Smackdown Of FatSmack: A Critique Of An
Anti-Obesity Ad Campaign That Fails in Advertising Theory – Page O’Leary
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).
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
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).
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).
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
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.
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
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.
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
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.
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).
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.
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.
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.
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
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.
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
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
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
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
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.
for Disease Control and Prevention. Overweight and Obesity. Atlanta, GA:
Center for Disease Control and Prevention.
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.
Centers for Disease Control
and Prevention. Overweight and Obesity Consequences. Atlanta, GA: Center for Disease Control and
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.
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.
Berkey CS, Rockett HRH, Field AE, Gillman MW, Colditz GA. Sugar-added
beverages and adolescent weight change. Obesity
Ebbeling CB et al.
Effects of decreasing sugar-sweetened beverage consumption on body weight in
adolescents: A randomized, controlled pilot study. Pediatrics 2006; 117:
Department of Public Health. Fat
Smack. Boston, MA: Boston Department of
Public Health. http://FatSmack.org.
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/
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;
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.
LW. A critical feminist perspective of
the health belief model: Implications for nursing theory, research, practice
and education. Journal of Professional Nursing.
16. Evans WD, Hastings G. Public Health Branding. Oxford University Press; 2008. Available
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.
Labels: Advertising Theory, Blue, FatSmack, Obesity