Smackdown Of FatSmack: A Critique Of An Anti-Obesity Ad Campaign That Fails in Advertising Theory – Page O’Leary

Smackdown Of FatSmack: A Critique Of An Anti-Obesity Ad Campaign That Fails in Advertising Theory – Page O’Leary

Introduction

            In the past twenty years obesity rates in the United States have risen dramatically.  Currently more than 35% of U.S. adults and 17% of children and adolescents age 2-19 are obese (1).  From 1980 to 2008 the rate of obesity in adolescents age 12-19 increased from 5% to 18%, and rising obesity rates were accompanied by increased risk for chronic disease including heart disease and type 2 diabetes (3).  The costs associated with rising obesity rates are astronomical.  Health care costs related to obesity and obesity related chronic disease exceeds $147 billion per year nationally (2).

Between the damaging health effects and associated health care costs of rising obesity rates, obesity has become the focus of many public health campaigns.  Research has shown that obese children and adolescents are more likely to grow up to be obese adults and to suffer the negative health effects associated with obesity, so many public health interventions have focused on children and adolescents in an attempt to decrease future obesity rates and improve the overall future health of the country (3).

Other efforts to target anti-obesity public health campaigns have focused on the causes of obesity.  The most commonly accepted cause of obesity is energy imbalance caused by the consumption of more calories each day than calories that are burned each day.  The prevalence of processed foods, refined grains and added sugars in the modern American diet has been blamed for the increase in caloric consumption leading to this imbalance.  Specifically, intake of added sugars, as high fructose corn syrup, has been shown to have increased 1000% between 1970 and 1990, and is suspected to be a major contributor to the rise in obesity rates in the U.S. (4).  The 2010 Dietary Guidelines for Americans, published by the U.S. Department of Agriculture and the U.S. Department of Health and Human Services identified soda, energy drinks, and sports drinks as the single greatest contributor to sources of added sugars in the diets of the U.S. population ages 2 years and older (5).  Dietary added sugars provide “empty calories,” that increase caloric intake without contributing nutritional value.  Additionally, it has been shown that calories from beverages do not satiate hunger (4,6).  A study of overweight teens showed that decreasing intake of sugar sweetened beverages lead to weight loss and lower BMI, with participants that started with the greatest BMI showing the greatest weight reduction (7).

With these facts in mind, one approach to anti-obesity public health campaigns has been to educate the public, and specifically children and teens, about the empty calories in sugar sweetened beverages.  In 2011, the city of Boston launched a public health campaign intended to do just that.  The campaign, called FatSmack, featured a TV commercial (http://fatsmack.org/media/), four posters (http://fatsmack.org/media/) and a web site (http://fatsmack.org) aimed at teens.  The ads show healthy weight attractive teens drinking from sugar sweetened beverages and getting hit in the face with a gelatinous blob meant to represent fat, accompanied by the print message “Don’t get Smacked by Fat.  Calories from sugary drinks can cause obesity and Type 2 diabetes” (8).  The obvious message of the campaign is that the sugar in sugar sweetened beverages can contribute to obesity and the obesity related complications of diabetes and heart disease (8).  The website features a rotating banner of factoids related to the message, including: the amount of money that Coca-Cola spent on advertising in 2008 ($2.67 billion), the number of teaspoons of sugar in a 20 oz. soda (16 or more), the percentage of overweight or obese students in the Boston public school system (40%), and the number of calories per day that youth age 12-19 consume from sugar sweetened beverages, per day (300 calories) (8).  The web site also contains web pages devoted to Sugary Drink Facts, as well as The Beverage Industry, with information about how the beverage industry markets to teens (9,10).

FatSmack is a well-intentioned campaign that seems on the surface like it would appeal to teens with its young, hip looking models in the ads, but upon closer inspection it is found to be lacking in behavioral theory and execution, which will lead to failure to connect with the target audience and have the desired effect of getting teens in Boston to reduce their sugar sweetened beverage consumption.

Critique Argument 1

            The primary failure of the FatSmack campaign is its reliance on the Health Belief Model (HBM), one of the founding theories on which traditional public health efforts are based (11).  The HBM was developed in the 1950s to describe the decision making process about health (12).  The theory posits that health seeking behavior in the individual is motivated by four factors: perceived susceptibility, perceived severity, perceived benefits of an action, and perceived barriers to taking that action (11).  Amendments to the initial model include cues to action, needed to motivate the individual to act, and the concept of self-efficacy, or an individual’s belief in their ability to take an action (11).  Public health interventions based on the HBM attempt to influence people’s behavior by affecting one of the six factors.  Basically, the theory suggests that by educating individuals about their susceptibility to, or the severity of, a health outcome, the benefits of an action, lowering perceived barriers to taking a healthy action, providing cues to motivate individuals to action, or increasing the individual’s sense of self-efficacy about the action, the behavior of the individual can be changed (11).  The HBM assumes that we can influence individual health behaviors by predicting an individual’s attitude toward health related behaviors and implementing an intervention designed to change these attitudes (13).  The effectiveness of the HBM is limited by the assumption that behavior is reasoned, the lack of designation of a separation between the intention to act and the actual execution of the action, and by the focus on changing behavior on the individual level rather than on the group level.

            The design of the FatSmack campaign makes the assumption that by educating teens that about the risks of consuming sugar sweetened beverages (obesity, diabetes) teens will then see that the benefits of forgoing sugary drinks outweigh the risks of drinking sugary drinks, and will therefore skip the soda and opt for water or some other sugar free beverage.  The web site is full of data about soda consumption, rates of obesity, and obesity related illnesses. The FatSmack campaign assumes that teens will weigh the risks and benefits of consuming sugar sweetened beverages and make a rational decision about how to act based on that knowledge.   However, teens are still developing cognitively and are not capable of rational thought to the extent that mature adults are (13).  Furthermore, studies have shown that when consumed, sugar elicits the same response in the brain as narcotic drugs, so the drive to drink sugary beverages goes far beyond the rational decision to consume or not to consume (14).  Both of these factors will influence the thought process related to beverage choice, and neither supports the theory that teens will make a decision based on rational thought. 

The campaign also fails to take into account other reasons that teens in Boston might be drinking soda. The campaign overlooks the influence of social groups and peers on the decisions made by teens, or that teens may want to change their behavior but not be able to because of their circumstances.  Teenagers are particularly susceptible to peer pressure, so much so that even if a teen is aware that the consumption of sugar sweetened beverages can contribute to the consumption of excess calories, it is an abstract idea that may be very motivating in the face of a group of peers who are choosing sodas and other sugar sweetened beverages (19).  In addition to neglecting the social influences on teen behavior, this construct fails to take into account the political, environmental and personal contexts that influence the behavior of an individual (15).  It may be that soda or other sweetened beverages are what is available at the markets or bodegas where teens are buying beverages, or that money is a factor and soda is the least expensive choice available.

Lastly, reliance on the HBM as the basis for a public health campaign focuses all of the effort on educating the individual to produce behavior change on the individual level.  Instead of trying to change behavior one person at a time, the campaign could have the power to influence the opinions of the masses, if it were designed based on a group-behavior model such as advertising theory.

Critique Argument 2

            Another shortcoming of the FatSmack campaign is that it fails to take advantage of advertising theory.  Advertising theory suggests that advertisements sell products not with facts or reason, but by convincing the audience that their product will lead the audience to achieve their aspirations.  The message in advertising theory is then supported with stories or images that reinforce the promise (16).

            Advertising theory is a group-level alternative model which attempts to overcome the shortcomings of the traditional behavior theory models by approaching behavior change at the level of the population rather than the individual, and by playing on people’s irrationality and dynamicity to persuade them to make behavioral changes, rather than assuming that people behave rationally and relying on their rationality to lead to behavior change.  Advertising theory postulates it is possible to change people’s knowledge and attitude by changing their behavior first.  Rather than using rational thought to convince them to change, advertising theory seeks to motivate people to change by playing to visceral desires and base aspirations, and assumes that once the behavior has changed, the attitude about the behavior will change as well.

            FatSmack is an advertising campaign that fails to employ any of the strengths of advertising theory.  Rather than using the advertisements to appeal to the base desires of a teenager to motivate them to give up sugary beverages, the ad campaign instead tries to convince teens that drinking sugary beverages is bad with comical and almost nonsensical images of hip-looking normal weight teens making cringing/laughing faces while holding a sugar sweetened beverage and getting hit in the face with an amorphous blob of goo intended to represent fat, accompanied by the message that sugar in drinks can lead to obesity and diabetes.  The ads try to use rational arguments to convince teens to change their behavior, instead of using the power of media to play on teens’ desires and emotions.  These ads contain no promise to the consumer that giving up sugar sweetened beverages will lead to contentment and fulfill their aspirations.   Furthermore, the representation of teens in the ads is goofy, and there is little to link teens viewing the print ads or the commercial to the teens represented in the ads.

Critique Argument 3

            Another way in which the FatSmack campaign fails to take advantage of alternative models of health change is that it fails to create a sense of ownership or belonging for viewers, and as such does not get buy-in for the message that that the campaign is trying to deliver.  The concept of ownership says that once a person feels like they own something, the value of that thing goes up.  Traditionally public health campaigns are at odds with ownership because the goal of the campaign is to get people to give up an unhealthy behavior.  Even though people might rationally know that a behavior is unhealthy, if they feel ownership of the behavior they will be motivated to keep it, as a means of maintaining control over their lives.  They will react with cognitive dissonance to rationalize their unhealthy behavior, in the end strengthening their connection to the unhealthy behavior.  By trying to convince teens to give up drinking sugar sweetened beverages, the FatSmack campaign may in fact be reinforcing that behavior (17).

Proposed Intervention – Hydr8 and El Hydratado

            The proposed intervention is designed to reduce teen consumption of sugar sweetened beverages while taking into account the shortcomings of the FatSmack campaign.  The format of the intervention will be similar to that of FatSmack, featuring an Internet/TV/Print ad campaign that promotes drinking water and non-sugared beverages.  However, rather than educating teens about the health risks associated with drinking sugar sweetened beverages, it will focus on drinking water or non-sugar sweetened beverages as a way for teens to assert their independence from beverage companies/advertisers, to give themselves the freedom to live the life they want without obesity or diabetes preventing them from attaining their aspirations.  The ad campaign will use Framing Theory to create a message for teens that associates drinking non-sugared beverages with the core value of freedom.  The video advertisements will then use Advertising Theory to package the core value of freedom with the promise that drinking non-sugared beverages will enable them to achieve their aspirations, supported with images and music that tie back into the core value of freedom.  Lastly, the new campaign will create an identity, El Hydratado, for teens that choose non-sugar sweetened beverages.  This community will address peer pressure and ownership by creating an identity for teens that choose water over sugar sweetened beverages, and provide a nucleus around which the movement can build buy-in and gain momentum.

Defense of Intervention 1

            Rather than educating teens about the detrimental health effects of drinking sugar sweetened beverages and then expecting them to rationally weigh the risks and benefits and choose to give up sugar sweetened beverages, the Hydr8 campaign will develop ads that appeal to the core value of freedom to motivate teens to change their behavior.  Freedom is the strongest core value, and teenagers in particular are drawn to things that give them a sense of freedom as they mature and try to develop a sense of individuality and personality while making the transition from childhood to adulthood. 

            The Hydr8 campaign will present the core position that choosing water or non-sugar sweetened beverages will give teens freedom from manipulation by beverage companies and retailers, who strive to influence teens to buy their products for the monetary benefit of the seller, and will give teens freedom from the constraints of health issues such as obesity and type 2 diabetes that can be caused in part by over consumption of calories from sugar sweetened beverages.  The core position will be strengthened by catch phrases repeated in the print and video ads such as “you choose” and “be free,” along with images that link teens drinking water with freedom to choose and rebellion from corporate control.  Together, these will tie the core position to the core value of freedom, which all teens can relate to.

A similar approach was used in Florida’s “Truth” anti-smoking campaign, which strove to appeal to the teen core value of rebellion, taking that away from tobacco companies and using it to strengthen their anti-smoking campaign (18).  The Truth campaign succeeded in lowering teen smoking rates by 7.4 percentage points in middle school students and 4.8 percent in high school students.

Defense of Intervention 2

            The Hydr8 campaign will rely on Advertising Theory to influence the population of teens in Boston, using ads that make the promise that they will achieve their goals if they choose water over soda.  By crafting subtle and creative ads that make the audience feel that choosing water over soda will give them freedom and help them to achieve their goals, the advertisements will get teens to change their behavior before they change their beliefs about sugared beverages and their health. 

Both print and video ads will feature teenage subjects that average teenagers can relate to choosing water over soda and having totally fantastic but relatable experiences.  The video ads will include music (Nick Drake, of course) and imagery that support the promise of the ads.  The promise, imagery and music will all tie in to the core value of freedom, which will hold together the various aspects of the new ad campaign.  The subjects in the ads will be the American “everyteen” with a range of body weights from slim to obese, so that the intended audience of the commercials and ads will see themselves in those that are delivering the message, which will reinforce the strength of the ad campaign by self-referencing.

By using Advertising Theory, the Hydr8 campaign will reach a large audience and get teens to change their behavior around drinking sugar sweetened beverages before they adopt the attitude that sugar sweetened beverages are bad for their health.

Defense of Intervention 3

            Lastly, the new campaign will create an identity for water and non-sugar sweetened beverage drinkers that creates a sense of ownership and buy-in for teens.  This will be similar to a successful anti-smoking ad campaign in Massachusetts, The 84 (http://the84.org), which created an identity for non-smoking teens and a group for them to belong to (19).  Teens will be invited to become part of “El Hydratado”, The Hydrated in Spanish, a group that is identified by the decision to drink water or non-sugar sweetened beverages over soda, sweet teas, sports drinks and other sugar sweetened beverages.  Creating an identity for teens that choose non-sugared beverages will give them a sense of ownership, which will necessarily strengthen their commitment to the cause. 

Another way that El Hydratado will serve to reinforce member commitment to choosing non-sugared beverages is by getting members involved in the movement.  People’s connection with a cause is strengthened when they are given a task to do in support of the cause.  Members of El Hydratado will be encouraged to take a pledge not to let beverage companies take away their freedom by manipulating them to buy sugar sweetened beverages, and schools will be enlisted to start El Hydratado clubs that will host events for members and be involved in the process of schools transitioning to healthier beverage choices in vending machines and in cafeterias. 

            Creating an identity and group for teens that choose not to drink sugar sweetened beverages will provide a nucleus around which the non-sugar sweetened beverage movement in teens can form.  If this movement becomes popular enough, other teens may be influenced to follow their example just by virtue of the existence of the group (17).  Members of El Hydratado will be trained at section meetings about how to set a good example and “nudge” their peers toward choosing water or other non-sugar sweetened beverages in school and at extracurricular activities. 

Conclusion

  The FatSmack campaign, launched by the Boston Department of Public Health in 2011, aims to reduce sugary beverage consumption in Boston teens with a print and video ad campaign that showed teens drinking soda getting hit in the face with blob of gelatinous goo meant to represent fat.  The images are accompanied by the message “Don’t the Smacked by Fat. Calories from sugary drinks can cause obesity and Type 2 diabetes.”  The effectiveness of the existing ad campaign is diminished by its construction based on the Health Belief Model, and failure to put to use alternative, group level behavioral models of advertising theory and ownership.  The proposed modified intervention, Hydr8, would have the same intended effect as the FatSmack campaign, but would use Framing and Advertising Theory to emotionally motivate the target audience, and create an identity for teens that choose not to consume sugary beverages to give them a sense of ownership and build momentum for the movement.  By adopting these alternative approaches to public health intervention the Hydr8 campaign would have a greater likelihood of success in reducing the amount of sugar sweetened beverages consumed by teens in Boston.

REFERENCES

1.       Center for Disease Control and Prevention.  Overweight and Obesity. Atlanta, GA: Center for Disease Control and Prevention.  http://www.cdc.gov/obesity/data/facts.html.

2.      Finkelstein E, Trogdon J, Cohen J, Dietz W. Annual medical spending attributable to obesity: Payer- and service-specific estimates. Health Affairs 2009; 28:w822-31.

3.      Centers for Disease Control and Prevention. Overweight and Obesity Consequences. Atlanta, GA: Center for Disease Control and Prevention. http://www.cdc.gov/NCCDPHP/DNPA/obesity/childhood/consequences.htm

4.      Bray JA, Nielsen SJ, et al.  Consumption of high fructose corn syrup in beverages may play a role in the epidemic of obesity.  Am J Clin Nutr.  2004; 79:537-43.

5.      U.S. Department of Agriculture and the U.S. Department of Health and Human Services.  Dietary Guidelines for Americans 2010.  Washington, DC: U.S. Department of Agriculture and the U.S. Department of Health and Human Services, 2010.

6.      Berkey CS, Rockett HRH, Field AE, Gillman MW, Colditz GA. Sugar-added beverages and adolescent weight change. Obesity Research 2004;12:778–88.

7.      Ebbeling CB et al. Effects of decreasing sugar-sweetened beverage consumption on body weight in adolescents: A randomized, controlled pilot study. Pediatrics 2006; 117: 673-680.

8.     Boston Department of Public Health.  Fat Smack.  Boston, MA: Boston Department of Public Health.  http://FatSmack.org.

9.      Boston Department of Public Health.  Fat Smack.  Boston, MA: Boston Department of Public Health.  http://fatsmack.org/drinking-sugar/.

10.  Boston Department of Public Health.  Fat Smack.  Boston, MA: Boston Department of Public Health.  http://fatsmack.org/be-smart/

11.   Edberg, M. Individual Health Behavior Theories (pp. 35-47).  In: Edberg, M.  Essentials of Health Behavior.  Sudbury, MA.  Jones and Bartlett Publishers, 2007.

12.  Janz NK, Becker MH. The health belief model: a decade later. Health Education and Behavior 1984; 11(1):1-47.

13.  Santrock JW. Physical and Cognitive Development in Adolescence (370-372). In: Santrock JW ed. Life-Span Development. McGraw Hill: New York, 2011.

14.  Fortuna JL.  The obesity epidemic and food addiction: clinical similarities to drug addiction.  Journal of Psychoactive Drugs.  2012;44(1):54-63.

15.   Thomas LW.  A critical feminist perspective of the health belief model: Implications for nursing theory, research, practice and education.  Journal of Professional Nursing.  1995; 11:4(246-252).

16.  Evans WD, Hastings G. Public Health Branding. Oxford University Press; 2008. Available at: http://www.oxfordscholarship.com/view/10.1093/acprof:oso/9780199237135.001.0001/acprof-9780199237135.

17.   Brehm, JW.  Psychological Reactance: Theory and Applications.  Advances in Consumer Research 1989; 16:72-75.

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

19.  The 84.  The 84 home page. Massachusetts: The 84.  http://the84.org.