Scaring Our Children: A Critique of Georgia’s Attempt to Fix the Childhood Obesity Epidemic – Yvonne Morales

Scaring Our Children: A Critique of Georgia’s Attempt to Fix the Childhood Obesity Epidemic – Yvonne Morales

Introduction

            The fact that childhood overweight and obesity is now an epidemic is no longer news. Results from the 2007-2008 NHANES report found that childhood around 16.9% of children and adolescents 2 to 19 years old are obese (1). The number of obese children has tripled since 1980 (2). The state of Georgia is one of the hardest hit by this epidemic, only falling behind Mississippi. Four in ten children are either overweight or obese in the state, the second highest in the country (3). Overweight and obese children are now suffering from diseases we use to think were only seen in adults (3). Children are suffering from joint pain, sleep apnea, hypertension, liver disease, high cholesterol and Type 2 Diabetes, which we use to call adult onset diabetes (3). The severity of the physical consequences of overweight and obesity action needs to reach a wide audience.

            Across the United States several strategies have been implemented to help combat childhood obesity. Common food policies implemented include altering the relative price of foods at schools, shifting the exposure to food and trying to improve the image of healthy food (4). Other strategies including increasing taxes on foods considered “unhealthy” and increasing taxes on these same foods have been considered (4). In Georgia the Children’s Healthcare of Atlanta Pediatric Hospital has taken matters into their own hands and created a 5 year 25 million dollar program, strong4life, aimed at reducing childhood obesity in the state (5).

This program started with the launch of a media campaign, named “Stop Childhood Obesity”, aimed at raising awareness about childhood obesity, which has created a lot of controversy nationwide (5). Using the tagline “Stop Sugarcoating It, Georgia” the campaign, which includes print and video ads, seeks to shock its citizens into action (5). The program goes beyond this ad campaign and includes a movement they named strong4life and other ads campaigns that were rolled out after the “Stop Childhood Obesity” campaign (3). For the purpose of this critique only the ad campaign launched as the first phase of the initiative will be discussed. In late 2011 and early 2012 when the campaign was launched a great deal of controversy was created. Some praised its boldness and directness while other criticized it for making a sensitive issue worse (5). The ads are shocking depicting sad little boys and girls that are either overweight or obese in an effort to raise awareness to childhood obesity.   

The campaign was very successful in getting people talking about the issue. A Google search for “Georgia childhood obesity ads” yields 322,000 results in 0.48 seconds. The campaign is so recent that we still don’t have any evidence on its ability to change what it set out to do yet many critiques agree that the possibility that it will do more harm than good is real (5). Even though it caused a stir the ad campaign fails to properly combat childhood obesity by alienating its target audience, failing to provide a viable model for children to follow and fails to create community awareness to the issue.

Critique 1: Stigmatizes overweight and obese children

            One of the print ads for the campaign stars an overweight girl who seems to be around 9 years old.  She is staring into the camera arms crossed, a banner runs at the bottom of the page, “WARNING: It’s hard to be a little girl if you’re not” (5). This is one of the images being plastered on billboards and online in Georgia. The other images are accompanied by the caption, “My fat may be funny to you but it’s killing me”, and “Fat prevention begins at home. And the buffet line” (6). The ads aimed at propelling parents and children into action may be instead further stigmatizing overweight and obese children.

Stigmatizing includes but is not limited to verbal teasing, physical bullying and relational victimization (7). Studies have shown that overweight and obese children are already the victims of bias and stereotyping by peers, educators and even parents (7). This has been well documented in scientific literature for more than 40 years (7). In a seminal study by Richardson et al in 1961 640 school children 10 and 11 years old were instructed to rank the pictures of six children in order of whom they would rather be friends with (7). The pictures included children with disabilities, and overweight child and an average child with no disabilities (7). On average the overweight child was ranked last and deemed least likeable (7). Many other studies have confirmed these findings (7). Stigmatizing associated with depression, low-self esteem, body dissatisfaction and difficulty establishing interpersonal relationships (7). So instead of pushing these children into action they are being pushed further into a cycle of low self-esteem, depression and further weight gain.

Critique 2: Fails to promote self-efficacy

            One of the video ads titled “Video Games” that forms part of the campaign stars Jaden, a young African-American boy, who likes to play video games, by himself, so he doesn’t have to be around the other kids that make fun of him (8). The ad is very effective in showing how lonely being overweight or obese can be. Most children that are overweight or obese already know this. The campaign “Stop Childhood Obesity” seems to be based in part on the health belief model. This model stipulates that there are six main constructs that propel people into action (9). These include perceived susceptibility, perceived severity, perceived benefits of taking action, perceived barriers, cues to action and self-efficacy (9). Self-efficacy refers to a person’s belief in his or her ability to take the action (10). The ad depicts Jaden in a dark light, and he talks about how he retreats to his video games so he doesn’t have to be around other kids. Jaden is not being given the tools or even told that he can change his situation. It seems he is condemned to playing video games, since “being fat takes the fun out of being a kid” (8). Every single ad that forms part of this campaign ends on a negative not or makes you feel sad.  If as an adult looking at this you don’t feel empowered to make a change, children will not either.

            This campaign was designed to raise awareness and create a buzz around the issue. It accomplished that but, how effective is an intervention that fails to empower those that they intend to help. Another huge issue with the campaign ads that only depict children in them is that they make it seem that this is an individual issue.  Given the large range of factors that contribute to childhood obesity it is clear that this is not an individual issue (11). Those behind the campaign, Children’s Healthcare of Atlanta, do admit that what they want to do is push parents into action saying that they need to be pushed out of a state of denial (12). Yet, they are not transmitting a message that promotes self-efficiency to parents either. None of these ads even suggests a course of action to be taken, we are just asked to stop sugarcoating it. Studies, like the one conducted in Australia by Lewis et al. have shown that obesity public health campaigns can cause more harm than good when targeted to adults (13). It would be interesting to study the effect these ads are having on parents. They are probably having similar effects, which included feeling stigmatized and blamed for their situation (13). 

Critique 3: Fails to create a model for children to follow

A TV ad shot in black and white stars Bobby and his mother, they are sitting face to face on two foldable chairs. Bobby asks his mom point blank, “Mom, why am I fat (14) ?” The conversation is set in the same tone all the other ads portray, dark, cold and seemingly hopeless. By bringing in Bobby’s mother into the picture the campaign is bringing in the environment into the picture. The Social Cognitive Theory (SCT) describes the dynamic in which personal factors, environmental factors and human behavior influence each other (10). The SCT says that there are three main factors that will increase the probability that a person will change a health related behavior (10). These factors are self-efficiency, goals and outcome expectancies (10). This theory later evolved to the Social Learning Theory that postulates that people learn by observing others, this is where this campaign fails completely (10).

Bobby isn’t given even a suggestion or anything that resembles an answer (14). We are just told, “75% of Georgia parents with overweight kids don’t recognize the problem” (14). So even if we look at the ad from the perspective of a parent that may have an overweight child and doesn’t recognize it we are not told how to do this. There is no suggestion of behavior to model at all. This is another huge missed opportunity. If we want to get parents on board with the program we have to show them where the door is.

Proposed Intervention

Successful interventions need to have impact on the individual and societal levels (11). Relying solely on children or even children and their parents to solve the childhood obesity crisis would be wasting some of the most important resources we have as a society, each other.  An effective intervention that will help combat childhood obesity in state like Georgia where the prevalence is high is to include everyone in the fight, not alienate those affected and make them feel like they are to blame. Yes, there is some blame to assign but this will not solve the problem. Working together and making the solution as easy as possible is the way to go.

            A great example of a campaign doing just this is the do® groove campaign created by Blue Cross Blue Shield of Minnesota (15). This campaign targets adults but could serve as a great model for a children’s campaign. The campaign features TV, print and online ads that promote a positive message towards achieving meaningful weight loss. The ads for the do® groove campaign include taglines like, “walk a mile in your own shoes”, “we hear the Joneses have been exercising”, “Groove. Breathe. Repeat.”, “put some step in your spring” among others (15).  

The TV ads star everyday people sharing their successful weight loss stories weight loss stories (15). The factor that is key here is that the people sharing their stories are not now super skinny health fanatics. They are people that are still in the trenches still struggling with the problem (15). Modeling a program for children that provides relatable models for both parents and children and empowers them to take action could be more successful that scaring children and pointing the blame at parents. A great way that the do® groove ads used advertising theory is that added a comedic element to the TV spots that is consistent throughout.  The same man appears at the end of all the ads, he stars in one, and invites everyone sharing their story to “groove” with him. Ending the spot with an uplifting moment even if the story might not have been.

            The Stop Childhood Obesity campaign makes good use of advertising theory and marketing theory. These strategies should be continued in the new campaign, with a different tone. The ads in Georgia were very effective at getting the community talking. Every media outlet picked up the story and discussed at length. This is a great way to et even more exposure and even free advertising for the campaign. Finding a creative way to accomplish this in a more positive tone will be hard since usually this type of attention goes to controversial topics (5). Making use of creative agencies and experts in advertising could help achieve this goal.

Defense 1: Providing a model to follow

            In the stop childhood obesity program that I am proposing TV ads would feature children that have been successful at losing weight. This will provide children with a model from which they can learn. According to the Social Learning Theory observational learning or modeling is behavioral changes that occur by watching the actions and outcomes of other’s (10). Portraying children that have been successful or are currently trying to lead a healthier lifestyle is important. The current campaign in Georgia doesn’t give children a better model to follow. Overweight and obese children need to see that changing is possible and shown how to do it.

            A second model that also needs to be provided is a parental model of how to help your child lose weight. Many parents don’t know how to help their children. Instead of casting them in the role of enabler or cause like they do in the Stop Childhood Obesity ads we can cast them in the role of support or better yet example. Getting parents to lead a healthy lifestyle will at the same time help children lead a healthy lifestyle. In other words providing parents a model on how to be good role models for their children.

Defense 2: Create a sense of community

           

            The initiative should create a sense of community; we got into this problem together we will fix it together. The cause of childhood obesity can be simplified to an excess delivery of calories (11). How we ended up having children that consume an excess amount of calories and don’t exercise enough is extremely complicated (11). So blaming the current generation of children and their parents for letting their weight get out of control is absurd. The current obesity epidemic is the result of many factor coming together is a sort of perfect storm. Many of these factors that caused the childhood obesity epidemics are environmental.  If the cause of the problem lies in the community so can the solution. According to the Social Cognitive Theory there is a dynamic process in which personal factors, environmental factors and behavior influence each other (10). Changing one of the three factors will later cause changes in the other two.

             

Defense 3: Create a sense of self-efficacy

            One really important thing that creating a sense a community and providing both children and parents a model to emulate does is that it creates a sense of self-efficacy. Each of these factors act together to empower both children and their parents. Some consider self-efficacy the most important personal factor that leads to behavior change (10). Its the factor that appears in every behavior change model (10). If self-efficacy is created this will eventually lead to action. In order for this to happen the campaign has to provide easy to follow and easy to access steps for both children and parents to take. Again looking at the do® groove campaign as an example they have a tab on the website called “Get Started Now” (15). Here people can find 3 easy steps that will get them on their way to a healthier lifestyle (15). A similar approach can be taken and adapted to children. There is still a lot to learn about how to motivate children to lose weight without causing eating disorders in the process (6). So instead of asking people to find their healthy weight like on the do® groove website children could be asked to set other type of achievable goals which are important to change behaviors (10).

Conclusion

            The childhood obesity epidemic is a real problem that must be dealt with now. The Children’s Healthcare of Atlanta Pediatric Hospital has that much right there is no more time to waste when it comes to confronting the issue and finding a solution. The way they are going about this is going to cause more harm than good. Further stigmatizing an already vulnerable population without proving actions to be taken can make the problem worse.  We can stop sugarcoating the issue without scaring a generation of vulnerable children. The Do® groove campaign created by Blue Cross Blue Shield of Minnesota does this for adults (15). A similarly positive and serious campaign can be crafted for children. Empowering them during a very vulnerable stage of life can create better end results. We need to stop sugarcoating the issue across the country; we just have to be careful not to create a bigger problem.

References

1.       Products - Health E Stats - Overweight Prevalence Among Children and Adolescents 2007-2008. (n.d.). Retrieved December 12, 2012, from http://www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.htm

2.      Obesity and Overweight for Professionals: Childhood: Data | DNPAO | CDC. (n.d.). Retrieved December 13, 2012, from http://www.cdc.gov/obesity/data/childhood.html

3.      We Are Strong4Life. (n.d.). Retrieved December 12, 2012, from http://strong4life.com/pages/about/about.aspx

4.      Frieden, T. R., Dietz, W., & Collins, J. (2010). Reducing Childhood Obesity Through Policy Change: Acting Now To Prevent Obesity. Health Affairs, 29(3), 357–363. doi:10.1377/hlthaff.2010.0039

5.      Controversy Swirls Around Harsh Anti-Obesity Ads : NPR. (n.d.). NPR.org. Retrieved December 13, 2012, from http://www.npr.org/2012/01/09/144799538/controversy-swirls-around-harsh-anti-obesity-ads

6.      Gray, E. (2012, January 3). Georgia Anti-Obesity Ads Say “Stop Sugarcoating” Childhood Obesity. Huffington Post. Retrieved December 12, 2012, from http://www.huffingtonpost.com/2012/01/03/georgia-anti-obesity-ads-stop-sugarcoating_n_1182023.html#s585825&title=Tamika

7.      Puhl, R. M., & Latner, J. D. (2007). Stigma, obesity, and the health of the nation’s children. Psychological Bulletin, 133(4), 557–580. doi:10.1037/0033-2909.133.4.557

8.     Stop Childhood Obesity: Video Games. (2011). Retrieved from http://www.youtube.com/watch?v=tK57ieGhE7w&feature=youtube_gdata_player

9.      National Cancer Institute. Theory at a Glance: A Guide for Health Promotion Practice. Part 2. Bethesda, MD: National Cancer Institute, 2005, pp. 9-21 (NIH  Publication No. 05-3896). Available at: http://www.cancer.gov/PDF/481f5d53-63df-41bc-bfaf-5aa-48ee1da4d/TAAG3.pdf

10.  Individual health behavior theories (chapter 4). In: Edberg M. Essentials of Health Behavior: Social and Behavioral Theory in Public Health. Sudbury, MA: Jones and Bartlett Publishers, 2007, pp. 35-49.

11.   Vos, M. B., & Welsh, J. (2010). Childhood Obesity: Update on Predisposing Factors and Prevention Strategies. Current gastroenterology reports, 12(4), 280–287. doi:10.1007/s11894-010-0116-1

12.  Do Georgia’s Child Obesity Ads Go Too Far? (2011, May 2). Huffington Post. Retrieved December 13, 2012, from http://www.huffingtonpost.com/2011/05/02/georgia-child-obesity-ads_n_856255.html

13.  Lewis, S., Thomas, S. L., Hyde, J., Castle, D., Blood, R. W., & Komesaroff, P. A. (2010). “I don’t eat a hamburger and large chips every day!” A qualitative study of the impact of public health messages about obesity on obese adults. BMC Public Health, 10, 309. doi:10.1186/1471-2458-10-309

14.  Stop Childhood Obesity: “Why am I Fat?” (2011). Retrieved from http://www.youtube.com/watch?v=ysIzX_iDUKs&feature=youtube_gdata_player

15.   What is Do Groove, How Can it Help You Get Healthier & more. (n.d.). Retrieved December 13, 2012, from http://www.do-groove.com/about