Sunday, December 16, 2012

Sugarcoating Childhood Obesity: The Shortcomings of Georgia’s Not So Sweet Strong4Life Advertising Campaign – Jessica Gottsegen

Childhood obesity is a growing health issue in the United States that has more than tripled in prevalence since 1980 and today, an estimated 17% of all children and adolescents between the ages of 2 and 19 are overweight or obese (1). The growing prevalence in childhood obesity is predicted to have an even greater burden on the health care system if trends continue. Long-term health outcomes associated with childhood obesity include, greater risk of obesity in adulthood and an increased likelihood of developing diseases associated with being overweight or obese, such as high blood pressure, diabetes, and heart disease (1). A report released by Trust for America's Health and the Robert Wood Johnson Foundation in September 2012 projected that if trends continue at the current rate, the number of new cases of type 2 diabetes, coronary heart disease and stroke, hypertension, and arthritis would increase ten times by 2020 and the medical costs for treating obesity-related diseases would increase by as much as $66 billion annually (2).
Due to the significant burden obesity places on both health outcomes and health care costs, effective national and state-level public health campaigns are necessary to address the growing obesity epidemic. In 2011, Children’s Healthcare of Atlanta launched Strong4Life, a statewide movement to raise awareness about the issue of childhood obesity. The movement was created in response to the growing crisis of childhood obesity in the state of Georgia where an estimated 40% of the state’s youth are overweight or obese (3). The Strong4Life movement created a comprehensive and interactive website designed to educate families about healthy lifestyle changes to improve the health of their children. The program focuses on four “simple” steps – eat right, be active, get support, have fun (3). Unfortunately, it is unlikely that the website itself has received much viewing time as a result of the movement’s very public ad campaign, which is often referred to by its tagline “Stop Sugarcoating It, Georgia.” The ad campaign uses black and white imagery of overweight youth asking questions such as, “Mom, why am I fat?” or printed with statements such as, “Warning: My fat may be funny to you but it’s killing me,” to bring attention to the serious problem of obesity (4). The ads, which are featured on posters, billboards, and in commercials, rely on gloomy imagery, harsh words, and statistics to raise awareness and promote the Strong4Life movement. According to Linda Matzigkeit, of Children’s Healthcare, the movement decided on an “arresting, abrupt campaign” after a hospital survey found that 50% of people did not identify childhood obesity as a problem and 75% of parents with overweight or obese children did not believe their children had weight issues. Due the extreme shock and shame features of the ads, they have been widely criticized. Based on Strong4Life’s misuse of the concepts of fundamental attribution error, self-efficacy, and advertising theory throughout its messaging, the campaign is ineffective and likely to have negative consequences on the movement’s long-term success.

Critique 1: Blaming the Individual and Ignoring Context
            As a result of the limited contextual information and sole focus on a single character, the Strong4Life ad campaign is designed in a way that leads its characters and the people they represent (overweight and obese children) more susceptible to victim blaming and bullying. Grim imagery of overweight children looking into the camera with statements such as, “I don’t like going to school because all the other kids pick on me, it hurts my feelings” is an example of the shame these ads have a tendency to promote (13). The ads are designed in a way that makes them particularly susceptible to blaming the behavior of the individual, a tendency known as the fundamental attribution error. The fundamental attribution error is a social psychology concept that describes the tendency of an observer to underestimate the impact of situational or contextual factors on another individual’s behavior, while overestimating the perceived internal factors of that individual (5). This mode of thinking is often reversed when an individual is explaining his or her own behavior. For example, a person may explain another person’s reason for being late to class is due to his or her laziness (an internal factor), but when explaining their own reason for being late, they are more likely to attribute it to an external force, such as bad traffic.
With a focus on shaming these advertisements are vulnerable to the concept of the fundamental attribution error. After viewing an ad, parents may be especially susceptible to this tendency in their thinking and are unlikely to acknowledge the environmental or social factors that attribute to obesity due to the absence of contextual information. Instead, parents are likely to see these ads and think, “well that child is lazy, they should just watch less television” (13). By emphasizing individual responsibility the ads fail to account for environmental or social factors such as, access to healthy food and safe outdoor space, which are resources that play an important role in one’s ability to engage in positive health behaviors (6). Research has shown that low income families are less likely to meet the recommended physical activity guidelines and more likely to have children who are overweight or obese (7). The ad campaigns focus on the individual, which promotes the idea of individualism, a value deeply engrained in western culture that often leads to victim blaming (8). Messaging that focuses solely on the image of an overweight individual appearing sad and frightened leads to placing blame on the child without accounting for the complex root causes of childhood obesity. Also, the ads reinforce the negative stigma associated with weight and open the door for an increase in bullying from their peers (6). The responses the Strong4Life campaign messages promote are in direct violation of the movement’s mission of educating and empowering families to “develop lifelong healthy habits” (3).

Critique 2: Messaging Severely Hinders Self-Efficacy
The Strong4Life ad campaign fails to take into account the concept of self efficacy and in fact uses messaging that promotes a negative reinforcement of health behaviors. Self-efficacy is a construct of Social Cognitive Theory. According to Social Cognitive Theory, individual behavior change is based on the dynamic interplay of personal, environmental, and behavior factors (9). Self-efficacy is a central element of this theory and is defined as “confidence in one’s ability to take action and overcome barriers” (10). Perceived self-efficacy greatly impacts behavior, including the adoption of new behaviors, maintenance of existing behaviors, and the amount of effort exerted on a specific task (9, 11). Research has demonstrated that high self-efficacy is a predictor of positive health-behavior changes and that individuals with high self-efficacy are more likely to make health behavior changes even when faced with obstacles (12). A 2005 study of 159 fifths graders examined the impact of self-efficacy in predicting four health behaviors associated with reducing childhood obesity – limiting television viewing time, increasing physical activity, fruit and vegetable consumption, and drinking water. The study found that self-efficacy was a predictor of both physical activity and fruit and vegetable consumption (12). Without strong self-efficacy, one’s personal belief that he or she can overcome barriers and successfully accomplish a personal goal such as making a health-related behavior change is extremely challenging.
Due to self-efficacy’s role in predicting behavior change it is evident that the messages created by the Strong4Life movement fail to account for the importance of this necessary factor in the design of their messages. The images and videos used throughout the ad campaign highlight the desperation and individual struggles associated with being an overweight or obese child, which result in public shaming. Although the act of shaming adds an element of shock value to the campaign’s messages, it greatly hinders self-efficacy, which reduces the overall effectiveness of the messaging (6). The ads offer no sense of hope or solutions to the problem and instead serve as explicit reminders of the isolation and emotional impact the issue of weight can have on the individual. In addition, the messages fail to instill a sense of empowerment and as a result, impede motivation and further reinforce the idea that little can be done to make healthy changes to one’s lifestyle. Although the ads were created to help raise awareness of the issue of childhood obesity among parents, it is impossible to conceal the massive billboards or commercials aired during prime time from youth exposure. As children are exposed to messages that communicate the idea that being overweight means you’re unhealthy, not a normal child, and deserved to be bullied, it further reinforces feelings of low self-efficacy in children who may already be experiencing self-esteem issues. By hindering the promotion of self-efficacy, the Strong4Life messages are ineffective in promoting the idea that anyone, regardless of shape or size, can incorporate the behaviors necessary to live a healthy and happy life.

Critique 3: An Ad Campaign that Violates the Fundamentals of Advertising Theory
Although the Strong4Life messaging may be described as memorable due to the significant shock value of its imagery and severe quotes, the campaign fails to take into account the fundamentals of Advertising Theory. Advertising Theory is a group level model based on the idea that by changing behavior first, knowledge and attitudes will eventually change as well. The theory is based on the notion of a promise and that the promise communicated through an ad’s messaging will fulfill a personal desire (13). The messaging used by the Strong4Life movement violates the Advertising Theory due to its focus on the negative consequences associated with childhood obesity. As a result of the campaign’s communication strategy their messages promote the promise of sadness and human suffering instead of a positive and greatly value human aspiration. For example, in one commercial, a girl perceived to be overweight looks directly into the camera and states, “my doctors says I have hypertension, I’m really scared” (14). The messaging used in this example as well as the other commercials developed by the Strong4Life campaign, do very little to promote an aspiration that people would be interested in achieving.
According to Advertising Theory, the effectiveness of an ad is not only based on the idea of a promise, but on the support and core values used to package that promise. As demonstrated through the success of the “Truth” campaign, Advertising Theory can be incredibly effecting in promoting a cause and changing behavior (15, 16). In order for an ad to be effective, the promise it promotes must be sufficiently supported through the use of compelling and likeable imagery, music, and personal narratives that elicit an emotional response. Based on these requirements it is evident that the Strong4Life campaign fails to successfully incorporate the three elements of support into its messaging. The commercials lack music and instead rely on heavy, single drum beats that communicate an end. Also, the imagery used in the print ads and commercials is dark, bland, and visually unappealing to the viewer. The impact of black and white imagery further reinforces the message that children who are overweight or obese are to be isolated and shamed due to the physical nature of their appearance. Also, the use of facts and statics seen at the end of several of the ads violates what can be considered effective support mechanisms for the promise. In addition to support, an effective ad campaign relies on a strong core value to hold the message together. Public health campaigns often rely on the core value of “health” when packaging their messages. However, because the value of health is rarely identified as a value that humans hold in high regards, messages based around the core value of health are often overlooked (17). A central element of the “Truth” campaign that contributed to its success was through the use of core values such as, control and freedom, which are values that humans hold in high regard (15). The Strong4Life messaging fails to incorporate a highly regarded core value into its campaign and instead relies on the core value of health. The campaign’s focus on the core value of health significantly limits its overall effectiveness in brining awareness to the issue of childhood obesity in the state of Georgia.

Be Strong, Be You: A Fresh Approach to Strong4Life’s Ad Campaign
Based on a critique of the Strong4Life’s messaging campaign using three social and behavioral theories and concepts, it is evident that in order to increase awareness surrounding the issue of childhood obesity in the state of Georgia, Strong4Life must reconstruct its media outreach approach. In order to overcome the shortcomings of the Strong4Life’s advertising campaign it is necessary to develop a multifaceted media campaign that raises awareness, while encouraging people to join the movement through the Strong4Life’s website. The movement’s website, which apart from the logo has no resemblance to its ad campaign, uses education materials and interactive features to provide an effective resource for families in need of healthy behavior support. To better reflect the website while creating effective advertising the revised media campaign will be comprised of commercials, posters, and billboards. The “Stop Sugarcoating It, Georgia” tagline will be replaced with a positive and empowering phrase that incorporates the element of strength from the movement’s name. The new tagline “Be Strong, Be You” will appear in all revised media elements. Each of the “Be Strong, Be You” ads will feature groups of children, families, friends, couples, and coworkers, of all ages, shapes, and sizes participating in activities that make them feel strong and are associated with a healthy lifestyle. The commercials will consist of a series of scenes in which different groups of people are taking part in activities. One scene may show a mother reading to her kids, while another scene depicts a group of friends taking a dance class, and while a third scene shows a grandparent riding a bike with his grandson. Each scene will connect seamlessly to the next as if they are all part of a single, larger story, however, scenes will be filmed throughout the state of Georgia in various cities, towns, and neighborhoods. The closing line of each ad will read, “Be Strong, Be You,” with a quilted image of all the just viewed scenes as its background. This quilted imagery of people taking part in activities that represent their strength centered on the phrase, “Be Strong, Be You,” will be the basis for the print ads as well. Based on the campaign’s revised focus on highlighting aspects of people’s lives that make them feel strong, the website’s home page will include a “Be Strong, Be You” pledge that invites you to join the movement by sharing what makes you feel strong. This invitation to join the movement will replace the website’s current, yet buried “Add your voice” form (18).
By removing the focus on the individual and adding elements of environment and context to Strong4Life’s ad campaign, the ads will no longer be susceptible to victim blaming as a result of the fundamental attribution error. Research has found that we can counter the tendencies associated with the fundamental attribution error by promoting greater altruism and empathy in our health messages and appealing to the cultural values for the target population (5). Through a depiction of groups of people taking part in everyday activities that are relevant to the residents of Georgia, the revised campaign will incorporate these elements into its messaging to eliminate the influence of the fundamental attribution error on the overall effectiveness of the messages. In addition, by showing scenes of people in groups, instead of highlighting a single individual, the restructured media campaign will avoid the negative implications associated with a focus on the individual, such as victim blaming and bullying (6). With the addition of cultural and environmental elements, as well as group level representation, the revised campaign will successfully overcome the issues associated with the fundamental attribution error.
In addition to eliminating the tendency to victim blame, the revised ad campaign addresses the issue of self-efficacy, which is greatly hindered in the current campaign’s design. Studies have shown that social cohesion and a greater sense of a role and identity help to promote self-efficacy among individuals and groups (19, 20). By depicting people from a range of demographics taking part in everyday behaviors that support a health living, the revised campaign brings people together and promotes social togetherness. Also, by emphasizing the importance of joining the cause and sharing what makes you feel strong the campaign adds a new element of labeling in which everyone who joins the movement is now part of the Strong4Life identity. In order to overcome the challenges of poor self-efficacy the revised ad campaign focuses on community and social cohesion, as well as the value of joining the movement.
Lastly, in order to overcome the current campaign’s violation of Advertising Theory, it was necessary to create an ad that successfully incorporates the three elements of effective advertising, a promise, support, and a recognized core value, into the revised campaign. The revised campaign highlights a range of everyday behaviors that promote the core values of independence and control. The revised ad focuses on the notion that if you take part in positive behaviors that bring you enjoyment you will feel in control of your life and independent. By reframing the issue in order to eliminate a focus on the core value of health, the campaign will be more effective at connecting with human emotion (17). Similar to the successful messaging approach of the “Truth” Campaign, which did not tell people what to do, but rather, encouraged them to make their own decisions about smoking, the “Be Strong, Be You” will not tell people they cannot watch television or drink soda, but instead depict healthy behaviors to encourage a shift in lifestyle practices (21). The ads will be appropriately supported by appealing images of scenes from throughout the state of Georgia, as well as uplifting music from a well-known artist, such as Phillip Phillip’s “Home,” to add an additional element of emotion to the campaign’s commercials. Using Advertising Theory, the “Be Strong, Be You” media campaign will help to effectively raise awareness and promote the goals of the Strong4Life movement.
Based on a critique of the Strong4Life’s current messaging, it is evident that several of its shortcomings are a result of the campaign’s failure to account for important elements linked to social and behavioral concepts and theories. The “Stop Sugarcoating It, Georgia” approach to messaging promotes victim blaming, hinders self-efficacy, and violates the elements of Advertising Theory. The flaws of this campaign make it not only ineffective, but may in fact result in negative outcomes for the community. Through the development of a revised media campaign it is possible to overcome the shortcomings of the current messaging approach. The “Be Strong, Be You” messaging campaign places a new emphasis on group behavior, incorporates culture and environment into the context of its ads, and focuses its messages on the core values of independence and control. The restructuring of the Strong4Life’s ad campaign will not only help to promote the underlying goals of the movement, but will empower people of all ages to take control of their lives by incorporating healthy, enjoyable behaviors into everyday life.


1.        Ogden, S. & Carroll, M. Prevalence of Obesity Among Children and Adolescents: United States, Trends 1963-1965 Through 2007-2008. Hyattsville, MD: National Center for Health Statistics, Centers for Disease Control and Prevention, 2010.

2.        Trust for America’s Health & The Robert Wood Johnson Foundation. F as in Fat: How Obesity Threatens America’s Future in 2012. Princeton, NJ: Robert Wood Johnson Foundation, 2012.

3.        Strong4Life. Defining What it Means to be Strong4Life: The Facts. Atlanta, GA: Children’s Healthcare of Atlanta. out/aboutDetailPage.aspx?articleid=0&sectionid=facts

4.        Teegardin C. Grim childhood obesity ads stir critics. The Atlanta Journal-Constitution. Atlanta, GA. 2011.

5.        Schwartz M & Brownell K. Actions necessary to prevent childhood obesity: Creating the climate for change. Journal of Law, Medicine, & Ethics, Spring 2007; 78-89.

6.        Adler N & Stewart J. Reducing Obesity: Motivating Action While Not Blaming the Victim. The Milbank Quarterly, 2009; 87(1): 49-70.

7.        Polhamus, B., Dalenius, K., Mackintosh, H., Smith, B., & Grummer-Strawn, L. Pediatric Nutrition Surveillance 2009 Report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.
8.        Marks DF. Healthy psychology in context. Journal of Health Psychology 1996; 1:7-21.

9.        Bandura A. Health promotion from the perspective of social cognitive theory. Psychology and Health, 1998; 13: 623-649.

10.    National Cancer Institute. Theory at a Glance: A Guide for Health Promotion Practice. Part 2. Bethesda, MD: National Cancer Institute, 2005.

11.     Stretcher V, DeVillis B, Becker M, & Rosenstock I. The Role of Self-Efficacy in Achieving Health Behavior Change. Health Education Quarterly, 1986; 13(1): 73-91.

12.    Sharma M, Wagner DI, & Wilkerson J. Predicting childhood obesity prevention behaviors using social cognitvite theory. International Quarterly of Community Health Education, 2005-2006; 24(3): 191-203.

13.    Ogilvy D. How to build great campaigns. In: Ogilvy D. Confessions of an Advertising Man. New York: Atheneum, 1964, pp. 89-103.

14.    Strong4Life: Warning Ads. Available at: watch?v=ysIzX_iDUKs&list=PL3B99758F38961860&index=3

15.     Hicks JJ. The strategy behind Florida’s “truth” campaign. Tobacco Control, 2001; 10:3-5.

16.    Apollonio DE & Malone RE. Turning negative into positive: Public health mass media campaigns and negative advertising. Health Education Research, 2009; 24(3): 483-495.

17.    Menashe CL, Siegel M. The power of a frame: an analysis of newspaper coverage of tobacco issues – United States, 1985—1996. Journal of Health Communication, 1998; 3(4):307-325.

18.    Strong4Life. I am Strong, Are you? Atlanta, GA: Children’s Healthcare of Atlanta.

19.    Carlson M, Brennan R, & Earls F. Enhancing adolescent self-efficacy and collective efficacy through public engagement around HIV/AIDS competence: A multilevel, cluster randomized-controlled trial. Social Science & Medicine, 2012; 75(6): 1078-1087.

20.    Tierney P & Farmer S. Creative self-efficacy development and creative performance over time. Journal of Applied Psychology, 2011; 96(2): 277-293.

21.    Allen J, Vallone D, Vargyas E, & Healton C. The Truth Campaign: Using Countermarketing to Reduce Youth Smoking. American Legacy Foundation: 195-215.

Labels: , , , , ,


Post a Comment

Subscribe to Post Comments [Atom]

<< Home