Challenging Dogma


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

Wednesday, April 25, 2007

Why Healthy People 2010 Will Not Positively Impact Childhood Obesity – Helyn Wynyard

As childhood obesity has begun to achieve epidemic proportions it has become the focus of national health policy. Initiatives have been put in place by public health policy makers to address the issue. This paper will focus one of their current initiatives and why, I believe, it cannot be successful. Alternative methods of delivering the message to the target audience will also be explored.

From 1991-2000, concerns about obesity among children in the United States began to emerge. Among children 6-19 years old, 16% are classified as overweight or obese (1). Among ethnic groups, these rates are even higher (1). In the Mexican American community, 22% of children aged 6-19 years are overweight or obese (1). Twenty-two percent of non-Hispanic black children in this age group and 30% of American Indian children 6-19 years are classified as overweight or obese (1).

There are serious health issues associated with childhood obesity such as hypertension, dyslipidemia, glucose intolerance, type 2 diabetes and arthritis (2). Based on these concerns, public health officials have initiated policies to try to change behaviors. I will look at a specific initiative, Healthy People 2010, and examine its goals, approach and why it will not be successful.

Healthy People 2010 seeks to specifically reduce the proportion of children and adolescents who are overweight or obese from a baseline of 11% to a target of 5% by 2010 (1). This public health policy focused on education, food labeling and advertising, food assistance programs and health care and training (1). Specifically, some of the initiatives of this program are school based and focus on nutrition and weight management education, more physical activity and sports in schools, and ban high sugar foods and soft drinks from school cafeterias and insure that foods offered in school meet federal nutritional requirements (1) . Healthy People 2010 implements programs that restrict advertising of high calorie, low nutrient foods in programs commonly watched by children and require broadcasters to provide time for healthy eating and activity messages (1).

Healthy People 2010 is a national initiative which must be disseminated on a state and local level. Formal partnerships with governmental and non-governmental organizations have been formed to work out policies and guidelines that will address childhood obesity at the school level. In addition, state government has been brought into the Healthy People 2010 initiative (3).

The strategies as put forth by the national consortiums have focused on programs that co-ordinate the efforts and resources of education and health services to develop programs that target children and try to promote positive behaviors (3).

The above initiatives are broad-based and multi-faceted and one would expect that they would be successful. However, because this approach is essentially based on the Health Belief model, it will not succeed. The Health Belief Model, in order to be successful requires the target to have a perception of severity associated with the condition targeted as well as a perceived susceptibility. In the case of childhood obesity, most parents do not see a problem with their children being overweight or obese unless there is a health issue associated with this condition (2). In addition, children themselves do not perceive being overweight or obese to be a problem until it impacts their appearance or performance (2). As a result, the fundamental beliefs you must have to internalize the message of the Health Belief Model do not exist here.

As a society, our health as a goal competes with many other social factors. Most Americans, particularly working women suffer from time poverty. We have learned that our lives will run more smoothly if we can make easy and accessible choices. It can be difficult to find the time to shop for and prepare nutritious and low calorie meals. Children have logged hours in front of television sets watching thousands of messages for sugary cereals, soft drinks and fast food. A program attempting to change behaviors based on the Health Belief Model will fail every time because it does not address the needs, desires, and limits of its target. In a society where people must focus on the here and now to meet their needs, a message on future health risks will not resonate.

The second major issue I see with the approach of Healthy People 2010 is that it does not present the message in a way that children and adolescents will relate to. The implementation is one which currently is crafted by adults and appeals to adults (2). This is a message that adolescents will not hear. In order to appeal and initiate change among adolescents, you must target the core group of change leaders in their community (2). These change leaders are usually seventeen and somewhat rebellious. This is the group that younger children look up to and try to emulate. Once this core has adopted a behavior, it will trickle down to the rest of the adolescent and younger community. In addition, in order to reach youth, you must give them their own defined place in which to find information. This is the tact adopted by the Truth campaign which targeted youth to not smoke when they disseminated the message on-line (2).

Marketers, including the fast food industry have become very sophisticated at promoting their products to children. They employ researchers, psychologists and advertising agencies to help them better understand the behavior and aspirations of children (4). This positions them to more effectively market their products. Marketers have also found that by making their products available to the coolest kids, they can develop a “street marketing” strategy that will appeal to their younger consumer (4).

The fast food, cereal and soft drink industries are very sophisticated in delivering their message to America’s youth. They begin at a very early age and many advertise in children’s programming and develop a brand awareness that grows with the child. They are also adept at understanding what influences their target market. Unlike Healthy People 2010, their message is not an adult message put in front of children. It is a message that reflects how adolescents view themselves in their community. A good example is the McDonald’s “I’m Loving It” campaign. This advertising campaign shows a group of hip, attractive and socially adept older teens eating McDonald’s food in a joyful and engaging environment. This represents selling a concept through by utilizing the core group that most youth aspire to. It also relies on basic advertising concepts of selling the benefit and promise of the product. It has a core value that is very strong and offers immediate gratification.

Advertisers have discovered that by treating young adolescents in a more mature fashion, they can remove parental influence (4). By removing the parental influence, they can play on pre-teen and teen insecurities. This then positions them to present their product and the message that in order to be cool, you must have whatever they are selling (4). Advertisers employ people to find out the latest trends so they can be brought back and marketed (4). They also are able to effectively reach adolescents through appropriate magazine and television advertising and sponsoring rock concerts (22). If public health practitioners are to be successful in reaching children with their message targeting childhood obesity, they will need to employ the tactics described here.

Since, as we demonstrated, marketers are so sophisticated at manipulating their target audience, one would assume that restricting advertising geared to children and youth would solve this problem. This tact was tried in1978 and was unsuccessful. The consumer businesses that stood to lose revenues objected and blocked the Federal Trade Commission’s efforts. It is my belief that these industries must have governmental and social pressure put on them to commit them to the fight against obesity.

One approach would be to require them to create concurrent messages aimed at youth that focus on healthy diet and exercise. They have already created a brand that this group buys into and their message around this lifestyle change would be more readily heard. They would also be required to couch this message in the same effective environment they use to sell their products. Another more controversial approach would be to present being overweight the way smoking is now viewed in this country. It has become socially incorrect to smoke. Smokers are restricted to stand outside their office buildings to smoke. In a similar vein, the message can be disseminated that it is uncool to be overweight or obese. Positive images around healthier lifestyles would be promoted to children. Again, these images would have to appeal to children not adults. Unlike the current images of impossible thinness promoted by magazines and the fashion industry, these messages would be about gaining control over your body and not letting big business negatively influence you with their messages around food.

The problem of childhood obesity will not be solved easily. However, until public health policy makers decide to understand what motivates the adolescent audience they are trying to reach, they will not be successful. In addition, they must adopt an “if you can’t beat them, join them attitude” with regard to food marketers. They would be more successful if they engaged this group and incentivized them to be part of the solution to the problem they contribute to. We may not achieve the goals of Healthy People 2010, but we may achieve Healthy People 2015.

References

  1. David L. Katz MD, Meghan O’Connell MPH, Ming-Chen Yeh PhD, Haq Nawoz MD, Valentine Njike MD, Laurie M. Anderson PhD, Stella Cory MD, William Dietz MD PhD. Public Health Strategies for Preventing and Controlling Overweight and Obesity in School and Workplace Settings, CDC MMWR Recommendations and Reports, October 7, 2005/54 (RR10); 1-12

  1. Strategic Plan for Overweight and Obesity Prevention – New York State Gisela Germano, Vice President Account Direct MPG Arnold Advertising www.health.state.us/prevention/obesity/strategic_ plan/major_threat.htm

  1. Carolyn Fisher EdD, Pete Hunt MPH, Laura Kann PhD, Lloyd Kolbe PhD, Beth Patterson MEd, Howell Wechsler EdD, Building a Healthier Future Through School Health Programs USA.gov

  1. How Marketers Target Kids www.media-awareness.ca

  1. Marion Nestle PhD MPH, Michael Jacobson PhD, Halting the Obesity Epidemic: A Public Health Policy Approach, Public Health Reports January/February 2000: Volume 115

  1. Children’s Food Choices, Parents’ Understanding and Influence, and the Role of Food Promotions, www.ofcom.org.uk

  1. Michelle M. Mello JD PhD, David M. Studdert LLB ScD MPH, Troyen A. Brenman MD JD MPH, Obesity-The New Frontier of Public Health Law, The New England Journal of Medicine Health Policy Report June 15, 2006 Number 24 Volume 354:2601-2610

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