Challenging Dogma - Fall 2011

Friday, December 23, 2011

The Failure of Creating an Effective Campaign: A Critical Analysis of “Beating Eating Disorders” with Proposed Modifications –Shamaila Usmani

The Failure of Creating an Effective Campaign: A Critical Analysis of “Beating Eating Disorders” with Proposed Modifications –Shamaila Usmani


The National Institute of Mental Health describes eating disorders as “an illness that causes serious disturbances to your everyday diet…the urge to eat less or more spiraled out of control”. (1) It is prevalent throughout the world, in some form or another, with societal and environmental factors often contributing to the illness.

It is only recently that abnormal eating patterns and related research have emerged into public spheres as celebrities and other influential people started speaking about their eating habits. (2) A custom once practiced in secret for centuries, the 80s brought along a wave of awareness about these issues and a higher prevalence of disordered eating. (3)

Many campaigns have attempted to use awareness as a technique for change. Others have used disturbing ad campaigns trying to play with emotions, but statistics continue to rise spreading to different age groups and demographics. (4)

This is due to the lack of understanding the target population’s needs. Often times campaigns are built upon what creators think they need not what they actually need. Campaigns need an element of understanding and appropriately addressing the root causes, in addition to providing the right resources, planning the correct interventions at the right times, as well as portraying appropriate role models in creative ways.

Beating Eating Disorders (Beat): Current Approach

Beating Eating Disorders (Beat) is the United Kingdom’s only nation-wide eating disorder organization, which campaigns for individuals, family and friends affected by eating disorders. Founded in 1989, Beat has come a long way since their beginning, including a change in name and vision. Many organizations and British celebrities such as Keira Knightly have supported Beat. Their activities are primarily based on raising awareness by providing information about eating disorders, lacking solid prevention component. Beat’s missions and aims are as follows:

Mission: “Eating disorders will be beaten”

Aims: “To change the way everyone thinks and talks about eating disorders”, To improve the way services and treatment are provided” and “To help anyone believe that their eating disorder can be beaten”

Although Beat has many different annual activities such as conferences and awareness weeks, their main source of support is through online services. Beat has two help-lines, online resources in addition to media including videos. (5)

However the foundational core that Beat is built off of is highly flawed. While their campaign aims to change the way people think and help inspire change amongst those that have the disorder, it really succeeds to isolate those that are suffering by making assumptions about their behavior. Beat’s approach to beating eating disorders is flawed for the following reasons: 1) inappropriate use of the Theory of Planned Behavior as a platform for behavioral change, 2) failure to create a behavior through the Social Learning Model and 3) it fails to take the root causes into account.

1) Using TPB: Human Rationality, Feelings, and the Lack of Perceived Control

Icek Ajzen first proposed the Theory of Planned Behavior (TPB) in 1985. Evolved as a revised version of the Theory of Reasoned Action, the central idea of the TPB is that behavior change occurs due to a combination of three factors: attitudes towards behavior, subjective norms, and perceived control. The individual internally weighs these three factors to procure an intention, which supposedly will lead to behavior change. (6)

Beat relies on the TPB as a platform to encourage individuals to either call Beat’s helpline or to make a positive behavior change related to his/her eating disorder. It is assumed that providing information and creating awareness will contribute to controlling the behavior or at least calling Beat’s helpline. Things such as workshops, awareness weeks, and mental health conferences are all aligned with their goal to raise awareness about eating disorders. The program continues to assume that by using examples of the emotional toll the behavior takes on the family and friends through videos, the targeted individual will succumb to the subjective norms leading to behavior change. Lastly, the program assumes that the targeted individual believes that s/he is capable and has the desire to take control of the behavior therefore will access the program’s resources: help-lines and online resources.

However, the program fails to take into account that raising awareness about eating disorders is ineffective as it relies on human rationality, forgetting that humans generally make irrational decisions. Dan Ariely explains this concept in his book Predictably Irrational as he states that humans are irrational or not capable of making the perfect and most ideal decisions. (7) For example in a rational world, one could assume that awareness campaigns including statistical information about eating disorders would somehow contribute to either prevention of the behavior or a positive behavior change. Unfortunately there are many cases that show exactly the opposite. The prime example is the Drug Abuse Resistance Education (D.A.R.E), which is a school based prevention mechanism that informed preteens about the dangers of drugs and alcohol. Over the years, numerous research studies were conducted to analyze the effectiveness of the program. It was found that tobacco and marijuana use was not reduced. Another study found that the knowledge of the types of drugs may have gone up, but alcohol and marijuana use was not affected. (8) In essence individuals are less likely to care about the core value of health, as they do not value the connection between their health and the information provided, nor do they understand the link.

In addition, Beat also assumes that the individual will be more likely to be motivated to change if s/he sees the effects of their behavior on friends and family. The video’s caption that portrays this is as follows: “The clip is about the effect eating disorders has on the family and the emotional process that the family goes through…how we have all moved forward by turning something so negative into something positive”. (9) Watching this video can ignite emotions of guilt as the individual may feel that s/he is putting their family through emotional turmoil. This idea of guilt is not the appropriate method especially since the disorders are often instigated by feelings of guilt and blame. (10) Beat’s expectation that individuals will be motivated by subjective norms is gravely flawed.

Lastly, the assumption that individuals will want to and are capable of controlling their behavior is faulty. A study conducted by Erica Berman at the University of Toronto shows that low eating self-efficacy is linked to negative thoughts about body image and weight preoccupation, both of which are considered to be traditional eating disorder symptoms. In addition, low eating self-efficacy is also linked to eating problems such as binge eating in both male and females. (11) Assuming that these individuals are capable (and have the desire) of taking control of their eating actions cannot be assumed until other underlying factors are addressed. Perhaps then, these individuals will make an effort to access these resources, as they will believe that they can control their actions.

2) Social Learning Theory: Failure to Create a Behavior, which Individuals will follow

The Social Learning Theory (SLT) suggests that individuals act/learn by watching and modeling others. “Most human behavior is learned observationally during modeling and from observing others, one forms an idea of how new behaviors are performed”. (12) This theory seems essential to understanding how affected individuals will model behavior if they are urged to seek help.

Beat has recorded many videos of which five are found on their website. One of these five portrays the stories of five individuals who have dealt with eating disorders. Beat tries to use the SLT with the expectation that individuals will be inclined to change their behavior once they see there are others who have gone through what they are currently experiencing and the positives of overcoming the behavior. The video caption claims that it is aimed towards “people who are suffering or are worried about someone who may have an eating disorder”. (5) One main issue is that most of the chosen individuals are pretty and relatively thin. The target individuals will be less likely to listen to those speaking about their experiences as their irrationality (stemmed from low self-esteem and body dissatisfaction) will not allow them to look past how these girls look. In fact it can even lead to more disordered behavior, which can lead to the SLT never taking off.

It is apparent that Beat never considered the negative effects that this could have on their intended population. This negative effect is otherwise known as Psychological Reactance Theory (PRT). According to this theory, people respond to perceived behavioral threats to their freedom by reinforcing control of their actions. (13) In other words, being told to do something (especially by those one does not hold in high esteem) will result in continued (or increased) engagement of behavior.

Another issue is that diversity is not acknowledged in this video, nor in most of their other productions. There is only one age group, one gender, and one race represented in this video even though eating disorders affect a wide range of age groups, races, and genders. (14) Beat claims to be working towards a national goal emphasized by words such as “everyone” and “anyone”, but their campaign, especially their website, hardly reflects this. In fact there is not a single colored person on their website (including the videos) and a limited number of males represented in their campaign. It is unfortunate that they have not taken other demographic factors into account, as this would contribute to Beat’s overarching mission of “to change the way everyone thinks and talks about eating disorders”. In addition Lizabeth Barclay suggests that because the social learning theory is an interactive approach, it is necessary to address issues of discrimination so that a more complete modeling behavior can occur. (15) In other words, people are more likely to act similar to those that are like them.

3) Failure to Emphasize the Root Causes

Beat’s main goals consist of finding ways to help individuals beat eating disorders. It seems more appropriate to have a greater emphasis on targeting prevention and the root causes rather than treatment. Beat does have a small prevention component but it is not as comprehensive or developed as the treatment portion.

The prevention component should look at key contributing factors. The Beat campaign unfortunately overlooks many of these key factors involved in acquiring eating disorders as well as trying to overcome them. In fact the question “why?” is barely if at all addressed. This is visible throughout their videos as well as their online resources. For example media influence (societal pressure), peer and family pressure and stress are three huge aspects of why individuals partake in these behaviors (10) yet Beat barely addresses them.

In addition, Beat wrongly assumes that each individual has friends and family that will support them through their struggle. This generalization is quite troubling as each person’s situation is different. In fact the lack of this social support (either family/friends encouraging thinness OR no friends/family leading to depression) could be a reason why they have the disorder to begin with. (10) For all Beat knows, the videos may be instigating a self-perpetuated cycle of depression and the individual’s behavior. It is very important to explore the root causes before building a campaign.

Proposed Changes: FREEDOM.

Beating Eating Disorders has the potential to rise as a successful campaign once a few changes are made. A two pronged approach will be the most beneficial as it will firstly, address their two relevant aims of “To change the way everyone thinks and talks about eating disorders” and “to help anyone believe that their eating disorder can be beaten” and secondly, incorporate a new aim “to prevent the occurrence of eating disorders through a holistic approach”. This new addition to their program will introduce a strong prevention component known as FREEDOM. to reduce the incidence of eating disorders.

1) What (Wo)men Want

Theory of Planned Behavior fails to take into account the numerous factors that individuals with eating disorders experience therefore Beat needs to remove the TPB as the platform for behavioral change. The proposed change strategy will incorporate the Social Marketing Theory (SMT). This group level model is more ideal than the individual-based TPB and is far more likely to initiate behavioral change.

Beat will work within the framework of the SMT to research the target audience’s needs and wants in relation to different environments (high school/college, friends, family, and other effective environments). (16) Researching the target audience will also lessen the chances of instigating behaviors related to eating disorders, as well contribute to understanding who influences these individuals the most.

The SMT will then be used to develop new content for the same activities Beat has been conducting (workshops, hotlines, “awareness weeks”-will be changed to “empowerment weeks”-, conferences, etc.). The content will now be built directly off of what the target population wants, not what Beat believes they want. The product will be delivered through messages and content containing a core set of values including freedom, control, trust, acceptance, power, self-worth and hope. (17) The integration of these values is essential, especially as this population is more likely to lack confidence and self-worth. (10)

The use of the SMT is essential as the group level model motivates far more than an individual level model. The mere process of researching the target audience can make a world of a difference in reaching out to these individuals. Through the SMT, three critiques of the TBP (irrationality, accidently instigating disordered behaviors, and the desire to want to control the behavior) are addressed.

Too Hot in Here

The last critique of the TPB regarding underlying factors and self-efficacy will be addressed by a combination of the prevention component, which will be addressed later, as well as Ariely’s idea of “cold” and “hot” states. (7) Ariely demonstrates, through experiments that rational decisions vary depending on which emotional state a person is in. In a “cold” state, decisions are rational but in a “hot” state, decisions vary greatly. In a hot state, one is more likely to have a realistic expectation of what they are capable of Ariely states that is essential to understand the decisions that will be made in a hot state. His sexual arousal experiment can be related to eating disorders as well, since certain factors instigate the behavior. He suggests that teens need to be taught to turn away from temptation before they’re too close and are enveloped by it. His experiment results say that it is easier to avoid temptation than to overcome it. (7)

This can be applied in the cases of specific disorders such as bulimia and compulsive eating. Ariely’s theory of “cold” state/ “hot” state should be factored in to Beat’s trainings for mental health professionals, so that professionals can integrate it into their therapy. This behavioral change approach of training individuals to turn away from temptation before they are close to either purging or binging can result in self-efficacy as well.

In addition to Ariely’s suggestion of turning away from temptation, part of the prevention/treatment campaign will include posters in bathrooms (near sinks and in stalls) with creative messages integrated with core values and pictures of a brighter future and hope. Intervening in the “hot” state will also return “control” to these individuals, further encouragement for perceived control.

2) Model On

The SLT an ideal component of Beat as individuals will always learn and act by modeling others. However, it is important to drastically re-frame Beat’s video productions into 30-second public service announcements. The Framing Theory (FT) defines how an issue is packaged in order to encourage or change a certain interpretation. (18) If used correctly, FT has great potential to influence people’s perceptions and beliefs. If recovered individuals are to continue to deliver their stories and experiences, Beat must reframe their approach to conveying the messages.

First and foremost, the cast of the videos will need to be replaced with diverse individuals. In addition, these individuals will need to be of healthy sizes. Recasting will contribute to reaching a broader audience consisting of a wider age range and a diverse racial and gender demographic. These individuals will become the new faces of the campaign. The cast will be more likely to be modeled once they build a personal relationship with their audience.

Instead of talking about their past experiences, the cast’s experiences can be symbolized by a notion of turmoil and emotional distress that is felt while suffering from an eating disorder. The focus can shift (through a tunnel with a light at the end) to the positives of life such as playing sports, graduating from high school/college, and being surrounded by positive things linked to acceptance and self-worth. The end scene can have the word “FREEDOM” transitioning into “TO CHANGE”.

Similarly the cast should also star in additional videos linked to the all core values mentioned above. This will further reinforce the core value system.

3) FREEDOM. To Prevent

Beat needs a prevention component that will address the various root causes of the question “why disordered eating?”. FREEDOM. will be an all encompassing, holistic approach of empowerment and wellness. The target population will be primarily high school and university aged individuals, including males and all races, as this age group is by far the most affected. (1) Over the years, most components will be phased out of the university atmosphere, as by then FREEDOM.’s program will have already empowered university aged young adults, in high school.

Because a huge portion of young individuals often compare themselves to others (peers, role models, celebrities) (19), it important to build a prevention program around the self as well. FREEDOM. will have already started their media campaign featuring the five familiar faces of the campaign. Even so, cultural and social norm change often takes time to change therefore FREEDOM. will also work on integrating empowerment workshops in educational settings. These workshops will run by individuals closer to their ages and will foster feelings of “control”, “power”, “acceptance” and “self-worth” by discovering their talents and worth. Additional workshops will work with individuals to break away from comparing oneself to others and empowering them to view themselves as beautiful/handsome.

In the competitive academic world mixed with other societal pressures, whether it be in high school or in university, stress is often a factor that everyone experiences at some point but often never taught techniques to handle it. (20) At a time where teenagers and young adults are often trying to discover who they are and their meaning in the world, individuals get lost never knowing where and who to turn to. FREEDOM. will advocate policy change to require that each educational institution require a Wellness Center offering services such as stress coping mechanisms, workshops on stress, how to develop positive lifestyle habits and learning the principles of fitness. These workshops will be far more than information based, rather filled with interaction and inspiring practical application, built around the needs of individuals that will be easy to apply once individuals are faced with stress. FREEDOM. will also recommend that high schools and universities integrate certain workshops into their required curriculum at strategic points of the year (at the beginning, a few weeks before midterms and finals).

The wellness centers will be strategically located and highly advertised on campuses. FREEDOM. In addition, a wide variety of fitness classes will be available, at no cost, at these centers including yoga and zumba fitness. Beat’s fabulous faces of the campaign will advocate for incorporating a fitness plan into one’s daily schedule, highlighting the “freedom”, “control”, “power” one achieves when they workout.

FREEDOM. will also advocate for a nation wide implementation of highly recommended exercise in all levels of schooling while taking care to present it to individuals in a way that their choice to make the decision is still under their control. Highly recommended exercise will come whichever form the individual chooses to participate in (sport, yoga, etc). Exercise has proved to be an effective mental health intervention as it helps with stress, depression, and low feelings about oneself. (21)


More often than not, interventions and campaigns for eating disorders are based on awareness often forgetting the needs of the target population. Beat, Beating Eating Disorders, is reflective of just this. Beat has a promising future of emerging as an organization of igniting social change, if a few additions and modifications are made. The Marketing Theory needs to be used to assess the target population’s needs and reformat the content of the messages conveyed. In addition Ariely’s theory of “cold” state/ “hot” state can be added into training professionals for intervening at the correct time. The last modification will use the Framing Theory to use the Social Learning Theory more effectively. In addition to the changes, Beat should also integrate a strong prevention competent: FREEDOM. This holistic approach to well-being will be an integral part of reducing the incidence of eating disorders.


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