What role do media play in Preventing Obesity in Adolescent? – Mi Luo

No Person, as the poet John Donne said, is an island. Especially in recent years, mass media is full of adolescent 's lives, which can have a real impact on their decision-making. Actually, a numbers of adolescent obesity campaign were using media as a preventing tool, but did those messages affect adolescent having health behavior? This article, through the mass media’s influence on the individual level, the interpersonal level and the community level, to analysis its effectiveness of preventing obesity in adolescent.

Individual level – two problems have emerged on health benefit messages

The individual or intrapersonal level is the most basic one in health promotion practice. The Health Belief Model (HBM) and the Theory of Panned Behavior (TPB) explored the importance of individual’s perception and cognitive-behavioral in changing behaviors. In generally, almost every public health campaign has used media to explain the harmful of adolescent obesity and beneficial of losing weight. But, their advocate modes on promoting health benefit message were not target on adolescent and the overloaded health benefit messages did not play corresponding effect.

Advertisements, websites, magazines, medical journals, health lectures and health brochures, public health campaign use variety media channels and types to introduce the harmful of obesity in adolescent (1, 2). According to obesity epidemic studies, they shown overweight and obesity in adolescent was associated with hypertension, congestive heart failure and diabetes (3). And obesity girls will have higher risk on lifetime nulliparity (4). Adolescent are recommended to eat more fruits and vegetables, increase physical activities and stop overeating unhealthy calorie-dense foods and carbonated beverages in order to decrease the risk on picking up those lifelong illness. Although those study reports were scientific and rigorous, their academic style was not attractive to the adolescents. Indeed, a recent national survey reported that nearly 50% articles related to adolescent obesity had high click through rate. But only 28% of the audiences were 12- to 17-year-olds people (5), a finding consistent with another recent study (6). As a result, although the public health campaign used media-promote to let adolescent perceived the severity and benefits about obesity, the really perceivers were not the adolescent themselves but their parents. Lack of research and precisely targeting on subjects, they just succumbed to the “ EZ program structure illusion ”.

As mentioned above, obesity campaigns media also made health benefits an important means to influence desirable behaviors (7). However, as the key concepts shared by both the Stage of Change model and the Precaution Adoption Process Model (PAPM) - knowledge is necessary for, but not sufficient to produce, most behavior changes. Motivation is one of the key influences on behavior at the individual level. As a matter of fact, health communications researchers find that health benefit messages geared toward adolescents are not highly effective in changing behavior (8).

Several explanations are offered as to why health benefit messages in the healthy eating and physical activity contexts are not appealing to adolescents. In the area of healthy eating, adolescents, as a form of rebellion, generally shun the notion of messages that portray mom-approved, healthy foods (9). Adolescent populations are also thought to be more motivated to engage in or adopt a new behavior if that behavior is attached to an immediate reward (9, 10). Health benefits are not appealing because adolescents are often already aware of the associated health risks and tend to feel invulnerable to them with the assumption that they can engage in healthy behaviors in the future to avoid such problems (11). Therefore, the other flaw of media use was focusing on giving knowledge rather than mining really motivate, which could encourage them making specific plans on preventing obesity in adolescent.

Intervention on individual level – concentrate on giving motivations

According to the Stage of Change Model and the PAPM, the key point to increase the media’s effectiveness on the influence of individual levels is to find the way to motivate the adolescent progress in the Contemplation Stage in Stage of Change Model or Stage 3 in the PAPM. That is, let them intent to take an action to prevent the obesity in the next six month or deciding about acting.  The strategy for motivate people is never try to change their own attitude, never confront they already believed but to reinforce them. In terms of adolescent, their nature is to enjoy the life and have fun with their friends. It is common and even part of their life to enjoy unhealthy calorie-dense foods and carbonated beverages during the parties with their friends. If the media always gives information on how did this unhealthy food due to the obesity and the harmful consequent the obesity given to the adolescent. undoubtedly，for adolescent, those warning will just go in one ear and out the other.

To be effective, the correct way is shifting the overloaded message in prevention campaigns and the negative health consequences of obesity. Then try to echo adolescent’s attitude, showing them other choice such like having fruit salad with friends, participating in popular physical activities, walking out to enjoy the nature. Besides, both the images and the background music need to fit the adolescent style. The entire information, which media give, did not use health benefit messages, but rather identified them as an appealing lifestyle. Thus was equally to their behavior and attitude to life. The positive experience from the media will motivate them begin to have a try on those healthy life style and this was just a start, the positive effect will cumulated and eventually became their behaviors.

Interpersonal level - Focus on body-image bring undesirable behaviors

At the interpersonal level, theories of health behavior assume individuals exist within, and are influenced by, a social environment. The opinions, thoughts, behavior, advices, and support of the people surrounding an individual influence his or her feelings and behavior, and the individual has a reciprocal effect on those people. Apart from health benefit messages, public health promotion campaigns also focus on body image as another strategy of mass media. Incontrovertible，the media is influential in defining the thin ideal for adolescent. To some extent, it can promote adolescent control their weight, but it also result in unintended affects on social environment, which bring two extreme undesirable behaviors on adolescent.  

Obesity campaigns often depict thin people, or the ideal body - image, as popular and successful while also containing anti-obesity messages. But most of those anti-obesity messages had no instructive and meaningful to guide adolescent losing their weight or preventing obesity. Since the ideal body image is truly attractive, after repeated exposure to the multitude of those images, adolescent will formulate concepts that people around them, like their parents and friends were approved to have an ideal body- image. Because of the interpersonal interaction, after all, unhealthy social environments will develop. Adolescent, especially the adolescent girls will express body dissatisfaction.

Research has clearly shown that body dissatisfaction is a key risk factor for disordered eating behaviors and eating disorders (12) On the one hand, if an adolescent has already been obesity, compared with the ideal body – image and being in the social environment mentioned above. One will let oneself under a big social pressure and without confidence to change the dissatisfied appearance. This will became an obstacle for one’s to engage in health behaviors (13, 14). Both the Psychological theory of reactance and the Social Cognitive Theory (SCT) could explain this circumstance. The Psychological theory of reactance states that when the target audience feels their freedom to engage in health risk behaviors has been threatened or eliminated, they will be motivated to reestablish the threatened or lost freedom, resulting in an increased likelihood for them to engage in the health risk behaviors. The SCT declared when people faced with obstacles, if they do not feel that they can exercise control over their health behavior, they are not motivated to act, or to persist through challenges (15). On the other hand, one might expect body dissatisfaction to lead to higher levels of physical activity or increased consumption of fruits and vegetables in an attempt to change one’s body. Several correlational studies have found that girls’ magazine reading is associated with engaging in unhealthy weight-loss methods (16), wanting to look like thin models (17), and dieting to lose weight (18), which always due to nutritional deficiencies and other health problems.

Intervention on interpersonal level – proper use Social Cognitive Theory

To begin with, obesity campaigns need to avoid using body dissatisfaction as a motivator but promote a positive body image among all adolescents. However, according to SCT, if the mass media wish to real impact adolescent change to a health behavior. They should provide effective and available information to help them get self-efficacy and make reasonable goals. They also need to show the real experience about preventing obesity on other adolescent to let them gain intuitive feeling on outcome expectancies and get benefit by observing the actions of other adolescent.

Body mass index (BMI) seems to be only way to judge whether an adolescent is normal weight, over weight or obesity. But for over weight adolescent, especially the obesity, only using normal BMI as a goal was meaningless，vague and unadvisable. Media need to give adolescent scientific principles, such as losing 1,5kg/month, to help them setting small, incremental and achievable goals. This will help adolescent build self – efficacy, have clear vision on the outcome expectancies and get anticipations about how long could they have normal weights.

Medias need to insist that adolescent themselves but not their parents are active performers in preventing obesity, but they need to give support information for parents to let them using correct method to help their children. For instance, telling parents take formalized behavioral contracting with their children to establish goals and specify rewards. This could effectiveness monitoring and reinforcement the adolescent health behavior.

Based on advanced media technology, media need to make some documentary or Interview movie about the real life experience on adolescent preventing obesity, which could offer credible role model for adolescent to understand what may happened during perform the same targeted behavior.

Community level - stigmatizing obesity results in an inequality social networks and norms.

Social networks and norms, or standards, which exist as formal or informal among individuals, groups, and organizations, are considered an integral part of community level. Social networks and norms can be seen as backup force and replenishment to an individual. The more diversified forms and more close relation network the people have and more matching up with the norms and standards, the more support and positive energy the people will gain from the community level during their health behavior change. In some instances, however, the messages from the media in adolescent obesity-prevention campaigns imply personal blame and stigmatize the obese, which results in an inequality social networks and norms and eventually undercuts effectiveness of public health campaigns. (19)

A small number of stigmatizing obesity could make adolescent who are an unhealthy weight feel bad about themselves because they seem to shame the obese. This mental crisis will let them estranged from the people. As more blamed information were given by media, the previous cognitive in public of fighting obesity, to some extent, change into fighting obese persons (20), which let the obesity adolescent even more alienated from people. At last, unfair social network and norm are formed.

For adolescent, the two major social networks are their families and their schools. However, according to reports，in both the families and schools, overweight adolescents have experienced stigmatizing and weight mistreatment, such as being the victim of weight-teasing or being excluded from activities because of one’s weight.

A report shown, although after adjusting for baseline weight status, adolescents who were teased about their weight were at twice the odds for being overweight 5 years later. Additional cross-sectional and longitudinal analyses from Project EAT (21, 22, 23) and other studies (24, 25, 26) have found that weight teasing is associated with numerous negative behavioral and psychological measures, including body dissatisfaction, low self esteem, depressive symptoms, and problematic eating behaviors. These findings strongly suggest that weight teasing can have harmful consequences on various aspects of an adolescent’s well-being.

We could clearly find that the social network like this could not give any support on adolescent to prevent obesity but undercuts effectiveness of the entirety public health campaigns. Sometimes, it even alienates the adolescent they intend to motivate and hinder the behaviors they intend to encourage.

Intervention on community level – given personal empowerment for health and find the right way to give message.

First of all, obesity campaign for adolescent need to awareness their fault on using stigmatizing obesity words to give message. They should be mindful of adolescent who are obese are very vulnerable to stigma and prejudice.

However, to address this problem, more systematic research is needed in order to find what kind of message is motivate and what kind is stigmatic and then guide the content and messaging of these campaigns to and make sure they’re helping and that they’re not detrimental.

Besides, the campaign need to help the obesity adolescent recreate the helpful social network and set a fair norms and standards for them. Therefor, the media should let the adolescents known that they deserve not to be mistreated because of their weight. Furthermore, family members and student in schools need to know that weight teasing should not be allowed at home and that even comments made in a playful or joking manner are not funny and can have unintended detrimental effects. Health care providers may be reluctant to bring up these issues because they may be afraid that they won’t know what to do with the information. It can be helpful to remember that it may be most important to just listen. Through talking about these experiences, teens may be able to figure out how to deal with different situations.

Conclusion

The real world health promotion campaign involves more than simply education individuals about healthy practices. It will affected by multiple levels of influence and individual behavior both shapes, and is shaped by, the social environment. This article tries to use an ecological perspective to analysis the media role in preventing adolescent obesity. Actually, as the age of information, mass media have a huge influence in people’s life. The most significant characteristics of mass media is quickly transfer and spread all kinds of information. On the bias of this characteristic, media can be the most effective and powerful method to give appropriate, accurate and target health-promoting messages to audiences. But it could also bring widespread harmful impact if there exist flaws in the messages. Therefore, the modern public health practitioner need pay attention when using mass media campaign. 

Reference

Journal Article:

1. Bernhardt JM, Cameron KA. Accessing, Understanding, and applying health communication messages: The challenge of health literacy. In: Thompson TL, Dorsey A, Miller K, et al., editors. Handbook of Health Communication. Mahwah, NJ: Lawrence Erlbaum; 2003. p. 583-605.

2. Brodie M, Hamel EC, Altman DE, et al. Health news and the American public, 1996-2002. J Health Polit Policy Law 2003;28:927-50.

3. Stephen E. Smalley, Robert R. Wittler, Ruth H. Oliverson. Adolescent assessment of cardiovascular heart disease risk factor attitudes and habits. Journal of adolescent health 2004; 35: 374-379

4. Alex J. Polotsky, Susan M. Hailpern, Joan H. Skurnick, Joan C. Lo, Barbara Sternfeld, Nanette Santoro. Association of adolescent obesity and lifetime nulliparity—The Study of Women's Health Across the Nation (SWAN). Fertility and Sterility 2010; 93: 2004-2011

6. Zhao S. Parental education and children's online health information seeking: beyond the digital divide debate. Soc Sci Med 2009;69:1501-1505.

7. Jennifer Allyson Dooley, Sameer Deshpande, Carol E. Adair. Comparing adolescent-focused obesity prevention and reduction messages. Journal of Business Research 2010; 63:154-160.

8. Edward Maibach, Roxanne L. Parrott (Eds.). Designing health messages: approaches from communication theory and public health practice. Sage, thousand Oaks, CA 1995; 114–1449.

9. Adrienne W. Fawcett. Going for the gross-out. Am Demogr 2000; 22: 42–43

10. Heather H. Mixon. Marketing nutrition in the middle grades: adolescent food habits and marketing strategies that work. National Food Service Management Institute 2001

11. Lisa K. Goldman, Stanton A. Glantz. Evaluation of antismoking advertising campaigns. Journal of the American Medical Association 1998; 279: 772–777

12. C. Jacobi, C. Hayward, M. de Zwaan et al. Coming to terms with risk factors for eating disorders: Application of risk terminology and suggestions for a general taxonomy. Psychol Bull 2004; 130:19–65

13. L.J. Heinberg, J.K. Thompson, J.L. Matzon. Body image dissatisfaction as a motivator for healthy lifestyle change: Is some distress beneficial? R.H. Striegel-Moore, L. Smolak (Eds.), Eating Disorders Innovative Directions in Research and Practice, American Psychological Association, Washington, DC 2001; 215–232

14. L. Heinberg. The role of body image distress in obesity: Is it motivating or malevolent? Academy for Eating Disorders International Conference on Eating Disorders 2005; 6

15. Hye-Jin Paek, Bryan H. Reber, Ruthann W. Laruscy. Roles of interpersonal and media socialization agents in adolescent self-reported health literacy: a health socialization perspective. Health Education Research 2011; 26: 131-149.

16. S. Thomsen, M. Weber, L. Brown. The relationship between health and fitness magazine reading and eating-disordered weight-loss methods among high school girls. Am J Health Educ, 2001; 32: 133–138

17. A.E. Field, C.A. Camargo Jr, C.B. Taylor et al.Relation of peer and media influences to the development of purging behaviors among preadolescent and adolescent girls. Arch Pediatr Adolesc Med, 1999; 153: 1184–1189

18. A.E. Field, L. Cheung, A.M. Wolf et al. Exposure to the mass media and weight concerns among girls. Pediatrics, 1999; 103: E36–40

21. D. Neumark-Sztainer, M. Story, P.J. Hannan et al. Weight-related concerns and behaviors among overweight and non-overweight adolescents: Implications for preventing weight-related disorders. Arch Pediatr Adolesc Med 2002; 156: 171–178

22. M.E. Eisenberg, D. Neumark-Sztainer, M. Story. Associations of weight-based teasing and emotional well-being among adolescents. Arch Pediatr Adolesc Med, 2003; 157: 733–738

23. J. Haines, D. Neumark-Sztainer, M.E. Eisenberg et al. Weight-teasing and disordered eating behaviors in adolescents: Longitudinal findings from Project EAT (Eating Among Teens). Pediatrics 2006; 117: e209–e215

24. P. van den Berg, E.H. Wertheim, J.K. Thompson et al. Development of body image, eating disturbance, and general psychological functioning in adolescent females: A replication using covariance structure modeling in an Australian sample. Int J Eat Disord 2002; 32: 46–51

25. H.A. Hayden-Wade, R.I. Stein, A. Ghaderi et al. Prevalence, characteristics, and correlates of teasing experiences among overweight children vs. non-overweight peers. Obes Res 2005; 13: 1381–1392

26. R.M. Puhl, J.D. Latner. Stigma, obesity, and the health of the nation's children. Psychol Bull 2007; 133: 557–580

Book:

5. Jones S, Fox S. Washington, DC: Pew Internet & American Life; 2009.

Website:

19. Christine s. Moyer. Stigmatizing obesity undercuts effectiveness of public health campaigns.

http://www.ama-assn.org/amednews/2012/09/24/hlsa0924.htm

20. Puhl R, Pererson JL, Luedicke J. Fighting obesity or obese persons? Public perceptions of obesity-related health messages.Rudd Center for Food Policy and Obesity, Yale University, New Haven, CT, USA.

http://www.ncbi.nlm.nih.gov/pubmed/22964792/