Obesity and public health campaigns: Finding the Holy Grail

Obesity is a disease. It has been since June 2013, at least according to the American Medical Association (AMA). The AMA formally recognized obesity as a disease with the intention that such a classification would prompt additional funding for obesity research. However, a set of studies published in Psychological Science1 earlier this year suggests that designating obesity as a disease without considering the psychological consequences has a variety of positive and negative implications for obese and average-weight individuals.

Across a set of three studies where more than 50% of the 700+ participants were classified as overweight or obese according to the Body Mass Index (BMI), psychology researchers Crystal Hoyt, Jeni Burnette, and Lisa Auster-Gussman found that obese individuals reported significant decreases in weight concern and body dissatisfaction when they received the message that obesity was a disease, whereas average weight individuals demonstrated no such pattern when exposed to the same message. At first glance, this finding suggests that the “obesity as a disease” model is effective at increasing body satisfaction and, perhaps, decreasing internalized stigma.

Choose Health LA County ad campaign

Example of weight management-focused (incremental mindset) public health strategy

At a recent talk I attended, Dr. Burnette discussed these findings as well as related findings from some more recent studies about the relationship between the obesity as disease message and an entity mindset. An entity mindset is the belief that an ability or characteristic, such as intelligence or weight, is fixed and not malleable as a result of effort or behavior change2,3. Burnette suggested that believing obesity is a disease implies that weight is static, that it’s not people’s lack of willpower or behavior making them obese, but rather, their genes and physiologies. This notion seems to decrease anti-fat prejudice and blame placed on obese individuals4. This approach seems promising: reducing stigma and blame, as well as increasing the likelihood of research funding.

There’s a catch, of course. In addition to the decreased weight concern and body dissatisfaction, obese individuals who saw the disease message were also more likely to make hypothetical unhealthy food choices, unlike average weight individuals or obese individuals exposed to the weight-management control. The researchers suggest that these food choices may be a downstream consequence of the disease label and the entity mindset it may induce. That is, if obesity indicates a physiological malfunction, thus making weight control efforts ineffective, why bother trying? The very message that decreases blame seems to reduce motivation to manage weight, too.

The belief that weight loss efforts are ineffective for obese individuals is not completely implausible. Food researcher Traci Mann and fellow obesity researchers have found that long-term weight loss for obese folks is the exception, not the norm. Receiving the message that obesity is a disease and fixed may be affirming to an obese person who was previously told that weight loss attempts were a personal failing. Regardless, it could be argued that the positive impact of affirmation and acceptance is diminished if it’s accompanied by regular unhealthy food choices.

In contrast, obese participants who were shown the control message of standard weight management strategies demonstrated a different pattern. Their concern for their weight did not decrease, but nor did they subsequently choose higher-calorie, unhealthy foods. The implication, which the researchers mention, is that some level of mild body dissatisfaction may be motivating to eat healthier foods and to be more active. But these findings present something of a double-edged sword, as Dr. Burnette mentioned at her recent talk.

The weight management (control) message may have induced an incremental mindset of weight, the alternative to an entity mindset about weight. An incremental mindset affords people more agency by implying that weight can be altered, presumably through behavior change. Accompanying empowerment, however, is the shift in blame away from an obese person’s genes and onto them and their behavior. As Burnette said, promoting either mindset to obese and non-obese individuals alike can have negative effects.

So, what’s a public health professional to do, particularly when obesity has already been officially labeled a disease? It’s exactly that sort of question that Burnette and her collaborators would like to pursue in future research. Specifically, how should public health messages be structured to motivate and promote an incremental mindset for obese individuals without the body image costs and blame? No obvious or simple answers exist yet. Burnette says that the answer to that question would be “the Holy Grail.”

Anyone out there come across research that might answer this or have a suggestion? Post it in the comments!

 


 

1Hoyt, C.L., Burnette, J.L., & Auster-Gussman, L. (2014). “Obesity is a disease”: Examining the self-regulatory impact of this public-health message. Psychological Science, 25, 997-1002.

2 Dweck, C.S., Chiu, C.Y., & Hong, Y.Y. (1995). Implicit theories and their role in judgments and reactions: A world from two perspectives. Psychological Inquiry, 6, 267-285.

3 Burnette, J.L., O’Boyle, E., VanEpps, E.M., Pollack, J.M., & Finkel, E.J. (2013). Mindsets matter: A meta-analytic review of implicit theories and self-regulation. Psychological Bulletin, 139, 655-701.

4Monterosso, J., Royzman, E.B., & Schwartz, B. (2005). Explaining away responsibility: Effects of scientific explanation on perceived culpability. Ethics & Behavior, 15, 139-158.

 

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Should kids avoid the cereal aisle for their health?

cerealboxpsychology01

Image courtesy of Cornell Food and Brand Lab

Is it just me, or is the cereal aisle much more complicated and sinister compared to when we were kids? Every time I walk down that aisle, my frustration spikes. The choices, so many choices! Chocolate Krave. Cap’n Crunch. Chocolate Cheerios. Frosted Flakes. Even Rocky Mountain Chocolate Factory has a cereal now, featuring chocolate bits that you can eat for breakfast. That last part is meant to pull in the kids, and it works. Those kids will nag their parents to buy it who will eventually give in[i] because, oh, they’re frustrated, too. Maybe even more than I am.

I’m not frustrated because of the mere existence of so many options necessarily. Rather, it’s the quality of the options that is concerning. Are any of these cereals actually healthy enough that children should be consuming them regularly? Not usually. A recent study on cereal quality found that cereal brands marketed to children had 56% more sugar, 52% less fiber, and 50% more sodium than cereals marketed to adults.[ii] Most of these cereals also feature spokes-characters, like the silly rabbit from Trix, Cap’n Crunch, or Tony the Tiger, which are familiar to children and increase the appeal of the cereal brand. And let’s not forget that the combined rate of obese and overweight children in this country is still holding strong at 17%.[iii] That’s nearly 13 million kids.

See what I mean about sinister? Now, brand marketing is not inherently negative, but when marketing of unhealthy foods is targeted toward children, then cereal companies like Kellogg and General Mills take a step into the danger zone. Sugary cereals are perhaps even more insidious than other snack foods because they are junk foods disguised as a friendly breakfast.

In-store marketing strategies take it one step further. Cereal companies pay top dollar to get an ideal shelf location that will appeal to children[iv]. In a recent study published in the journal Environment and Behavior, researchers found that cereal brands marketed to children were more likely to be at a child’s eye level and to contain spokes-characters whose gazes angled downward at approximately the height of an average child[v]. In contrast, cereals marketed primarily to adults featuring spokes-characters (think Wheaties) had level gazes. And this seemingly subtle shift in height and gaze is effective. People in the study reported a strong preference for the cereal that featured a spokes-character that made eye contact. By placing their cereals on the middle or bottom shelf, then, companies are ensuring that children will make eye contact with spokes-characters and feel connected and loyal to that brand.

This type of marketing exploits and manipulates children. Cereal companies should be held more accountable. In the past few years and in recent months, especially, there has been a serious push to create stricter regulations for companies that market primarily to children. Based on the findings of Musicus and colleagues, just one of many similar studies, these regulations can’t come soon enough. The issue of obesity is still current. People may be tired of hearing about it, and obesity rates may have stabilized in several states[vi], but that doesn’t mean that it’s gone away.

But even if we take obesity out of the equation, even if we recognize that not all children have the same risk factors for becoming obese, it doesn’t mean that kids should be regularly consuming unhealthy sugary food. Parents want to protect their children in every way they can, and they’re stretched to their limits as is. Cereal companies, and all other food companies for that matter, should be held to stricter regulations. Some marketing standards have been successfulvii, but more needs to be done. Regulations should stretch beyond nutrition and include specific marketing techniques, such as shelf placement and use of spokes-characters. We shouldn’t make the cereal aisle another battleground where parents need to be on the front lines.

Posted by Jen

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If you’re interested in this topic and would like to learn more, check out the links below.

Center for Science in the Public Interest: Food Marketing Workgroup

Yale Rudd Center for Food Policy and Obesity

Healthy Eating Research

Salud Today

Eyes in the aisles: Why is Cap’n Crunch looking down at my child? (abstract)

[i],vii A Review of Food Marketing to Children and Adolescents — Follow-Up Report. See http://www.ftc.gov/reports/review-food-marketing-children-adolescents-follow-report .

[ii] Harris, J. L., & Graff, S. K. (2012). Protecting young people from junk food advertising: Implications of psychological research for First Amendment law. American Journal of Public Health, 102, 214-222.

[iii] http://www.cdc.gov/obesity/data/childhood.html

[iv] Wilkie, W.L., Desrochers, D.M., & Gundlach, G.T. (2002). Marketing research and public policy: The case of slotting fees. Journal of Public Policy and Marketing, 21, 275-288.

[v] Musicus, A., Tal, A., & Wansink, B. (2014). Eyes in the aisles: Why is Cap’n Crunch looking down at my child? Environment and Behavior, 0013916514528793.

[vi] http://www.latimes.com/science/sciencenow/la-sci-sn-american-obesity-crisis-stabilizing-20140904-story.html.