Challenging Dogma - Fall 2007

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

Monday, December 10, 2007

The MetroWest Childhood Obesity Campaign: A Nocuous Shot at Self-Efficacy- Amaru J. Sanchez

It is abundantly clear that mass communication plays an integral role in our culture and society. Mass media has, in essence, taken a critical part in the American culture’s institutional cores of economics, politics, religion, education, and family (1). Our dependence on the media as an informational resource has led many to ascertain that the media may be responsible for shaping the public’s attitudes and beliefs about certain topics. Mass communication scholar, Melvin DeFleur, alluded to this very concept in his 1975 paper by suggesting that media coverage may serve as an insinuating resource and activator of social problems (2). He further went along to propose that the media may even play a role in actually shaping the very conception of importance to a given topic (2). As the quintessential paradigm for entertainment and culture, the media is in the forefront for influencing our impression of society and therefore establishing any potential concerns that may arise (1). One such topic, which has been given much importance in recent times, has been that of childhood obesity.
Unfortunately, within the past 30 years, we have seen an exponential rise of obese children. The Institute of Medicine’s 2005 report, speculates, that approximately 9 million children nationwide, over the age of 6, are considered to be “obese” (3). “Obese” is a term referring to the physiological state of either being overweight and/or at-risk to be overweight as set forth by the child-specific body mass index (BMI) standards released by the Center for Disease Control and Prevention (CDC) (3). The BMI index is an inferential calculation of an individual’s body fat composition measured via the ratio of the individual’s body weight in kilogram to the square of their height in meters (3). Children would then be considered obese if their BMI ratio is at or above the 95 percentile for their age and gender, and would be termed “at-risk” if the child’s BMI is within the 85-95 percentile range (3). Much attention has been given to this topic due to the health problems associated with childhood obesity such as hypertension and type-II diabetes (3). Since the report’s release, a plethora of efforts have been made to address this issue. One national campaign in particular was able to positively motivate youngsters into action.
From 2001 to 2006, the CDC attempted to thwart childhood obesity by coordinating and promoting the national campaign VERB geared at increasing physical activity among children (4). Much was learned through the VERB campaign’s exploratory research techniques aimed at gaining insight on its target population of children; principally, the acquisition and maintenance of children’s attention on the subject of physical activity. Just after one year, the VERB campaign witnessed a 74% increase in awareness and understanding of the campaign as well as positively affecting free-time physical activity within the subgroup of children ages 9-13 (11). Their success was the result of integrating the fundamentals considered important within their young cohort: activities that are fun, occur in an inclusive environment, emphasized self-efficacy, self-esteem, and belongingness (4). Sadly, funding and support by the federal administration declined, inevitably terminating the campaign. What the VERB campaign exemplifies is how with proper techniques, one can obtain insight on a population and deliver a product that is well understood and supported.
As there are successes, there are failures as well. Unsuccessful campaigns may fail not because of lack of motivation or good intentions, but perhaps in their delivery and insight. One such example is the MetroWest Community Healthcare Foundation’s campaign to address childhood obesity. The campaign aims at educating children and families concerning the health risks associated with childhood obesity, along with promoting healthy food choices and physical activity (5). The comprehensive campaign includes media advertisement in the form of billboard, print in local newspapers as well as television spots. Additionally, the campaign is also providing grants to a plethora of local schools and organizations. Despite their efforts, several considerations were not taken into account that may greatly hinder the success of the campaign. The current campaign relies heavily on an individual behavior change model, known as the Health Believe Model (HBM). This model fails to put into perspective the social and cultural environment that continuously influences our daily lives. The MetroWest Childhood Obesity Campaign will be ineffective in addressing childhood obesity due to its reinforcement of a negative social stigma, its failure to empower its audience and through its improper use of effective persuasive techniques.
The Metrowest Campaign Reinforces Negative Social Stigma Regarding Obesity
Over the years, the literature on the detrimental effects of stigmatization of obesity in childhood has been increasing (6, 7). These articles have highlighted the social impact that obesity has on the individual and the unrelenting effects it has on personal growth, “Obesity creates an enormous psychological burden. In fact, in terms of suffering, this burden may be the great adverse effect of obesity.” (7). Additionally, it has been suggested that the negative stresses and the stigmatic internalization that these individuals endure may have health-related consequences such as eating disorders and cardiovascular disease (6). Similarly, weight based stigmatization has a negative consequence on physical activity. The more the overweight youngsters are victimized, the less likely they are to engage in physical activity, resulting in depressive symptoms and loneliness (6).
But when and where do these forces begin emanating? It is hard to believe, but the fact is that biased attitudes towards overweight peers have been documented as young as 3 years of age and evidently does not have an endpoint (6). With today’s society obsessed with thinness, these constant social and cultural pressures contribute to an increase of weight bias across the country; an unrealistic ideal as to what is considered “normal” and attractive. With these social factors at work, it is not surprising that many of obese children, adolescents, and even parents sometimes blame themselves for not obtaining these inaccurate interpretations of normalcy and consequently, believing the stigmatization that obese individuals are morally responsible for their condition (7).
The apathetic attempt of the MetroWest campaign to address the topic of childhood obesity can be observed in their advertising and marketing campaign. As mentioned earlier, the use of billboards was one of the mediums which they used for promotion. One such billboard read “FAT CHANCE” capitalized and bolded in red alongside the lower extremities of a presumably obese child standing on a scale (5). It is disheartening at the plethora of negative affects that this billboard portrays. Not only does it continually emphasize the undesirability of being overweight, but it highlights the weight-based stigmatization of the term “fat”; a term that many individuals may find derogatory. Furthermore, the negative connotation derived from this billboard reinforces that obesity is a controllable outcome, and may lead some to feel worse about themselves if they have previously attempted to lose weight. What this individually focused approach does is humiliate and blame the individual into feeling helpless.
As previously mentioned, the MetroWest childhood obesity campaign relies on the strategy of a behavioral change model whose focus is short sighted and is not inclusive of other elements beyond the individual. The HBM suggests that in order to motivate an individual into action they must show an increase in the perception of susceptibility, severity, and benefits of the new behavior and a decrease in its perceived barriers (8). What this model fails to take in account are the variances in behaviors that are related to attitudes and beliefs as well as the social environmental factors (9). The MetroWest campaign assumes that these obese children’s behaviors are not influenced by their social environment, one in which we have seen is unrelentingly cruel. Thus, what is primarily lacking with this construct is a thorough understanding of how the individual views the world and themselves.
The MetroWest Campaign Fails to Promote Self-Efficacy
Research studies have observed a relationship between obesity and the development of a low self-esteem (6). Tragically, those most vulnerable to having the lowest self-esteem are children that believe they are personally responsible for their obesity, and thus internalizing the negative stigma (6). We can infer that the weight-based teasing, which these youngsters are being exposed to, has generated a poor body image on these kids and has left them with a feeling of hopelessness and humiliation. It is these attitudes and beliefs that have disheartened and hindered progress in personal weight management. The key element missing is the personal conviction to transgress these negative outlooks and empower oneself to change,
Among the mechanisms of agency, none is more central or pervasive than people’s beliefs about their capabilities to exercise control over their own level of functioning and over events that affect their lives. (10)
What social psychologist, Albert Bandura, is referring to is the attainment of self-efficacy to change how one thinks, behaves, and feels about a certain ideology. Hence, the stronger an individual’s self-efficacy, the higher the likelihood of remaining focused in achieving a goal in spite of adversities. This theory goes further and extrapolates that one’s self-efficacy is also dictated by how the individual’s new action or behavior is socially evaluated. Therefore, an environment has the capability of raising self-efficacy if: it accentuates and harbors the new behavior or skill as something that is acquirable, minimizes negative social comparisons, as well as promotes one’s own personal accomplishments (10).
The MetroWest campaign is antagonistic to the above stated theory. One only needs to look at their “FAT CHANCE” billboard and quickly ascertain that this does little to quite the opposite of building self-efficacy. It demoralizes and places doubt in the individual by insinuating that there is little hope for them. Moreover, it is a clear representation of the lack of empathy for obesity by the community since it is on an enormous advertising venue. The billboard can be viewed as what society and hence, their community, believes. What this does in fact is further stigmatize overweight and obese youngsters, perpetuating the undesirability of being overweight via this negatively focused health message (6). How is a child going to motivate themselves when they feel that no one believes in them? How are they going to feel when they see that the community they live in has spent vast time and resources on a campaign that humiliates and victimizes them? This isn’t a “Call to Action”, as another one of their slogan states; it’s a nocuous shot at building self-efficacy for the child.
MetroWest Campaign Uses Inadequate Persuasion Techniques
Persuasion is a skill and talent that has an unlimited capability of influence in all aspects of human thought and action. The art of persuasion has roots which extends far back into human communication history. Nowadays, it has taken many forms and is used in a variety of communication mediums, one of which includes mass media. In essence, the goal to be ultimately achieved is an “actual modification of behavior” (1). Within the topic of persuasion, one classic strategy can be discussed: The Psychodynamic Strategy. The Psychodynamic Strategy relies on the presentation of a persuasive message that will alter the individual’s cognitive factors (beliefs, attitudes, etc.) and lead into an overt behavior. This strategy aspires to initiate change in human behavior not foreseen or anticipated beforehand. The MetroWest obesity campaign violates several principles in the Psychodynamic Strategy to elucidate an overt behavior.
The persuasive tactics that the MetroWest campaign used is a contraindication of the Psychodynamic Model. This model focuses on the internal learned cognitive processes, particularly attitudes, which are theorized to determine behavior (1). It is said that if one understands an individual’s attitude on a certain topic or belief, then it is possible to ascertain their behavior, and possibly change it (1). Thus, by presenting a persuasive enough message, the persuader can overtly alter someone’s attitude and therefore action. The campaign showed a lack of this understanding by their prejudice stigmatization seen in their “FAT CHANCE” billboard. As discussed earlier, the negative connotation that this billboard displays increases the likelihood of weight-based bigotry, decreases the development of self-efficacy and consequently, ruins any persuasive attempt. The execution of the message is not persuasive at all. Instead of presenting a message that inspires one to alter what they think, feel and act towards obesity, they are in fact discouraging any attempt to do so. It is suffice to say that what we will see is a complete disregard.
Conclusion and Discussion
The over imposing presence of mass media in human civilization today is daunting. No other form of communication in human history has ever had the capabilities of reaching the multitude of people that the media does. It is a powerful force that shapes and alters societies and cultures. The media’s inception in our lives has resulted in a somewhat codependence of information. We rely on the media to dictate and cultivate our beliefs about the world around us. Likewise, the media relies on the world to provide it with information. It is a symbiotic relationship that has been established and will be permanently fixated in human civilization.
Being the forefront for influencing the impressions of society, the media is an excellent gateway for presenting an issue. Recent times have highlighted the ever increasing rates of childhood obesity and its health related consequences. It is not enough to just present an issue; action must be taken to correct it. Johann Wofgang von Goethe put it eloquently, “Knowing is not enough; we must apply. Willing is not enough; we must do.” The United States has previously attempted to confront the issue of childhood obesity through their VERB campaign. Unfortunately, funding was reallocated and the program inevitably was terminated despite significant success. Local governments then decided to take it upon themselves to confront the issue. One such case was the MetroWest Community Healthcare Foundation’s campaign to address childhood obesity. It is a very comprehensive campaign involving several media outlets including print and television advertisements. Despite its good intentions, the MetroWest campaign has been flawed since its development and implementation. In approaching the issue directly with little hindsight, the campaign inappropriately reinforces a negative social stigma about obesity. Additionally, in reinforcing these negative views, there is a lack of social support for the development of self-efficacy within the obese child, a quintessential step in the empowerment of the individual to achieve the goal of weight management. Lastly, these fundamental errors have disregarded several key persuasive tactics to induce change in weight management behavior.
The MetroWest obesity campaign reminds us that tackling a health issue is a multi-layered conundrum that should be approached meticulously and with great prudence.
1. Melvin L. DeFleur and Sandra Ball-Rockeach. Theories of Mass Communication Fifth Edition. Longman: New York, 1989. 123-141.
2. Hubbard, DeFleur, and DeFleur. Mass Media Influences on Public Conceptions of Social Problems. Social Problems 1975; 23(1): 22-34.
3. United States Government Accountability Office. Childhood Obesity: Most Experts Identified Physical Activity and the Use of Best Practices as Key to Successful Programs. Washington, D.C.: United States Government Accountability Office Congressional Requesters, 2005.
4. Food and Nutrition Board. Government (127-192). In: Jeffrey P. Koplan, Catharyn T. Liverman, Vivica I. Kraak, Shannon L. Wisham, Ed. Progress in Preventing Childhood Obesity:How Do We Measure Up? Washington, D.C.: National Academies Press.
5. MetroWest Kids. Resources and Support for Healthy MetroWest Kids. Framingham, MA: MetroWest Community Health Foundation (Accessed October 1, 2007 at
6. Rebecca M. Puhl and Janet D. Latner. Stigma, Obesity, and the Health of the Nation’s Children. Pschological Bulletin 2007; 113 (4):557-580.
7. Erik Z. Woody. The Obese Child as a Social Being and Developing Self. Canadian Psychology 1986; 27(3):286-298.
8. Irwin M. Rosenstock. Historical Origins of the Health Belief Model. Health Education Monographs 1974; 2(4):328-335.
9. Mary Kathryn Salazar. Comparison of Four Behavior Theories. American Association of Occupational Health Nurses Journal 1991; 39(3):128-135.
10. Albert Bandura. Perceived Self-Efficacy in Cognitive Development and Functioning. Educational Psychologist 1993:28 (2):117-148
11. Human M., Potter L.D., Wong F.L., Banspach S.W., Duke J.C., Heitzler C.D. Effects of a Mass Media Campaign to Increase Physical Activity Among Children: 1-Year Results of the VERB Campaign. Pediatrics 2005; 116: 277-284.

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