Sugarcoating Childhood Obesity: The Shortcomings of Georgia’s Not So Sweet Strong4Life Advertising Campaign – Jessica Gottsegen
Introduction
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.
Conclusion
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.
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Labels: Diabetes, Health Care, Maternal and Child Health, Obesity, Physical Activity, Pink
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