, which is one behavior Change4Life promotes)(2). People inherently like control, and once they
feel that it is taken away, they might do the exact opposite behavior that is
wanted, as in not eat healthy foods or avoid physical activity(22). Parents were not convinced they needed to
change their child’s diet by the information presented in the Family Packet,
illustrating that the individual-level targeting information by the Family Information
Packet, one component of the Change4Life’s Marketing campaign, was unsuccessful
in promoting behavior change(17).
Critique Argument III
Another flaw of the Change4Life Marketing strategy
is that it assumes that people act rationally.
This is illustrated through their use of health as a core value and the
use of an individual behavior model (Transtheoretical Model) that assumes that
people act logically and rationally.
These models assume that once a person is educated on risky health
behaviors, and creates an intention, the corresponding health behavior will
follow. However, past public health
campaigns that have used this approach have had poor results. For example, the National Youth Anti-Drug
Media campaign uses health as their core value and bombards its target audience
with health information; however, it failed to decreased marijuana usage among
teens(18). It is ineffective for people
to have the health information (consider the large amount of education smokers
receive about tobacco’s negative health effects and yet still do not quit); as
Menashe et al. concluded, “Political battles are seldom won only on the
elegance of logic, or by those who can best assemble rational arguments(16).”
There is mounting evidence that people do not act
rationally and instead are swayed by social influence. An individual’s behavior can be completely
unpredictable, depending on the circumstances or their mood. Alternative theories of behavior change pose
that change more often happens at the group vs. the individual level. In other words, take groups of people and you
may be able to elicit behavior change, due to the power of social
influence. Edward Bernays, the father of
the Theory of Mass Persuasion, said it best: “It’s easier to change the minds
of millions than the mind of an individual.” He believed that people are often affected by
those before them and the theory of group behavioral change can be more
powerful than individual behavioral change models(12).
The power of those around us can be huge in
changing our behaviors(13). In fact,
friends of children who are overweight or obese tend to gain weight
themselves. Childhood obesity is quickly
becoming a social norm in our society.
Despite the fact that Change4Life’s Marketing strategy discusses
alternative theories of behavioral change, it does not seem to be utilizing
these principles in the campaign effectively and is wary of fully adopting
alternative social marketing strategies(2).
However, it is imperative for it to embrace group behavioral change if
it wishes to make a difference in childhood obesity. As dictated by the Diffusion of Innovations
Theory, small changes or small social nudges from early adopters of physical
activity and health eating to another, can lead to a tipping point, at which
point the targeted behavior (in this case, healthy weight in children) may
become a social norm(12,13).
Overview of Proposed Intervention: The Activ8
Campaign
The Activ8 campaign will be a
multi-faceted campaign that will strive to decrease childhood obesity by
motivating the teenage population (ages 12-20) to take action against unhealthy
food companies and to make a change in their daily lives. The “8” portion of the Activ8 campaign title
is due to the fact that there will be 8 teenagers from different backgrounds
and ethnicities who will generate ideas for the campaign to target healthier
eating and increasing physical activity.
These 8 teens will work with their communities and their teen peers to
help determine the backbone of the campaign(14). They will also serve as the
spokespeople for the campaign, so that the target audience feels a sense of
familiarity with Activ8, and to minimize psychological reactance(22). The Activ8 logo will feature the core 8
jumping into the air against a brick backdrop; the logo will emphasize the core
8’s energy, enthusiasm, and unity.
The Activ8 campaign will incorporate
effective ideas from other obesity campaigns, such as Move It! by First Lady,
Michelle Obama, EmpowerME, and the Change4Life campaigns(6,2,23). Due to the teenage target population, the
core values behind the campaign will be control and independence. Led by the 8 core teenagers and members, the
campaign will promote youth activism in their communities and empowerment.
Defense of Intervention, Section I
Unlike the Change4Life campaign, the
Activ8 campaign will incorporate theories of mass persuasion, and will not be
based on individual behavior change.
Group behavior change has been shown in the literature to be more
effective than individual behavior change(11). Instead of attempting to change each
individual person’s beliefs, the Theory of Mass Persuasion asserts that large
groups of people can be influenced at once.
Starting with the core 8 teenagers, the Activ8 campaign will grow by
each of the original members reaching out to groups in their community and
“nudging” them to join the movement, in addition to advertising
techniques(12).
Advertising and marketing theory will be strong
components of Activ8, the theories of which will be discussed in more detail in
the next section. There will be a
strong social media component, such as Facebook and Twitter, which will aid in
reaching large members of the teenage community. Facebook and other social networking sites
will allow followers of the Activ8 campaign to provide feedback and have an
ongoing dialogue with the core 8. It
will also promote friendships to be made amongst members, as seen in the
Change4Life campaign(2).
Additionally, community events will be planned that
are focused around physical activity or healthy eating (although they will not
be advertised that way); these may include planning a school or community
garden or an Activ8 walkathon (with live performances every mile by popular
singers in the teen world). The website,
in addition to information about the movement, will also have an “I’m Bored”
tab, under which will be posted different physical activities for teens to do
with their friends, such as planning a flashmob (instructions by Beyonce, or
another known celebrity), an Activ8 wheel (based off of the Change4Life’s “Fun
Generator”) with ideas such as hula hooping contests or relay races(2). Teens will be able to post pictures of
themselves participating in any of the events and “tag” photos of their
friends, like on Facebook, in order to “nudge” others to get involved(12). There will be an Activ8! tab on the website
that will have local deals for joining sports classes, such as boxing or
cycling, or workout tips from Olympic athletes or celebrities. Another tab will have downloadable discounts
on healthy foods that teens like and healthy recipes.
In order to make change on a larger scale, the
Activ8 campaign will partner with schools and local businesses to help make
activities and healthier foods affordable, much like Change4Life and Let’s
Move!(2,6) School food constitutes 51%
of daily energy intake for low-income students, so this is an important area
where Activ8 can have an impact on teen nutrition. Schools can also work to incorporate more
physical activity into the school day, through walking group competitions among
grade levels or more physical activity-based learning(24).
The initiatives set forth by the
Activ8 campaign will help to change teen’s physical activity levels and eating
practices through group and community activities that are engaging for the
teenage population. As they start to
feel more healthy and energized, their beliefs about healthy eating and
physical activity will start to change.
This is much more effective than the reverse, or trying to force facts
on teens about healthy eating/physical activity to try to change their
behaviors(12,13).
Defense of Intervention, Section
II
The most important component of the Activ8 campaign
is that its marketing and advertising techniques will not include the core
value of health, or bombard its audience with health facts, like the
Change4Life campaign. Also, Activ8 will
have a more defined target audience of teenagers, aged 12-20(2). It will follow the guidelines of Advertising
theory, with a promise of empowerment by rebelling against fast food companies,
which are controlling their generation.
This promise will be framed using core values of control and
independence, both that are strong for the teenage population. Support for the promise will come directly
from the 8 core teens themselves and the research they have done amongst teens;
it will include powerful music, images, and stories(14,26).
As mentioned earlier, there will be no mention of
the word obesity or health(16) in the Activ8 marketing, nor will it preach to
teens(14). Like the Truth campaign,
Activ8 will work with teen populations to determine what it is they want, in
order to have a more successful advertising and marketing campaign(14). As Keven Hogan describes in his book, Covert Persuasion, changing beliefs
about obesity through framing and by using the core values that resonate with
the teen generation will help to reinforce the ideas that eating well and
taking part in physical activity aligns with their beliefs(25,16). Hence, instead of trying to change teens by
educating them on healthy habits, the Activ8 campaign will emulate their core
values (control and independence) throughout its marketing strategy.
The media will be a powerful modeling tool for the
Activ8 campaign and will help to combat obesity amongst teens(26). It will not only highlight events that are
taking place with the campaign, but the core 8 members will stage press
releases for events during which they rebel against fast food companies. This rebellion against sugar and fast food
companies will be a major portion of the advertising and marketing for
Activ8. Like the Truth campaign, Activ8
hopes to reveal what the fast food companies aren’t telling us and how they are
slowly killing us (such as how their food is processed, inhumane animal
practices, and how they get us addicted)(14).
The core 8 Activ8 members and others will film an ad (similar to the
Truth campaign) in which they stack body bags in front of major fast food
companies; each body bag will have a disease linked to obesity written on it,
such as “diabetes,” “heart attack,” or “stroke.” In the ad, people nearby will start to notice
and will be shown putting on an Activ8 shirt and helping move the body bags,
with the Activ8 theme song playing in the background.
Another Activ8 commercial idea would be to compare
fast food prices to homemade food prices to show that families can afford to
eat healthier food, at lower costs. This
might be done with teens performing a flashmob with a celebrity and chanting
their findings in the background. A
final ad idea would be to have the core 8 members of Activ8 stuck between many
fast food or dessert restaurants, scrambling to find a way out. Once they do, they start running as fast as
they can, (with their frowns turning into smiles as they feel free) until they
reach a community garden with fresh food, or a farm – and help the group to
make a wholesome meal together (only teenagers will be in the video). These are just a few of the ideas that might
help to promote physical activity and healthy eating using the core values that
are strong for teens: independence & control.
By working alongside teens in their
communities and promoting the idea that the Activ8 campaign is run by teens
only, there will be less of a chance for psychological reactance. The anti-tobacco TRUTH campaign utilized
similar strategies and had very good success, along with their effective
marketing campaign(14). The most
important component of Activ8 advertising is that teens will not feel bombarded
with what they should and should not do – even from other teens
themselves. By having the core 8 teens
be visible in the advertising and on the website (with their 8 individual bios
posted), as well as opportunities for other teens to post photos from events,
there will be a sense of familiarity established, which, as Communications
Theory describes, can increase influence and effectiveness of the
campaign(26). Additionally, new
advertising ideas brought forward will be pilot-tested on diverse groups of
teenagers, asking if it embodies the core values; for example, questions might
be: “does this commercial make you feel like you are in control?” or “did this
message try to make a decision for you?(27)”
In addition to gaining an understanding for the explicitness and
familiarity felt by the target audience, this research will help decrease
psychological reactance. Psychological
reactance is a theory that when people are told directly what to do, they tend
to do the exact opposite(22). As a
result, it is very important to reduce the potential for psychological
reactance in a campaign.
Defense of Intervention, Section III
Unlike the Change4Life campaign, the
Activ8 campaign embraces the notion that people do not act rationally. In order to make a difference, particularly
among teenagers, social norms about unhealthy eating and physical activity are
going to have to change. This is no
small feat. Social influence can be
incredibly powerful, not to mention peer pressure amongst teenagers. In the book, Nudge, the author discusses how “obesity is contagious. If your best friends get fat, your risk of
gaining weight goes up(12).” Compared to
20 years ago, being overweight today has become the social norm.
However, Activ8 aims to take
advantage of the power of mass persuasion and social influence by building a
group of highly influential teens (beginning with the core 8) backed by a
powerful brand & logo, celebrity support, as well as an effective
advertising and marketing campaign. As
Activ8 continues to grow through strong initiatives, it will eventually
hit a “tipping point” followed by an upward spike in the numbers of teens
getting involved, as described in the Diffusion of Innovations theory(13). Such strong initiatives include powerful
advertising revealing the truths about the sugar and fast food industries,
ideas on the website for community involvement and physical activity with
friends, healthy recipes and downloadable healthy food discounts from
businesses, as well as ways for teens to become involved and recognized for
their work through social media outlets.
Additionally, teens will feel empowered by starting their own community
garden, designing a flashmob with friends, or working to create an Activ8
walkathon(2). As with the Social
Expectations theory, the media’s involvement in portraying what large numbers
of teens are doing as part of Activ8 will inspire teen audiences to be more
active in their communities and become part of the Activ8 movement. The Activ8 campaign’s numerous powerful
methods will ensure that it is successful in changing social norms and beliefs
about obesity and physical activity among teens(26).
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Labels: Adolescent Health, Diabetes, Green, Health Communication, Nutrition, Obesity, Physical Activity
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