Challenging Dogma


...Using social sciences to improve the practice of public health

Wednesday, April 25, 2007

VERB, It’s What You Will Not Do: How the CDC Fails to Effectively Target the Childhood Obesity Epidemic - Allison Siebert

Today, one of the most prevalent topics in public health and the media is that of childhood obesity. In the past few decades, youth obesity rates have skyrocketed. According to the American Obesity Association, around 15.5% of adolescents are considered obese, compared to 5% twenty years ago (1). One reason for this change is due to societal changes. Children today lead more sedentary lifestyles due to the advances in technology that provide them with video games and computers. Also, the average family dynamic has changed. More women are in the workforce today than ever before and do not have time to provide a sit-down family dinner. Also, single parents are more common with higher divorce rates, and tend to work multiple jobs. Unfortunately, this lifestyle leads to feeding youth in the most efficient, affordable way and that often means fast-food. Today, we are a society of convenience, which has caused us to be less physically active. The price we pay for modern convenience and efficiency is now becoming a health problem, especially for our youth. Currently children are having such health problems as Type 2 diabetes. This was unheard of twenty years ago. Not only is this a popular media topic, but a national health crisis.

Now that obesity has become a national pubic concern, many public health organizations have campaigned to educate the public and slow the problem. The Center for Disease Control and Prevention is one of the organizations involved in a social campaign targeted at the childhood obesity epidemic in the United States. The campaign is most commonly known as VERB. You may recognize the popular slogan it advertises on television commercials, “Verb, It’s what you do” (2). The purpose of the campaign is to make exercise “cool” for youth and to encourage them to maintain physical activity along with an overall healthier lifestyle. The campaign mainly targets tweens, youth between the ages of nine and thirteen. It also reaches out to a secondary audience of parents, teachers, health professionals, and others closely involved with youth. Verb’s approach to the public offers a website detailed with numerous facts and game ideas for physical activity. It also offers pamphlets, stickers, posters, and other tools that can be downloaded and distributed to youth.

The goals of the campaign are commendable, but fail to address other factors of obesity, such as poor nutrition, socioeconomic status, maturity level of youth, and more. The technique used in conveying the message is also deficient in its approach. The campaign is based on the logic model, which incorporates ideas from common social and behavioral models, such as the health belief model. The idea is that through input from facilitators and activities a “buzz” will be generated which will in turn change beliefs and attitudes to produce a behavior (2).

Exercise is not the only answer:

The campaign focuses on exercise as the main solution to solving the obesity epidemic. The overall mission is to educate youth about the dangers of a sedentary lifestyle and to influence and encourage them to stay active. The goals as stated by the CDC campaign are as follows: increase knowledge and improve attitudes and beliefs about tweens’ regular participation in physical activity; increase parental and influencer support and encouragement of tweens’ participation in physical activity; heighten awareness of options and opportunities for tween participation in physical activity; facilitate opportunities for tweens to participate in regular physical activity; and increase and maintain the number of tweens who regularly participate in physical activity (2).

VERB is distributing stickers, pamphlets, and online game ideas to encourage kids to be physically active. The stickers, posters, and game ideas are designed to excite and educate youth about healthy lifestyles (2).

All of the goals stated by the Verb Campaign only address physical activity as a solution. While physical activity is certainly a key factor in maintaining a healthy lifestyle and curbing obesity, it is not the only factor. The problem of childhood obesity is multi-factorial. Such factors as poor nutrition, socioeconomic status, and others also play a significant role in obesity. These factors must be considered as a whole to effectively address the issue. The program is failing because it is saying that exercise is the best and main way to solve the problem. The campaign is too narrowly focused. How can one live an overall healthier lifestyle without knowledge of nutrition? If I run eight miles a day, but only consume happy meals, chips, and soft drinks, how will I really be a healthy individual?

Also, the campaign should take into account socioeconomic status of those children most likely to be affected by obesity. Children of low socioeconomic status tend to be disproportionately affected by obesity. According to Gortmaker et al., “women who had been overweight had completed fewer years of school, were less likely to be married, had lower household incomes, and had higher rates of household poverty than women who had not been overweight (3).” Another study by Parsons et al. states, “an associaton between obesity in adolescence and undesirable socioeconomic consequences, such as lower educational attainment and income, has been observed (5).” Children that reside in a relatively poor community may not have access to expensive organic foods, and fresh fruits and vegetables. Instead, the tweens may be presented with a fattening, less expensive fast-food meal. If these youth come from a single parent environment, it is highly likely the parent is working multiple jobs to support the family. In this case, fast-food may be the most obvious choice due to finances and convenience. Tweens at this stage of life still depend on their parents and guardians. Therefore, whatever the parent provides for food is what the youth will eat. The child may grow up not knowing what is appropriate for nutrition.

Failure to reach the target audience:

This aspect of the campaign relates to another failing factor of VERB. The campaign targets youth between the ages of nine and thirteen years of age. The campaign states that, “parents, partners, and professionals who serve tweens can take advantage of VERB’s reach to tweens and the excitement the campaign is generating among this age group to get moving” (2). The campaign’s website provides tweens with resources to encourage physical activity and to make it “cool” for tweens. Verb is confident that it can influence youth by distributing posters, stickers, and by displaying game ideas for physical activity on its website. One of VERB’s game options is to download VERB YELLOWBALL. The game advertises, “nothing can replace the rush and exhilaration of physical activity; Yellowball ignites desire for physical activity freeing kids to play out their dreams—I can’t NOT play (2)!” How is a sticker motivating a child to go out and play baseball or go for a jog? How does sitting at a computer playing a video game encourage youth to go outside and play?

The campaign fails because it is not truly reaching the target audience. At this stage of life, “tweens” are still quite immature and most intensely influenced by their peers. They look to their friends for acceptance and modeling. True the campaign looks to incorporate the factor of influence, but not in a realistic manner. Often, youth are encouraged to participate in more activities that are taboo and dangerous, such as smoking or drinking alcohol. This is because it creates excitement for the youth. Exercising is neither taboo nor dangerous.

The campaign website addresses the various chronic health risks of being overweight, such as heart disease, Type 2 diabetes, and many more. Verb’s website states, “being overweight can increase one’s risk for Type 2 diabetes, high blood pressure, sleep apnea, and gall bladder disease (2).” Youth of this age cannot be truly impacted by health scare tactics. They simply cannot relate. How can you ask a nine year old to think about being diagnosed with diabetes forty years from now?

Another factor related to this issue is that of socioeconomic status. Areas of poor and low socioeconomic environments tend to have a higher concentration of childhood obesity. Youth may want to play outside and go to the park, but due to neighborhood crime rates, it may not be safe.

Ineffective and Weak Models:

Lastly, the campaign is stating that their ideas for intervention stem from a specific logic model. The model is created from ideas originating from various social and behavioral models. Ideas from such traditional models as the Health Belief Model and Theory to Reasoned Action Model most likely were incorporated to create this program. The logic model states that through input from facilitators and activities a “buzz” will be generated. This, in turn, will change beliefs and attitudes to produce a behavior. The inputs for the campaign are consultants, staff, research and evaluation, contractors, community infrastructure, and partnerships. The activities are advertising, promotions, the web, public relations, and national community outreach. After the implementation of these activities, the program expects to see short-term outcomes. The short-term outcome is the awareness or “buzz” among the youth and adult facilitators about physical activity. This awareness then leads to mid-term outcomes which are states as changes in subjective norms, beliefs, self-efficacy, and perceived behavior control. The campaign hopes to have youth encourage their parents and other adults to support them in exercising. What parents or adult guardians would not support youth being physically active? Lastly, the long-term outcomes are to maintain a healthy, physically active lifestyle. This is to manage weight and prevent chronic diseases later in life (2).

This program model is influenced by ideas from such traditional social and behavioral models as the Health-Belief Model and Theory of Reasoned Action Model, which have been continuously criticized for being weak and ineffective. These models assume that human beings are rational individuals when well-informed, but this is not reflected in reality. For example, individuals know that smoking is a dangerous behavior and can lead to lung cancer. However, many continue to smoke. Another example of clear irrational behavior, despite education is that of alcoholics who continue to drink post liver transplant. In a study by Dr. Tram T. Tran, “nineteen percent of patients had recurrent alcoholism and 52% of those who resumed drinking developed recurrent cirrhosis (4).” These examples show that although people are informed about their health risks and their severity, they choose their own perception of the degree of severity and do not make rational decisions. According to a social psychology article by Martyn Denscombe, “personal health constitutes a commodity which people are willing to trade off against other benefits (6).” The CDC may be informing and educating the youth, but it does not mean that it will result in a rational behavior change.

Conclusion:

In conclusion, I believe that the CDC and the Youth Media Campaign have the best interests of the public at heart. However, they should reevaluate their techniques and broaden their view of childhood obesity. The campaign is failing to see the problem of childhood obesity in its entirety. Once the multivariate factors are all addressed; I think we can hope to see a vast improvement.

References:

1. American Obesity Association. Childhood Obesity: Prevalence and Identification. Washington, DC. http://www.obesity.org

2. Centers for Disease Control and Prevention.Verb: Youth Media Campaign. Atlanta, GA. http://www.cdc.gov/youthcampaign

3. Gortmaker et al., Social and Economic Consequences of Overweight in Adolescence and Young Adulthood. The New England Journal of Medicine. 1993; 329: 1008-1012.

4. Tran, Tram T. M.D.; Controversies in Liver Transplantation. 56th Annual Meeting of the Amercian Association for the Study of Liver Diseases-Complications of Cirrhosis. http://www.medscape.com.

5. Parsons et al., Childhood Predictors of Adult Obesity: A Systematic Review. The Department of Epidemiology and Public Health. Institute of Child Health. London, UK. 1993.

6. Denscombe, Martyn, Personal Health and the Social Psychology of Risk Taking. Health Education Research. Vol. 8, No. 4, 505-517, 1993. Oxford University Press.

Labels: , ,

0 Comments:

Post a Comment

Subscribe to Post Comments [Atom]

<< Home