Wednesday, January 30, 2013

Spring 2013: Will There be an Obesity Tipping Point in NYC – Aileen Ledingham

Spring 2013: Will There be an Obesity Tipping Point in NYC
–Aileen Ledingham

            These are very interesting times pertaining to the association of soda consumption and obesity, particularly in New York City.  Without any doubt, it is of benefit to the American people that the rate of obesity in the population begins to decline because obesity contributes to the disease incidence of diabetes and hypertension.  However, there is a fair amount of doubt regarding the best way to address this issue.   Is this an issue for the government to intervene?  Just as the government has intervened to protect drivers by mandating air bags verses teaching people to drive safely at the speed limit and teaching them not to fall asleep at the wheel.  Or is this an issue for people to make better decisions based on better knowledge of factors influencing obesity. 
            Mayor Bloomberg proposed a ban on the sale of sugary drinks in containers greater than 16 ounces.  The ban was approved by the Board of Health in September 2012 and hence, beginning in March of 2013, food service facilities will have to abide with the law.   Restaurants, movie theaters, street carts, delicatessens (delis) and sports arenas are all such food service facilities (1).  This paper will provide a critique on how the Public Health Department in New York City managed their obesity campaign, and it will provide suggestions on how to improve the campaign’s effectiveness.

First Critique Argument:  
Too much dependence on individual behavior change models
            Educating the public via health clinics and fairs, provision of food coupons for farmers markets, were all expected to reach individuals and help them change their behaviors to decrease obesity (2).  The use of the Health Belief Model, the Theory of Planned Behavior, the Transtheortical Model and the Precaution Adoption Process Model, all limit intervention to the individual level, without consideration for the environment or social influences that the world provides (3).  Secondly, these individual behavior models assume that by providing knowledge, you will change a behavior.  This could be valid, however there is evidence that behavior can change without any knowledge or planning.  In his book R.B Cialdini writes  “In fact, automatic, stereotyped behavior is prevalent in much of human action because in many cases it is the most efficient form of behaving, and in other cases it is simply necessary” (4 pg.6).   Lastly, the conceptual basis of these models asserts that people are rational; we know that is not true.  For example, Dan Ariely writes about  “The Truth of Relativity” how the use of decoy can create an illusion of a better deal, the “deal” being exactly what the seller wants us to buy, because our behaviors can be predictably irrational (5).

Second critique argument:  using health as a core value
            “We are absolutely committed to doing everything in our power to help you get on track and stay on track to maintain a healthy lifestyle,” he said (Mayor Bloomburg) “Because this isn’t your crisis alone — it is a crisis for our city and our entire country”(2).   This is one of many examples where health is used as a core value.  As if having good health is the secret to a lifetime of happiness.  The opponents to the soda ban are using Freedom as their core value.  The campaign by the soda industry emphasizes that individuals will lose their “freedom to buy beverages as they see fit” (1).  The meaning of Freedom instills much more emotion then the meaning of Health.  Resistance to loss is a strong emotion (5).   Once we own the right to buy any size soda we do not want to lose that right.  Intuitively, health should be a motivator, but irrational human reality speaks differently.   The New York City department of public health campaign would be more successful if the message delivered to the target audience had meaning to people who are obese.  Instead, the message is about health and at the end of the day, it is too weak a concept to combat freedom.
Third critique argument:  Poor use of advertising theory.
            One video advertisement I observed illustrated a young white adult male of normal body weight, wearing cloths I would describe as business casual, drinking a pint of liquid fat (6).  The purpose was to impose a fear to getting fat.  The New York City Department of Public Health were hoping that the “disgusting” illustration would promote a viral advertising campaign that will move people toward healthy eating habits, combating obesity (7).
            What were they thinking when they chose the actor?  Maybe they were thinking the demographics of obesity are more prevalent in young adult white males?  Are young white professional males the targeted audience?  I think not, because the area of New York City with the highest percentage of obesity is in the Bronx, where Hispanic race is the majority and White race is the minority (2).     A study conducted by Rehm reported 1. people of black race and hispanic race consumed more soda then white race; 2. households with lower income and 3. individuals with less education consumed more soda (8).    One lesson from the Communications theory to consider:  The person delivering the message has to be likeable, and the more familiar the person is to the audience, the more persuasive the message can be.   I have doubts that a young professional white adult was the right person for this message.  
            This same message “Don’t Drink Yourself Fat” was provided to print media. Were they thinking that capitalizing on psychological reactance would help this campaign?   Telling a person not to do something, only makes it more desirable to do that same thing (9).   “Don’t Drink Yourself Fat” will create a desire to drink fat, in this case fat being soda.  The bold explicit language of the message triggers reactance (10).  This campaign provides no compelling reason to abide by the message; there is nothing to like about it.  The use of a positive message would have more of a change effect then a negative message (11).

Proposed intervention. 

            Promote freedom from obesity.  The New York City public health professionals “need to steal the flag” of freedom.  They need to re-frame their campaign to foster the sense of freedom that can be achieved by having “normal” body weight.  Promote the right for individuals to have access to healthier choices, be free from that temptation of a “better deal” with a larger soda.  Get people to rebel against the soda companies that just want to sell more soda and make more profits.  Fire up some emotion to protect their freedom from the lure of the soda companies.  Find a better reason why people should want to drink less soda.  They need to find a substitution for the fear people have over loosing the control of purchasing larger drinks.  This would be supported by Kevin Hogan who writes “because we naturally resist what we don’t believe and we experience reactance to all that we fear, there is a real need to help customers create new pictures with new information to allow them to arrive at a new outcome in their head” (12).    The first step that needs to be taken is research.   What needs to be know is what aspires the targeted audience; what do obese individuals dream of.  Having this information will help formulate a better advertising campaign.  Having this information provides an opportunity to fit the product of less soda consumption, into a marketing campaign.  Having sound research information, provides opportunity to create a brand that can further help sell the idea of less soda consumption.  Having sound research can foster early adapters to trigger a  “skinny” herd of people moving the campaign across the nation via diffusion of innovation theory.   A campaign with the right frame, the right advertising principles and the right marketing principles can turn this rebellion against the NYC soda ban into a successful “let’s drink something other than soda” movement. 

Why change the core value to freedom
            Freedom is a stronger when compared to health as a core value.  Freedom comes with responsibility, but it has a distant association to loss.  When people feel freedom, they feel strength.  They feel confidence.  They feel like they can concur the world.  
            Freedom from obesity will bring freedom from ridicule of what you are eating or what you are wearing.
            Freedom from obesity will bring freedom from isolation or loneliness because you will feel more desirable to other people. 
            Freedom from obesity will bring freedom from embarrassment due to excessive body sweat. 
            My basic research into how it feels to be obese provided some insight to the idea that these individuals wish to feel desirable, but no one desires them.  Obese individuals are subjected to critical inspection when they eat in public, as to what they are eating.  They live in fear of embarrassing social situations, such as not being able to maneuver into the back seat of a car; or being told they must buy two seats to fly on a plane.  And on a day-to-day basis, they perspire more then most non- obese individuals, a situation that can crush self-confidence (13).
Why use more marketing theory and less individual theory models                    Marketing theory looks at what a group of people want compared to individual health theory which looks only at individuals.  Individual health theories virtually ignore the social aspects of people and the environment that surrounds them.  As if people live in a vacuum.  Marketing theory recognizing and maximizes the idea that people have universal wants and desires.   Knowing those wants and desires can foster a campaign to reach masses of people.  Behavior can be changed because an individual wants to become part of a group movement (11).   This change in behavior can happen automatically, without any planning (4). 
            One of the key aspects of marketing theory is creating a brand.  This strategy was successfully used in the Truth Campaign, which facilitated adolescents to rebel against the tobacco industry (14,15).  Having a brand provides an identity of a promise.  One promise that could be used in the NYC campaign is “NoSweat”.  It would be implicit to obese people.  It would promise that decreasing soda intake will decrease bodyweight, which in turn will decrease body sweat.  The term “no sweat” has an alternative meaning of “taking it easy”.  I think this positive message is far more attractive then “Don’t Drink Yourself Fat” and I am confident, because the positive message is also more subtle, there would be less psychological reactance and the message would be better received by the targeted audience. 

Why change the advertising campaign, and how to change it
            The message of the current advertising campaign is not effective, it instills psychological reactance and actually reinforces the act of drinking soda.  What follows are my ideas on how to make improvements to this New York City advertising obesity campaign.
            Create a promise of happiness due to being free of obesity.  By doing the right research, within a community of obese individuals, the means of their happiness can be discovered and used to sell the promise of being happy (16).   
            Incorporate the message with as many images as possible of overweight, Hispanic & Black people drinking water instead of soda.  Sell the message that water can be free, be happy not to spend money on soda.  Support the message with a popular song by someone like Enrique Iglesias.  The use of music can set a emotional tone that can reinforce the promise of happiness.
            Create a commercial using a celebrity such as Viola Davis.  I would choose someone like her because of a number of reasons.  First, she is a woman in her late forties.  A woman in her late forties can implicitly bring motherhood into the picture.  Mothers can influence a child’s choice and promote non-sugary drinks.   Second, she is black and therefore looks similar to a majority of people in NYC who are obese. Third, she is of average body size – not too skinny.   Because of her successes, I think the targeted audience can use her as a model of body weight to aspire to.

Conclusion:  Will there be a tipping point
             There are two points that Malcolm Gladwell writes about in his book referring to epidemics:  1. it needs to be contagious and 2. there is a need for geometric progression where the action is repeated to an explosive level and it is surprising how a little action is out of proportion to the cause. (17).
            I believe, given the right advertising campaign, early adapters of switching from drinking costly soda to drinking free water is a possibility.   “Free” is contagious and it could spark a tipping point.  This could be achievable given the right, multifaceted approach using Advertising Theory, Marketing Theory, Communication Theory and Diffusion of Innovation Theory to change behavior.

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            2. WINNIE H. Obesity ills that won’t budge fuel soda battle by Bloomberg,                          The New York Times 2012; June 11, 2012
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            9.  Brehm, S., Weinraub, M. Physical barriers and psychological reactance:               2-year-olds’ responses to threats to freedom. Journal of Personality                         and Social Psychology 1977, 35(11):830-836.
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            15.  Bauer, U.E., Johnson, T.M., Hopkins, R.S., Brooks, R.G. Changes in                         youth cigarette use and intentions following implementation of a                                 tobacco control program.  JAMA 2000; 284(6):723-728.
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