The Ineffective Message of the “Fat Smack” Campaign by the Boston Public Health Commission: – Andrea Muirhead

Introduction

In September of 2011, the Boston Public Health Commission released a campaign that aimed to reduce the amount of sugary beverages children and adolescents drink (7). The print (www.fatsmack.org) and video advertisements (http://fatsmack.org/#!prettyPhoto/0/) depict thin and attractive teenagers drinking a soda as an orange gelatinous substance hits them in the face (2,3). The advertisements read, “Don’t get smacked by fat. Calories from sugary beverages like sodas, sweet teas and sports drinks can cause obesity and Type 2 diabetes. Reduce how many you drink and learn more at fatsmack.org” (2,3).

It is clear that there is a need for effective public health initiatives to reduce the prevalence of obesity. As the “Fat Smack” campaign alludes to, obesity increases the risks of a number of diseases including cardiovascular disease, hypertension, stroke, type 2 diabetes, and various cancers (5). Obesity rates in the United States have continued to rise over the past several decades to reach epidemic proportions. In 1990, 10 states had an obesity prevalence of less than 10% among adults, and no states had a prevalence of 15% or greater (9). By 2010, there were no states with less than a 20% prevalence of obesity among adults (9). In 2010, thirty-six states had a prevalence of 25% or greater, and 12 states had a prevalence of 30% or greater (9). The numbers of obese children has also skyrocketed in recent years. In 2008, 16.9% of children between the ages of 2 and 19 in the United States were obese (10). Massachusetts also has a high rate of overweight and obese children. In 2010, a survey implemented by public school nurses in Massachusetts showed that 33.4% of students in in grades 1, 4, 7 and 10 were overweight or obese (6).

Sugar-sweetened beverages (SSBs), such as sodas, juice drinks, flavored water, sweet teas and sports drinks contribute a significant amount of empty calories to an individual’s daily caloric intake. In the years between 1977 and 2001, caloric intake from SBBs increased from 3.9% of total daily caloric intake to 9.2% (5). The likelihood that a child will become obese increases by 60% for every extra serving of SBBs per day (4). Decreasing the amount of calories from SBBs has been shown to have a positive effect on body weight. Ebbeling et al. (2006) found that decreasing SBB caloric intake among adolescents decreased body weight over a 25 week period, and that participants with the highest body mass index (BMI) were most significantly affected (11). Thus, campaigns aimed at reducing caloric intake via SBBs have the potential to contribute to a healthier lifestyle in the United States.

The Fat Smack campaign is based on the “Pouring on the Pounds” campaign first introduced to New York City in 2009 (12). Like the “Fat Smack” campaign, “Pouring on the Pounds” featured an image depicting a bottle of soda being poured into a glass and during the process it turned into body fat (http://www.nyc.gov/html/doh/html/pr2009/pr057-09.shtml). In another “Pouring on the Pounds” video, an actor is shown drinking what looks like a glass of chunky fat (http://www.youtube.com/watch?v=-F4t8zL6F0c). New York’s Department of Health and Mental Hygiene determined from focus groups that a “shocking and in-your-face” message would be effective (13). To date, there have not been any published studies investigating the effectiveness of this campaign. However, the “Fat Smack” and the “Pouring on the Pounds” campaign differ in their shock factor. While the “Pouring on the Pounds” campaign depicts more realistic imagery of human fatty tissue, the “Fat Smack” uses a clear, orangey, gelatinous substance that coincidentally looks like some of the SSBs it is warning against.

While well intentioned, the “Fat Smack” campaign is not likely to be effective at reducing the prevalence of obesity among children and adolescents. Unfortunately, the campaign makes three major mistakes, which render the message ineffective. These three flaws become apparent when the advertisement is viewed through the lens of a number of public health theories. First, the campaign’s advertisement is based on the health belief model of public health, and it assumes that the targeted audience would stop drinking SSBs if it knew how unhealthy they were. Second, the campaign misuses advertising theory because it lacks reasonable evidence to support its message and it fails to appeal to the audience’s core values. Finally, the campaign fails to address the psychological reactance of the targeted audience, which can often be a major concern when campaigning a message towards adolescents and teenagers.

Utilization of the Health Belief Model and its Shortcomings

The “Fat Smack” campaign inappropriately utilizes the health belief model to convey the message that SSBs can contribute to obesity and type 2 diabetes, and it also fails to recognize the shortcomings of the health belief model itself. The health belief model was first developed in the 1950’s to determine why human beings forgo screening and preventative measures to prevent disease (14). The basic premise of health belief model is that individuals weigh the perceived costs and benefits of a particular behavior or preventative measure, and make a well-reasoned decision about whether to continue that behavior or to implement a preventative measure (14). The “Fat Smack” campaign makes the incorrect assumption that adolescents will cease their consumption of SSBs if they learn that SSBs can cause unhealthy weight gain and can contribute to disease like type 2 diabetes. There are a number of problems with this logic. For instance, humans often do not make rational decisions about their behaviors, and adolescents, in particular, are known to make riskier decisions than adults, which is in part due to their incomplete cognitive development (15, 16). Therefore, if a substantial percentage of adolescents are incapable of making a rational decision when deciding what types of food and drink to consume, simply explaining that SSBs can cause health problems is not likely to influence their behavior.

Another problem with the assumption that adolescents will make reasoned decisions about drinking SSBs is that there are a number of misconceptions that persist in the targeted audience. Research has shown that overweight adolescents and adults tend to underestimate their daily caloric intake compared to individuals of normal weight (17). One study showed that 76% of students in grades 6-12 overestimated the normal consumption of SSBs of students their age, and 24% thought the norm was 3 or more beverages per day (18). In addition, adolescents that drink SSBs are more likely to think that people worry too much about their weight (17). While the “Fat Smack” advertisement directly states that calories from SSBs can contribute to obesity, it does not attack the underlying misconception that many overweight individuals have about their daily caloric intake. Thus an individual could rationalize that the “Fat Smack” advertisement does not apply to them, since they do not believe they take in an excess of calories. Therefore, a major flaw of the advertisement is that it attempts to educate adolescence about the realities of SSB consumption while it neglects to consider their cognitive processes and rationalizations.

The “Fat Smack” campaign focuses on changing the health beliefs of the individual, versus a group or social network. Unfortunately there are a number of factors that are potentially relevant to adolescent SBB intake that the health belief model does not take into account. First, the health belief model does not take into account the value of social norms and influences. An individual’s peer or familial group could be influential on whether that person is more likely to consume SBBs, especially if consumption of this product is widely accepted. In addition, the health model of the “Fat Smack” does not take into account the perspectives of teenagers and adolescents that are obese or those that have type 2 diabetes. Given that the campaign’s website is quoting that 40% of Boston public school students are obese or overweight, sensitivity to their perspective would be essential to change the behaviors of these individuals as well as teenagers that are of healthy weight (2). Overweight adolescents are more likely to face stigmatization and rejection from their peers. These negative social experiences among overweight and obese adolescents are associated with higher rates of depression and decreased levels of self-esteem (25). Given the increase stigmatization of this group, reinforcing the message that overweight individuals have complete control of their weight could further stigmatize and isolate overweight and obese teenagers and adolescents (25). While the “Fat Smack” campaign aims to prevent individuals from becoming obese, it is irresponsible for it to neglect the individuals who already are obese. By further discouraging and isolating this vulnerable group, the campaign is less likely to make a meaningful impact.

Misuse of Advertising Theory

The biggest flaw of the “Fat Smack” campaign is its misuse of advertising theory. This theory posits that a successful advertisement requires three core principles, an effective messenger, including a reasonable argument and supporting evidence, and a message that appeals to the target audience’s core values (20). The campaign’s main flaw lies within the last three of these principles. The first principle of an effective messenger is reasonably fulfilled. Since the “Fat Smack” print advertisements have been placed on the MBTA trains and subway stations, the chosen messengers in the advertisements are reasonable. The individuals depicted are young, attractive, and thin African Americans. These individuals are appropriate, given that the messages are targeted towards urban adolescents and teenagers.

The “Fat Smack” campaign may make a reasonable argument that calories from sugary beverages can contribute to obesity and diseases like type 2 diabetes. However the advertisement does not provide supporting evidence. Instead it displays an unrealistic and frankly comical image of a young person getting hit in the face with a substance that looks suspiciously like orange Jell-O. While most advertisements are often unrealistic, getting smacked in the face with a glob of orange goo is not likely to happen if you take a sip of soda. Displaying this as the consequence to consuming SSBs makes a joke of the message. The campaign’s serious message is lost by the juxtaposition of slapstick humor, which renders the message no longer compelling, reasonable or effective. In addition, the odd imagery itself will not leave a lasting effect; research has shown that concrete messages receive more attention, are viewed as more important and generate more positive assessments of the source (19).

The last advertising based flaw of the “Fat Smack” campaign is that it does not supply a message that appeals to the audience’s core value. The most striking example of this is the value of freedom and autonomy, which are values that adolescents and teenagers often aggressively protect. Development during adolescence involves gaining new freedoms that will prepare for the responsibilities of early adulthood (16). The “Fat Smack” campaign does not appeal towards either of these values, and instead it tells the audience what not to do. The campaign reads, “Don’t get smacked by fat”, and implies that the audience’s diet must be restricted to prevent chronic diseases. Thus, instead of appealing towards the audience’s core value, the advertisement attacks them. The “Fat Smack” campaign’s attack on the audience’s core values brings us to the next major flaw in the campaign; its failure to address psychological reactance. Failure to Address Psychological Reactance

The “Fat Smack” attack on the targeted audience’s core values likely provokes psychological reactance, which is one of the striking flaws of the “Fat Smack” campaign. Brehm first described psychological reactance theory in 1966, and the theory suggests that any message that attempts to change a behavior can be perceived as a threat (21, 22). This perception of threat or loss of freedom provokes a reaction in the individual that aims to restore that freedom (23). Psychological reactance theory posits that forceful language in a message will not only fail to persuade the targeted audience, but that it will provoke anger and negative attitudes towards the message (23). The attempt of the individual to restore freedom that they perceive as threatened can often result in a boomerang, or the invocation of the exact behavior that the message is trying to dissuade or prevent.

Psychological reactance has implications in public health especially, since a number of studies have shown that reactance occurs when individuals are exposed to forceful health messages. One example of this is a study that examined persuasive messages aimed at encouraging individuals to join exercise classes, and the study showed that the adults surveyed responded negatively towards these forceful messages (23). In another study, college students that were exposed to messages that aimed to dissuade from excessive alcohol intake. The perception of a loss of freedom was positively associated with reactance to the message, and a boomerang effect (24). In this instance the boomerang effect was excessive alcohol consumption (24).

In the case of the “Fat Smack” campaign, the freedom under threat is the freedom of choice. Specifically the advertisement seeks to dissuade adolescents and teenagers to drink SSBs. The campaign is telling adolescents and teenagers that they cannot consume whatever types of food that person should choose. It is also worthwhile to point out that the advertisement itself uses the word “Don’t”, which indicates that the advertisement is trying to control the audience. Most teenagers do not enjoy being told what not to do, which again goes back to the fact that this is a period of development where boundaries and freedoms are expanded (16). What makes this command even more ludicrous is the punishment that is displayed by the advertisement, namely the smack in the face with Jell-O. The potential psychological reactance to the “Fat Smack” campaign’s message could range from either ignoring the advertisement completely, or actually increasing SBB consumption.

FREE YOURSELF: A new public health campaign

In the Wealth of Nations, Adam Smith wrote “sugar, rum and tobacco are commodities which are nowhere necessities of life, which are become objects of almost universal consumption, and which are therefore extremely proper subjects of taxation” (4). Tobacco and alcohol have been the subjects of taxes in the United States, and yet of the three, sugar continues to be untaxed. In addition, restrictions on tobacco and alcohol advertisements have been put into place. For example, in 2009 FDA Tobacco Regulation Bill was passed which gave the FDA the authority to dictate to tobacco companies what ingredients could be included in their products, and it also eliminated misleading product titles like “light” or “mild” (26). However, advertisement restrictions have not been applied to beverage companies.

The comparison between beverage companies and the tobacco and alcohol industry is important because successful public health campaigns have previously been targeted towards the tobacco industry. Successful campaigns from the past can provide models for future campaigns. The most successful campaign has been the “Truth” campaign, and using this campaign as a model targeting the beverage company is likely to be successful (31). The “Truth” campaign began in Florida, and it utilized advertising and marketing to provide anti-tobacco advertisement to youth (30). The “Truth” campaign’s message focused on the manipulative tactics and advertising that the tobacco industry utilizes. The campaign reduced smoking initiation from 18% to 11% during a two-year period (30).

A campaign based on the “Truth” campaign as a model would be more successful than the “Fat Smack” campaign. To the “Fat Smack” campaign’s credit, it does have a similar message somewhat hidden on it’s website. This message states that in 2008, Coca-Cola spent over $2.67 billion in advertising (2). It also has a message stating, “Don’t Get Played” by the beverage industry (2). This message is the most moving message of the “Fat Smack” campaign, and therefore creating a new campaign called “Free Yourself” could that improves upon the message using the “Truth” campaign as a model would be successful. Therefore, an improvement on the “Fat Smack” campaign is make this the focus of the advertisements.

One of the most effective advertisements of the “Truth” campaign was a commercial that depicted “Truth” campaigners piling up 1200 body bags representing the 1200 people who die each day from tobacco use, (http://www.youtube.com/watch?v=c4xmFcrJexk). The first advertisement of the FREE YOURSELF campaign should show a similar image. The video would be shot outside Coca-Cola, Pepsi or another large beverage company, and show 112,00o body bags representing the number of obesity related deaths that happen yearly in the United States (27, 28). The video would have an actor using a loudspeaker saying, “Do you know how many people die every year from obesity? Why don’t we show you what 112,000 looks like? Your products contribute to obesity, and you spend about $2.5 billion dollars a year in advertising; that’s $22,000 for each person that dies every year from obesity. So I just have one question for you: Is it worth it?”

There are three main reasons that this tactic would be successful, since it would effectively correct the shortcomings of the “Fat Smack” campaign. First, the message would not be based on the health belief model. Second, the campaign would successfully utilize advertising and marketing. Third, the campaign would take advantage of the audience’s psychological reactance, and turn the reactance towards the beverage industry.

FREE YOURSELF: A Group Level Campaign

One of the improvements that the FREE YOURSELF campaign would have over the “Fat Smack” campaign is that its message would make rejection of SSBs a group or community movement versus a health appeal to each separate individual. Focusing the campaign at the group level versus the individual can be advantageous, especially among teenagers and adolescents. During this period of development, peer and social status becomes very important, and the FREE YOURSELF message would create a common goal (16). The message says that as a group, we can show the beverage industry that they can no longer take advantage of us. Also, by making the message less about the health statistics and more about the group’s movement, the campaign can be spread within social networks. The acceptance of the FREE YOURSELF campaign among teenagers and adolescents has the potential to spread within their network of friends and families. If more individuals reject the beverage company’s marketing and if they choose to reject SSBs, it is more likely that the campaign will also affect that individual’s social network.

Proper use of Advertising Theory

Utilizing advertising theory to change health behaviors has been shown to be successful through the “Truth” campaign, and therefore using this tactic will be successful in the FREE YOURSELF campaign (31). To ensure the success of FREE YOURSELF, the three components of a successful advertisement would all be incorporated into this campaign. These components are an effective messenger, including a reasonable argument and supporting evidence, and a message that appeals to the target audience’s core values (20). The messenger would need to be a group of ethnically diverse young adults, and the actors selected for the video must be able to convey a quality of rebellion. Since the group targeted for the FREE YOURSELF campaign is similar to the group targeted by the “Truth” campaign, similar actors could be used. In addition, by using imagery of a group of young adults protesting, this would give the impression that by joining FREE YOURSELF the audience is also joining a social movement. This gives the audience a sense of belonging. This is in contrast to the potentially isolating messages of the “Fat Smack” campaign, which could be interpreted as obesity is only under the individual’s control.

The reasonable argument and supporting evidence of the advertisement would not focus specifically on the health consequences of consuming SSBs. The majority of the population already knows that these beverages are not healthy options. The argument of the FREE YOURSELF campaign is that beverage companies manipulate people via advertising into falsely believing that their products will make them sexier, funnier, and more attractive. The focus should be on the manipulation and not the health consequences. Thus the reasonable argument of the campaign would feed into the audience’s core values of freedom and control. Humans do not like being tricked, deceived or manipulated. By pointing out the beverage industry’s use of these tactics, the FREE YOURSELF campaign would allow the audience to take back control by rejecting the industry’s messages. By employing this strategy, the FREE YOURSELF campaign would achieve the intended behavior of reducing consumption of SSBs.

Turning the tables: psychological reactance

Psychological reactance can be used as a tool in public health campaign if the reactance is targeted towards the unwanted behavior. Some of the ways psychological reactance can be reigned in to the advantage of the FREE YOURSELF campaign is by using messengers that are similar to the intended audience, affirming the audience’s beliefs and values, and framing the message with the audiences core values upfront and presenting the reasoning behind the argument afterwards (32). The FREE YOURSELF campaign would utilize the similar messengers to the audience. Since the “Fat Smack” campaign is claiming that 40% of Boston public school students are overweight or obese (2), it would be useful to use young adults from Boston that are ethnically diverse. In addition, a certain proportion of the actors used should be overweight. By placing overweight individuals in the FREE YOURSELF campaign, the blame would be shifted from overweight individuals towards the beverage industry. This would also relate back to the sense of community by creating a bonded social network.

The FREE YOURSELF campaign would affirm the audience’s beliefs and values by the name itself and by the message that it can keep its freedom and stay in control by resisting the advertisements of the beverage industry. The campaign conveys a message of protest, which is incredibly timely considering recent history. In 2011, the world saw the Arab Spring, austerity protests in much of Europe, and Occupy Wall Street. The “Protester” was named Time Magazine’s person of the year (33). If using this type of message could help improve our nations health and take back control from the beverage industry, the “Protester” would most likely approve.

While the “Fat Smack” campaign attempts to address an increasing concern of the health of our nation, it does not convey its message successfully. By changing the campaign to the FREE YOURSELF campaign, the intended behavior of reduced consumption of SSBs is more likely to become a reality.

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