Live Your Life Campaign: A Critique and Refined Solution For Curbing Adult and Childhood Obesity – Alex Su
It does not come as a surprise to any that the prevalence of childhood obesity in America has been rapidly increasing due to a multitude of social and environmental factors. The increase in the obese category in adult’s ages 20 years or older has more than doubled between 1980 and 2004, from 15% to 32% [1,3]. In addition, the prevalence of overweight children has tripled in adolescents between ages 6 and 19 years . Specifically, racial, ethnic, regional and economic disparities have resulted in one of our nations worst health care epidemics. Obesity has been proven to be a major risk factor for many chronic conditions, including hypertension, cardiovascular disease, type-2 diabetes, as well as certain types of cancer, and significantly decreased life expectancy . Particularly, the rate of obesity in school-aged children is sobering. Almost one third of U.S. children over 2 years of age are already overweight or obese, according to the 2007–2008 National Health and Nutrition Examination Survey . Among children ages 2–5, the prevalence of overweight increased from 7 percent in 1994 to 10 percent in 2000 to almost 14 percent in 2004 .
Figure 1 below displays data from the National Center for Health Statistics and the Center for Disease Control, illustrating that the prevalence of overweight and obese children is rapidly escalating at an alarming rate. A portion of the problem stems from the fact that parents are constantly informed of the problem without being given any practical solutions. Therefore, it does not come as a surprise that this epidemic has spread to younger generations across all ethnicities. Subsequently, millions of tax dollars are being spent annually on ineffective interventions that do more harm than good. Advertisements and intervention initiatives that attempt to change people’s attitudes instead of directly targeting behaviors are inherently flawed because they fail to address the core values of their target audience. The solution comes from giving parents and adolescents the tools and resources to change their attitudes about food and exercise by targeting the behavior first, not their attitudes. Therefore, in order to have a truly successful and comprehensive program that encompasses adults and children, anti-obesity campaigns must stimulate prevention efforts that target the youngest generation because they currently represent the population with the highest probability for developing as well as avoiding this entirely preventable disease.
Figure 1: Prevalence of Overweight and Obesity Among U.S Children 2 to 5 Years of Age
New York City’s Anti-Obesity Campaign: Calorie Counting
In 2008, New York City’s Department of Health and Mental Hygiene (NYCDHMH) launched a campaign intended to build on the city’s new regulation requiring all fast food chain restaurants to post calorie counts on their menus. Figures 2 and 3 shown below are a few examples of advertisements that have been circulated throughout New York City’s public transportation system. The advertisements displayed in Figures 2 and 3 are headlined with the slogan “2000 calories A DAY is all most adults should eat.” As part of New York City’s new healthy-eating campaign, these adds focus on the fact that people should limit themselves to 2,000 calories a day. These posters display the calorie contents of certain foods in an attempt to make consumers more aware their calorie intake and how certain foods may contain a higher caloric content then they assume. By informing consumers of calorie contents, the NYCDHMH hopes that fast-food consumers will make smarter, conscious decisions when it comes to selecting foods.
Figures 2 and 3. Advertisements from NYC’s Anti-Obesity Campaign
New York City’s Anti-Obesity Campaign: Pouring On The Pounds
Subsequently, in the fall of 2009, in a new effort to highlight the health impact of sweetened drinks, the Health Department is confronting New Yorkers with a bold question: Are you pouring on the pounds? The agency’s new public-awareness campaign includes posters in the subway system as well as a multilingual Health Bulletin aimed at targeting both adults and children who consume these sugary beverages . The NYC Department of Health has directly targeted soft drinks as one of the main culprits contributing to the obesity epidemic. Soft drinks are the quintessential “junk” food. A 12-ounce can of regular soda contains 40 grams of added sugar – and provides 160 calories – but little else of nutritional value . Figures 4 and 5 shown below illustrate the somewhat grotesque sugar amounts found in conventional sodas and sports drinks. Driven by the success of the anti-smoking campaigns by graphically increasing awareness of the negative consequences of long-term smoking, the NYCDHMH is hoping that this will also encourage consumers to think twice when purchasing certain unhealthy foods and beverages and instead to choose healthier alternatives.
Figures 4, 5, 6. Pouring on the Pounds Campaign Advertisements
Critique 1: The Health Belief Model – People Do Not Think Or Act Rationally
Both the “Calorie-Counting” and “Pouring On The Pounds” campaigns launched by New York City’s Department of Health and Mental Hygiene (NYCDHMH) are rooted in the idea that people are inherently sensible and that when informed of something that is detrimental to their health, they will change their behavior accordingly. By making people aware of their calorie and sugar intake, the NYCDHMH hopes to change people’s behaviors by changing their attitudes and ideas first. Thus, by implementing the Health Belief Model into their campaign strategy, the Department of Health predicted that these advertisements would be the most effective instrument in curbing the rising rates of obesity in adults and children in New York. By informing adults and parents to choose “healthier” alternatives, it was predicted that they could simultaneously change the eating habits of both parents and adolescents. However, these campaigns assume that people act and think in a rational manner, when in fact they tend do the complete opposite.
The main assumption of the Health Belief Model is that health-related action depends upon the simultaneous occurrence of perceived severity, perceived vulnerability, and perceived benefit . Behavior is thus based on a cost-benefit analysis that fuels the motivation that determines the outcome. The NYCDHMH’s approach to solving the obesity crisis was simple – people are rational and they will make logical decisions once they are informed of their perceived susceptibility and the perceived benefits. For example, the “Calorie-Counting” campaign aimed to inform people that calories are the main cause of obesity. According to Figure 2 and 3, by not choosing to super-size your combo meal and substitute diet soda in place of regular soda, and additionally avoiding “unhealthy” snacks such as giant apple raisin muffins, you will ultimately weigh less. The “Calorie-Counting” campaign focuses on the potential benefits based solely on the perceived susceptibility and the perceived severity. The items advertised in the calorie-counting posters are common foods that target audiences are easily exposed to on a daily basis such as fast foods and snacks. The campaign further claims that 2,000 calories a day is all most adults should eat, implying that most adults are not conscious of the amount of calories they intake in a normal day, creating the perceived severity in their methodology. Based on these perceptions, this campaign intends to change people’s behaviors by first increasing awareness. In theory, this approach would be valid if people were rational. However, because there is no causal link between people’s intentions and behaviors, this campaign is likely to exhibit little impact on parents or adolescents, as well as against the obesity epidemic.
Subsequently, the “Pouring On The Pounds” campaign – NYCDHMH’s following attempt at curbing the increasing rates of obesity – does not appear too promising. By employing the same thought process as before with the “Calorie-Counting” campaign as well as combining the intervention with some marketing strategies from the anti-tobacco campaigns, the Department of Health has recently targeted soda companies as one of the leading causes of obesity and overweight individuals in this country. In theory, tobacco smoking and obesity have a great deal in common. Both stem from lifestyle choices that ultimately shorten lives and result in huge public health expenditures. Therefore, by utilizing the Health Belief Model again and adapting their marketing strategy to resemble that of the graphic anti-smoking advertisements on cigarettes, the Department of Health believes that this will capture their target audience’s attention while subsequently reducing the rates of obesity. Nevertheless, public health interventions that limit food choices or dictate food options will likely be more difficult to sell to the public than measures that have restricted smoking.
Figures 4-6 are examples of the profound advertisements being shown on television and across New Yorks public transportation system as part of a continuing effort to educate New Yorkers about the potential serious health effects of consuming sugary drinks. Building on a previous campaign, sugar content is measured in “packets” to illustrate how a daily routine of just a few sweetened drinks can cumulate to a whopping 93 packets of sugar by the end of the day as well as single handedly cause obesity, type-2 diabetes, and heart disease. These excessive amounts of sugar would amount to almost 1,400 empty calories of pure sugar – that's nearly ¾ of the daily recommended calories for most people . Some advertisements even go as far as showing graphic representations of soda morphing into globs of vascularized solid fat as they are being poured out of bottles, representing that the sugar in soda equates to fat. The purpose of these advertisements was to shock audiences into compliance in a similar fashion to that of the anti-tobacco campaigns. The NYCDHMH are once again utilizing aspects from the Health Belief Model in order to stimulate awareness concerning unhealthy eating habits that will eventually lead to obesity. Furthermore, these advertisements are intended to target lower income families, who on average consume more foods of low nutritive value than wealthier Americans . By again illustrating a relatable, commonly consumed beverage, the advertisements aim to create a sense of perceived susceptibility to the issue at hand. In addition, these advertisements display the slogan “Are you pouring on the pounds?” indicating that most adults and children consume an exorbitant amount of sugar daily without even knowing it, thus dramatically increasing the severity of the situation. Additionally, these public health initiatives also single out sodas and sugary drinks as the only cause of serious diseases such as obesity, type-2 diabetes, and heart disease, thus further overstating the severity of the situation. Again, this campaign fails to realize that even when provided with the heightened sense of perceived vulnerability and severity, people will inherently adhere to their irrational habits. Therefore, adolescents and adults will continue to drink soda or even diet sodas that contain no real sugar and nutritional value due to habit.
Critique 2: Psychological Reactance Theory – People Do Not Like Being Told What To Do
In a recent press release in regards to the new “Pouring On The Pounds” campaign, New York City’s Health Commissioner Dr. Thomas Farley claims “this new campaign shows how easy it is to drink a staggering amount of sugar in one day without realizing it. We hope that this campaign will encourage people to make the simple switch to healthier alternatives such as water, seltzer or low-fat milk” . Both the “Calorie-Counting” and “Pouring On The Pounds” campaigns share a common setback – they are together telling people what not to do. By telling people that they should only eat 2,000 calories a day and that they should not drink soda because it causes obesity, they are evoking feelings of resistance and psychological reactance that inevitably do more harm than good.
In a study conducted in 1987, researchers from Indiana University and the State University of New York College at Potsdam were interested in investigating the effects of reactance theory in relation to underage drinking on college campuses. They hypothesized that because new legislation made alcohol illegal for students under the age of 21, this act would lead to reactance motivation and result in higher consumption of alcohol as well as increased levels of binge drinking . Because consuming alcohol in college has been an important tradition for students for decades, they believed this new legislation would in fact increase alcohol consumption by minors. There results indicated that telling people not to do something often produces the opposite reaction [9,10]. By increasing the minimum drinking age, they may have actually contributed to increased drinking among underage students through the arousal of reactance motivation . Therefore, similar in the case of drinking alcohol and smoking, telling audiences what not to eat may actually increase reactance and anxiety, causing people to engage in the undesired action.
The theory of psychological reactance states that whenever people believe their freedom either has or will be unjustly threatened, they enter into a reactance motivational state and act to regain control by not complying [9,10]. This behavior is especially common when individuals feel obligated to adopt a particular opinion or cease a certain behavior. Freedom of behavior is a pervasive and important aspect of human life . Therefore, both adults and adolescents are motivated to regain the lost or threatened freedom by whatever methods are available and appropriate, usually through lack of compliance [9,10]. In respect to both the “Calorie-Counting” and “Pouring On The Pounds” campaigns, together they are informing both adolescents and adults that eating more than 2,000 calories per day or drinking sugary sodas will cause you to weight more and become obese. Therefore, these advertisements are telling both adults and children that they should not order the supersized combo meal and refrain from having soda. These campaigns focus around a legitimate argument that in theory may have an impact on some audiences. However, because this intervention is telling audiences not to do what they have been ingrained to do for so long, they are inadvertently causing people to feel as if their freedom is being taken away. As the level of reactance rises, the motivation to reestablish freedom increases accordingly. Thus, campaigns such as these cause audiences to do the opposite of what was originally intended because they have threatened one of the most important aspects of human life – freedom.
Critique 3: What now that you have my attention?
Despite the shortcomings previously mentioned concerning the concepts behind both the “Calorie-Counting” and “Pouring On The Pounds” campaigns, both initiatives are further lacking in information as well as solutions to the problem. After bypassing the initial message, most audiences are left to ponder an alternative resolution to their bad habits. Both campaigns lack further direction or clarification into the most basic aspects of any public health campaign – an alternative.
In the case of the “Calorie-Counting” campaign, audiences are instructed to first choose diet soda instead of regular soda and opt for the smaller serving of french fries. It is generally true that consuming less calories will result in the individual weighing less. However, the Department of Health failed to address the real issue at hand – the high calorie, innutritious fast food that plagues the standard American diet. Still pictured in Figure 1 as a “ healthier alternative” is still the same double cheeseburger with the same greasy french fries. The NYCDHMH is essentially telling children and adults alike to continue engaging in unhealthy eating habits, but only to the extent of not exceeding their 2,000-calorie a day limit. This “alternative solution” is in fact not a solution at all. Furthermore, a subsequent advertisement shown in Figure 2 displays a 470-calorie apple raisin muffin. Unfortunately, nowhere else in the poster does it provide any solution or alternative healthier options such as fresh fruits, produce, and granola bars as potential substitutes. In addition, the 2,000-calorie a day statement applies only to adults, thereby disregarding adolescents and ignoring one of the nations fastest growing epidemics – childhood obesity. Furthermore, these advertisements fail to take into consideration exercise habits as well as disregards exercising as a supplement to eating healthier . Thus, even if these public health advertisements were able to effectively communicate the message across to target audiences, people would still be left to figure out their own, appropriate healthier alternatives.
Subsequently, the “Pouring On The Pounds” campaign makes an attempt at providing target audiences with an actual substitute to sugary beverages. Unfortunately, their alternative options are in fact not reasonable solutions. In the two advertisements pictured in Figures 5 and 6, the NYCDHMH states “For healthier alternatives: Go to nyc.gov and search for healthier alternatives or call 311.” Given that the reader actually takes the time to stop and read the message, they again are left with no immediate solution. Only after going online or calling a number will they be informed of an alternative solution. However, in other advertisements that say the same message, in fine print, the Department of Health does offer some options in the place of sodas and sugary drinks such as water, seltzer, or fat-free milk. These alternatives are good options for people in general, but are not effective for adults or children already seeking sugary beverages. Options such as 100% fruit juice or other low-calorie sugar-free beverages may have resulted in a better marketing strategy. Furthermore, one of the major drawbacks of this public health advertisement is that it singles out sugary sodas as the leading cause of obesity. It is unreasonable to pinpoint a few food items and blame them for an individual's obesity when diets are comprised of hundreds or thousands of foods [11,12]. Finally, these advertisements did succeed in shocking people, but most likely in a negative way. Some audiences may be too disgusted by the pictures of vascularized solidified fat that they may not even read the public health message, thereby negating the purpose of this type of intervention.
Though both the “Calorie-Counting” and “Pouring On The Pounds” campaigns possess the potential to be effective public health interventions in the fight against the rising obesity epidemic in adolescents and adults, they both consistently fail to utilize effective social models that incorporate people’s core values and beliefs.
Live Your Life Campaign: A Solution To The Solution
The proposed public health campaign, Live Your Life, plans to encompass adults and adolescents as well as incorporate social models that relate to core values and beliefs of the target audience by targeting behavior first rather than the attitude. Because both adults and children have a synergistic effect on each other’s daily routines and lifestyle choices, it is crucial to implement an effective public health intervention that appeals to both parties. Furthermore, the main focus of the Live Your Life campaign is that it provides the individual the freedom to choose a better lifestyle for him or herself. By implementing a program that includes both adults and kids by incorporating an active lifestyle into their daily routine, it is possible that people will begin to change their diet habits accordingly.
In a generation where playing outdoors instead on in front of a television set is virtually unheard of aside from the occasional school sport, it is becoming increasingly difficult to change the sedentary lifestyles of future generations. Public health interventions such as the “Pouring on the pounds” and “Calorie-Counting” campaigns implemented by the New York City Department of Health and Mental Hygiene have attempted to address diet directly as the main cause of adult and childhood obesity. These campaigns combined cost taxpayers close to $800,000 over a 3-month period with a majority of the funds going to advertisement costs [4,8]. However, it comes as no surprise that they have seen marginal decreases in the obesity rates in New York City. This new and innovative program plans to deviate from the conventional methods of public health posters and signs and instead focus on providing a tangible, interactive program that can help both adults and children begin to re-implement exercise into their daily routine. By utilizing the government allocated funds to various Departments of Health across the nation to build new parks and school-based programs, it may be possible to essentially change peoples attitudes towards obesity by first targeting their habits and behaviors.
The Live Your Life campaign is designed to be an answer to the multitude of other ineffective “solutions” previously implemented by various health departments nationwide. By incorporating successful campaigns such as First Lady Michelle Obama’s “Let’s Move” campaign and The New York-Presbyterian Hospital/Columbia University Medical Center’s CHALK program (Choosing Healthy & Active Lifestyles for Kids), this campaign will similarly attempt to change peoples attitudes about maintaining a healthier lifestyle by first changing their behaviors. Both the “Let’s Move” and “CHALK” campaigns focus on improving the nutritional standards of the National School Lunch Program, increasing children’s opportunities for physical activity, and improving access to high-quality foods in all U.S. communities through the development of a social marketing message that promotes healthily lifestyles while identifying barriers and resources to healthily living [2,14,15]. By providing a multifactorial approach to solving the obesity epidemic, this program has the potential to alter the course of adult and childhood obesity. By changing this countries approach to eating, nutrition, and physical activity by simultaneously targeting individuals, neighborhoods, and larger communities, it is possible to stimulate prevention methods as early as possible . Therefore, by developing an interactive program consisting of recreational, school, and work-based programs for both adults and children, it is possible to reduce the long-term effects of bad habits.
Improvement 1: Social Expectation Theory vs. Health Belief Model
In the city of Boston, MA, city funded playgrounds are beginning to appear across the city that encourages both adults and children to include exercise back into their everyday routines. One in particular, the Charlesbank/Esplanade playground incorporates activities that promote exercise and a healthier lifestyle for both adults and children . A unique feature of this park is that this community play area is only accessible via a short walk down the Boston Esplanade. The playground is surrounded by miles of trails suited for exercising and outdoor activities that attract thousands of people daily to engage in physical activity. The purpose of this example was to illustrate how, contrary to the Health Belief Model based interventions used by the NYCDHMH, obesity is not simply based on diet and that healthy behaviors can in fact be incorporated into people’s everyday routine to curb the growing obesity epidemic. One of the main assumptions behind both the “Calorie-Counting” and “Pouring On The Pounds” campaigns was that people do not know what is good and bad for them. However, contrary to what the Department of Health believes, people actually are aware of what is health and unhealthy, but have no real motivation to change their daily habits. It is likely that many health experts and journalists alike have begun to realize individual-level approaches alone cannot solve the problem. Despite all the efforts to make changes in individuals’ lifestyle and eating habits, such as the fast growth in gym membership and diet programs, obesity has continued to increase at an even faster rate than before, calling for more drastic societal changes . Therefore, by implementing a theory known as the Social Expectation Theory into modern public health campaigns, it may be possible to reverse the expected behavioral habits of this generation.
Social Expectation Theory states that people’s behaviors as essentially dictated by social norms. Through both observational and experiential learning individuals have come to believe that a given behavior is likely to bring specified consequences . These beliefs or expectancies regarding behavior's consequences then influence individuals' behavioral choices. Individual differences in learning histories are reflected in different expectancies, which are thought to be a source for individual differences in motivations toward a given behavior; in this sense, expectancies are thought to mediate the influence of early learning on later behavior . Therefore, the Live Your Life campaign will incorporate exercising and physical activity as a product of social norms early on in order to help maintain later behavior. Specifically, physical activity and healthy diets should be incorporated into school-based curriculums as early as possible. An example could be making recess the first component of the day for children as well as companies implementing “health breaks” throughout the day, thereby creating healthy habits instead of harmful practices. Multitudes of well known, successful companies such as Pixar and Google have already begun to promote healthy diets and exercise as part of their daily routines. Similarly, school are beginning to re-implement recess as one of the first activities of the day for children, making it a part of their everyday routine. By making exercising and good nutrition an integral part of everyone daily routines as early on as possible, it may be conceivable to directly target behavior in order to change how exercise and healthy diets are viewed in terms of social acceptance. Once people begin to notice that exercise is an expected daily routine, they may begin to alter their behaviors and stray from bad habits as a result of changing their behaviors first.
Improvement 2: Social Expectation Theory Reduces Reactance
A major flaw of the “Calorie-Counting” and “Pouring On The Pounds” campaigns was that they focused their intervention on telling audiences what not to do instead of informing their campaign on giving people reasonable alternatives. In a study conducted by Elbel et al., researchers studied the effects of calorie labeling specifically in New York City where mandatory calorie labeling first appeared in July of 2008. The researchers concluded “eating behavior is notoriously resistant to change. A large body of research has shown that weight-loss interventions designed to educate people about healthful food choices are generally ineffective” . Thus, simply displaying information about the caloric value of various food options may fail to translate into attitudinal, motivational, or—most importantly—behavioral changes in line with choosing healthier food options. Menu labels may need to be coupled with additional policy approaches . Thus, a main advantage of the Live Your Life intervention is that it focuses on indirectly educating audiences by not dictating what individuals should and should not be doing. Instead, this program focuses on letting the individual first see the adapt the healthy behaviors to their lifestyles, and then letting their actions reinforce their attitudes and beliefs towards maintaining a healthier lifestyle. Because this intervention emphasizes adding to an individual’s lifestyle instead of taking something away, reactance is not a factor. By first attempting to change their behavior through marketing exercising as a common, everyday practice, it is entirely possible to change peoples opinions on physical activity as well as healthier diets. Through advertising exercise a habit rather than a choice, this intervention will avoid reactance all together and give people the freedom to incorporate healthier food options to supplement their every day routines.
Improvement 3: Branding and Social Expectations Theory Provides Answers To The Solution
Another major shortcoming of the “Calorie-Counting” and “Pouring On The Pounds” campaigns was that they aside from telling audiences what not to do, they failed to provide people with an actual alternative. Because studies have consistently shown that by attempting to control an individuals diet fails at altering people’s actions, this program plans to successfully integrate a solution that will effectively change peoples behaviors . Therefore, the key element in making this intervention successful is to build habits and connections at an early age through school-based and community support networks.
Branding is a concept that allows for widespread, universal appeal. A brand allows a unique connection with the product being sold and the consumer. Essentially a brand is a contract or promise to the consumer. A perfect example of branding at its finest is the Apple corporation. They have succeeded time and time again in associating their products with a new and innovative way of thinking. However, branding also can be applied to effective public health interventions. The “Eighty-Four” campaign is a successful youth-led movement fighting for a tobacco-free generation Massachusetts . Their members represent the 84% of smoke-free teenagers in the state of Massachusetts. Part of the reason why this campaign has been so successful is because it brands its members as being part of a rebellion against the tobacco industry and provides a tangible solution to the problem at hand.
Therefore, the Live Your Life campaign fundamentally promises good health and a longer life by adhering and associating with a healthier lifestyle. By learning to associate exercise as daily activity, members can become an integral part of the Live Your Life campaign. The Live Your Life campaign symbolizes a commitment to living a longer and healthier lifestyle that is accessible to everyone. By allowing individuals the opportunity to be a part of something significant, this program may help people develop long-term, healthier habits. By utilizing the government allocated funds across the nation to incorporate these programs throughout schools and workplaces, it may be possible to combine both Social Expectation Theory as well as branding to essentially change peoples attitudes towards obesity by first targeting their habits and behaviors.
Studies have proven that healthier lifestyle choices such as exercise and diet tend to follow a positive correlation with one another [19,20]. Those who eat healthier tend to exercise more and vice versa. Therefore, the solution to the rising obesity epidemic does not come from dictating people’s diet and exercise patterns, but in changing people’s behaviors to reflect the attitudes of the individuals towards living a better life for themselves. The Live Your Life campaign focuses on allowing the individual to choose to live a healthier and longer life, thereby making the choice to exercise and maintain a healthy diet a decision based habit.
1. Yaniv et al., Junk-food, home cooking, physical activity and obesity: The effect of the fat tax and the thin subsidy. Journal of Public Economics 93, Feburary 2009: 823-830
2. Wojcicki, J. M., & Heyman, M. B. (2010). Let's move — childhood obesity prevention from pregnancy and infancy onward. N Engl J Med, 362(16), 1457-1459. doi:10.1056/NEJMp1001857
3. Bellows et al., Formative Research and Strategic Development of a Physical Activity Component to a Social Marketing Campaign for Obesity Prevention in Preschoolers. Journal of Community Health. January 2008: 33(169-178).
4. New York City Department of Health and Mental Hygiene. Pouring On The Pounds. August 2009. www.nyc.gov.
5. Nestle, M., Soft Drink “Pouring Rights”: Marketing Empty Calories. Public Health Reports. August 2000: Vol. 115.
6. Rosenstock et al., Social Learning Theory and the Health Belief Model: Health Education and Behavior. June 1988 15: 175-183.
7. Bittman, M., Bad Food? Tax It, and Subsidize Vegetables: The New York Times, July 2011.
8. New York City Department of Health and Mental Hygiene. Pouring On The Pounds. Press Release. January 2011. www.nyc.gov.
9. Engs R. and Hanson D. J., Reactance Theory: A Test With Collegiate Drinking. Psychological Reports. 1989. 64:3(1083-1086).
10. Brehm J. W., A Theory of Psychological Reactance. Organization Change: A Comprehensive Reader. 377-387.
11. Daily Values Table. USDA/ARS Children’s Nutrition Research Center. Baylor College of Medicine. www.bcm.edu/cnrc/consumer/archives/percentDV.htm.
12. Pear. R., Soft Drink Industry Fights Proposed Food Stamp Ban. The New York Times. April 2011.
13. Charles River Reservation. Department of Conservation and Recreation. www.mass.gov/dcr/parks/charlesRiver/recreation.htm
14. Chalk Center Campaign. Dec. 2011. http://www.chalkcenter.org.
15. Lets Move Campaign. Dec 6. 2011. www.letsmove.gov.
16. Kim S. H., and Willis L. A., Talking about Obesity: News Framing of Who is Responsible for Causing and Fixing the Problem. Journal of Health Communication. June 2007. 12:4 (359-376).
17. Hohlstein L, Smith G, Atlas J. An application of expectancy theory to eating disorders: Development and validation of measures of eating and dieting expectancies. Psychological Assessment [serial online]. March 1998;10(1):49-58. Accessed December 6, 2011.
18. Elbel B. et al., Calorie Labeling and Food Choices: A First Look At The Effects On Low-Income People In New York City. Health Affairs. December 2011.
19. Leichter, H. M. (2003). Evil habits and personal choices: Assigning responsibility for health in the 20th century. Milbank Quarterly, 81(4), 603-626.
20. King, D. E., Mainous III, A. G., Carnemolla, M., & Everett, C. J. (2009). Adherence to healthy lifestyle habits in US adults, 1988-2006. The American Journal of Medicine, 122(6), 528-534. doi:10.1016/j.amjmed.2008.11.013
21. The Eighty-Four Campaign. Dec 6. 2011. www.the84.org