Monday, December 13, 2010

Let’s Move: Looking at the Flaws of a Childhood Obesity Intervention-Katherine Keating Simons

Let’s Move is a nationwide campaign promoting healthy eating and behavior in American children. The campaign, started by Michelle Obama in February 2009, focuses on four main sections: empowering parents and caregivers, providing healthy food in schools, improving access to healthy, affordable foods, and increasing physical activity. The campaign’s major objective is to solve the childhood obesity problem in a generation, by having the obesity rate for children be just 5% (1). The Let’s Move campaign at this point seems to be mostly web-based. The website provides information and tips to parents and caregivers on how to eat healthier and be more active, it lists a number of health related items linked to obesity, and gives ways that parents can set a good example at home (1). There is also a “meetup” area of the website to allow users to meet face-to-face in the hopes of solving the obesity problems in that town or city (1). President Obama takes this seriously as well, and created a Task force on Childhood Obesity to review programs and policies related to child nutrition and activity. The Task Force also developed ways to meet all four sections of the Let’s Move objective (1). Even though the campaign is still in it’s early stages it is bound to get more press with The First Lady backing it.
Childhood obesity has become a significant problem in the United States due to the rising statistics of overweight and obese children and the number of health problems that are associated with obesity. The 2007-2008 National Health and Nutrition Examination Survey (NHANES) found that 17% of children ages 2-19 are obese (2). The statistics are even more staggering when broken up by age group (2). In pre-school age children 2-5 years of age, obesity increased from 5 to 10.4% between 1976-1980 and 2007-2008 and from 6.5 to 19.6% among 6-11 year olds (2). Adolescents aged 12-19, obesity increased from 5 to 18.1% during the same years (2). A number of health problems are related to obesity, such as type 2 diabetes, cardiovascular disease risks, and asthma (2). While there is no doubt that there is a problem with childhood obesity, this problem has taken over 20 years to get to where it is today. Let’s Move is not only flawed based on a number of social and behavioral theories, but also may be setting itself up for failure by being too ambitious in having the childhood obesity rate down to 5% by 2030 (1).
While Let’s Move aims to address a number of issues which affect what children eat and how active they are, the intervention in this program is flawed in a number of ways. First the Let’s Move campaign assumes that people make rational decisions and that parents and children will be healthier based on this campaign. Second the campaign is trying to sell health as its primary product, thus not using advertising theory correctly. Finally, Let’s Move is assuming that people intend to change their behavior based on a health intervention and assumes that behavior is static once they make a decision.
Let’s move assumes people make rational decisions.
The First Lady is assuming that people will see the benefits of this intervention (healthier children) and that this benefit will outweigh any barriers to becoming healthier. This is a major limitation of the Health Belief Model. The Health Belief Model focuses on an individual’s state of readiness to take action on a problem and how beneficial this action will be in reducing an illness (3). The Health Belief Model has identified three factors that will affect the likelihood of an individual taking appropriate action in reducing their risk of a disease/illness. First is the individual’s perception of how susceptible they are to the health threat. Second is the perceived severity of the threat, and last is the perceived benefits or barriers in reducing the perceived threat (3). The Health Belief Model was developed to explain preventative health behaviors and how those behaviors would relate to early detection of diseases (3). In Linda Thomas’ critique of the Health Belief Model, she argues that this means that we will be able to predict a person’s attitude towards a health behavior (3). This is a major flaw of the theory since behavior is not always rational (4). The Let’s Move campaign is assuming that parents or caregivers will see that their children are susceptible to becoming overweight or obese, that this threat is severe, and that the barriers to overcoming this threat are easy. The data from the CDC does show that this threat is real and that it is severe, but the barriers to overcoming this aren’t easy, otherwise the problem wouldn’t exist in the first place. Let’s Move has also not assessed the American public’s readiness of change, based on the fact that the Task Force that developed ways to achieve Let’s Move’s benchmarks was made up of Federal Agencies, and almost no public opinion (1). The Let’s Move campaign is trying to make the barriers to overcoming obesity less daunting by empowering parents and improving access to health foods, but the campaign can’t rely on these to change behavior since they are not addressing positive effects of negative behavior (good tasting junk food) and the influences of social and environmental factors, such as friends or lifestyle (5). Let’s Move is working on taking away junk food from school lunches and vending machines and doesn’t address the social and environmental factors that go into eating and choosing specific food items (1). Since obesity is a problem that could happen to anyone at any point in their life, eating healthy and being physically active requires long-term adherence. Such long-term adherence to a particular way of living requires addressing the influence of sociopsychological factors, which Let’s Move does not address (1,5). Let’s Move is assuming that people’s behavior will change based on the Health Belief Model that a perceived threat will lead to a behavior change, but the campaign is not addressing the fact that behavior is irrational and just because the threat is there, doesn’t mean a person will change their behavior (4). This is a major flaw of Let’s Move and a reason for why the campaign will most likely fail.
Let’s Move is trying to sell health as its product
The Let’s Move campaign is not using Advertising theory correctly since it is trying to sell good health as the campaign’s product. Traditionally, most public health campaigns focus on health and reducing the risk of disease, hoping that this knowledge will lead to a behavior change (6). This is often a major challenge of public health campaigns, since in reality they are selling health or a health behavior. Successful use of advertising theory starts with a large promise. This promise is then supported with basic core values, such as youth, freedom, or sex. The support shouldn’t come from statistics and facts, but instead from images, music, and stories (4). What Let’s Move is missing is the focus on core values and what being healthy could represent. Even the name of the campaign, Let’s Move, is using advertising theory incorrectly as it is knowledge based, rather than feeling based. People are more likely to follow a particular health behavior, like movement and healthy eating, when it applies to an individual’s feelings about the behavior, rather than their knowledge about it (6). Another factor that Let’s Move is missing is the trust factor. What made the “truth” campaign such a success in getting teens to stop smoking, was that the youth who were interviewed and questioned trusted the media message since the advertising company did their research in places where youth were comfortable, like the mall or skating parks (7). As Jeffrey Hicks so rightly says in his article The Strategy behind Florida’s “truth” campaign, “trust led to real answers” (7). The Let’s Move public health campaign doesn’t show that parents can trust it. The task force behind how the campaign will be implemented did use some public comments from the American people, but was made up of 12 federal agencies to provide the majority of the ideas and expertise (1). The Let’s Move campaign lacks trust because it wasn’t developed by parents and caregivers, but by government officials. When Advertising theory is used correctly it is not about the product it is selling, but about the promise and the support for the promise. Let’s Move has a large promise, but it’s lacking core values and support. Most people are aware of the growing obesity problem in children and the health consequences that go along with obesity. Rather than focusing on the statistics and evidence, Let’s Move should stop selling health and instead sell a core value to combat the obesity problem in children.
Let’s Move assumes that people intend to change behavior
One of the main components of the Let’s Move campaign is to provide healthy foods in schools and to improve access to healthy, affordable foods (1). This will be done through different legislative acts to make healthy foods more available in rural and underserved urban areas and updating the types of food that will be served or sold in schools. What Let’s Move is using in this strategy is the Theory of Planned Behavior. The Theory of Planned Behavior is very similar to the Theory of Reasoned Action, except that it includes perceived behavioral control, which is supposed to influence intention and behavior (8). Perceived behavior control is a person’s perception on the extent of whether performing a behavior is under their control. It is then measured by how difficult or easy it would be to perform that behavior (9). Let’s Move is using the theory of planned behavior’s perceived behavior control portion of the theory in assuming that it can predict people’s behavior in eating or choosing healthier food when it is made more easily available to them. In this campaign the healthy food is not under a person’s direct control to buy, because it is unaffordable or unavailable. The Theory of Planned Behavior also uses intention as a way to measure how likely a person is to perform a specific behavior (9). Icek Ajzen, the founder of the Theory of Planned Behavior, argues that perceived behavior control will affect intentions, because if a person believes they can perform the behavior, they will intend to perform it (10). The major flaw in the Let’s Move campaign is that the American public was never asked if they felt they were able to, or intended to, buy healthier food or to become more physically active. A task force of twelve different federal agencies developed Let’s Move, with only 2,500 comments from the public contributing to ideas and suggestions (1). This is a very small sampling of the American public and most likely represents those that feel very passionate about the issue, and not those people that would benefit the most from this sort of intervention. To say it is a good idea of what the American people want, feel, and intend to do is a gross mistake. Let’s Move is trying to use the Theory of Planned Behavior correctly and even addresses the perceived behavior control issue in that healthy food may not be within someone’s control to purchase, but they are missing the most important part of the theory. No one ever asked the American people if healthy food was made available, would they intend to buy it. Because of this lack of information and research, Let’s Move will not be successful in its intervention.

Let’s Move Intervention
Let’s move has the beginnings of a successful public health campaigns, it is group oriented, wants to empower its target audience, and has a plan on how to implement the four sections of the campaign to correspond to it’s one generation timeline. Unfortunately, the campaign does have three major flaws that will need to be improved before the campaign will be really successful. This intervention will look at the three flaws outlined above and suggest changes for them to improve the campaign. The three changes will include diffusion of innovation to address irrational behavior, using advertising theory correctly, and using social network theory to develop factual intervention strategies.
Diffusion of Innovation Model
Let’s Move can be improved by using the diffusion of intervention model. This theory states that diffusion, or the spread of an idea, is the process by which an innovation is communicated through certain channels among members of a social network (11). The four main elements of the model are innovation, communication channels, time, and the social system (11). The diffusion of innovation model is particularly helpful in determining the adoption of behaviors by people (12). Diffusion of innovation will help improve Let’s Move since it will address the social aspect that was missing in the campaigns usage of the Health Belief Model theory. Diffusion of innovation relies on an idea or behavior to spread among people, and acknowledges that some people may adapt the behavior before others (13). The First Lady has been using her status as a very important member of society to spread her message of healthy eating, but now she needs to recruit more early innovators, like herself, to spread it more (13). These leaders in society should speak out more about the campaign on a national level and then the message will eventually be able to be spread at a more local and community level. Diffusion of innovation is an appropriate intervention to improve the Let’s Move campaign because it can affect a large number of people at one time and acknowledges that people don’t make a decision at the same time. For Let’s Move to work, early innovators will have to adopt it first before the majority adopts it as well.
Advertising Theory
As shown earlier, Let’s Move is not using Advertising Theory correctly. It is trying to sell health, which isn’t going to make the campaign successful (4). Instead of emphasizing health and being healthy, Let’s Move should focus on youth and physical attractiveness. Let’s Move can do this by coming up with a different name for itself, so the focus isn’t on physical activity and health. Let’s Move should also create a brand for itself and through images, music, and stories show that being healthy is youthful and will make you feel attractive. If Let’s Move were to create a brand they would be able to have different messages tailored to different audiences. Currently the information for the parents, communities, and schools are all grouped together. By creating separate messages the campaign may be more successful, since the message to the parents will be different than what the message is to the school. The tone of the message will also have to be different (7). Rather than telling parents what to do, the campaign should speak to them in language that is familiar to them. Parents don’t want to feel attacked or judged and the campaign should address that and work with focus groups to see what language would be appropriate and make parents want to help their children be healthy. Right now Let’s Move is too focused on health to be successful. Let’s Move needs a complete brand make over so that the focus is on youth and physical attractiveness and so that the campaign speaks to parents in a way that isn’t judgmental. This would be achieved by using Advertising Theory correctly.
Social Network Theory
Let’s Move is assuming that by offering healthy foods and making it more affordable that people will start eating healthy. This is not the case as people do not behave rationally (4) and because the American public was not asked if this change would make them eat healthier (1). Social Network Theory could be applied to this flaw of the campaign since social networks aim to see how relationships between people influences health (14). It has also been proposed through various research studies that social network theory could affect mortality (15). This is based on the way in which social networks operate, which includes social support, social influence, social engagement, person-to-person contacts, and access to resources (15). Social network theory also uses the concept of homophily, the tendency to form bonds with specific people, to explain how social networks can influence health behaviors (15). All of these concepts will be important in improving Let’s Move, since the campaign doesn’t address how person-to-person connections and social influences influence health and eating behavior. In fact, it seems that Let’s Move doesn’t know what is important to the American population at all, since the majority of American’s were never asked. Let’s Move will need to take a social network approach and go into different communities to see how their eating habits are influenced and how people are connected to each other, so that the Let’s Move message might be better tailored to reach people with a message that could make an impact. Since social network theory relies on the bonds between individuals (16), this approach will allow for a group response to the question and will ensure that Let’s Move is getting the best answer and intervention strategy to affect the American population. If after using social network theory and coming up with an answer on how relationships influence health, then Let’s Move could develop an appropriate intervention on how to get people to be more physically active and eat healthier foods.
Let’s Move is a worthwhile campaign to improve because it has the potential to touch so many people. This is mainly because of its group model approach and because of The First Lady’s support. That said, obesity in children will be very hard to combat, especially in the given time frame of one generation. There are a number of flaws about the current campaign that will have to be fixed before Let’s Move can be truly successful. It will have to address the fact that people don’t act in rational ways, it will have to stop selling health as its primary product, and it will address the fact that this plan was developed by a Federal Task force and not the American people.
There is a solution though to these problems. The campaign can focus on getting early adapters to adapt to the campaign and help spread the message among people. This addresses people adapting to a behavior change at different times and the irrationality behind behavior. The campaign should also focus heavily on its advertising and marketing. Let’s Move needs to stop selling health as its product and instead sell a core value, like youth and physical attractiveness. Let’s Move should also revamp the name to take away the health aspect of it. Finally, Let’s Move should use a social network approach in figuring out how Americans would respond to the Let’s Move intervention and adjust it accordingly. Let’s Move has all the markings to be a major campaign to address children’s obesity rates, but without these adjustments it will just be another public health campaign that we laugh at in the coming years.

1) Let’s Move. About Let’s Move. Available at: Accessed November 29, 2010.
2) Centers for Disease Control and Prevention. Childhood Overweight and Obesity. Available at: Accessed November 29, 2010.
3) Thomas, LW. A critical feminist perspective of the Health Belief Model: Implications for Nursing Theory, Research, Practice, and Education. Journal of Professional Nursing 1995;11:246-428.
4) Siegel M. Social and Behavioral Sciences for Public Health Notes. Boston University Fall 2010.
5) Munro S, Lewin S, Swart T, and Volmink J. A Review of Health Behavior Theories: How Useful are these for Developing Intervention to Promote Long-Term Medication Adherence for TB and HIV/AIDS? BMC Public Health 2007;7:104.
6) Apollonio, DE, Malone RE. Turning Negative into Positive: Public Health Mass Media Campaigns and Negative Advertising. Health Education Research 2009;24:483-495.
7) Hicks JJ. The Strategy Behind Florida’s “truth” Campaign. Tobacco Control 2001;10:3-5.
8) Armitage CJ, Conner M. Efficacy of the Theory of Planned Behavior: A meta-analytic review. British Journal of Social Psychology 2001;40:471-499.
9) Sheeran P, Trafimow D, Armitage CJ. Predicting behavior from perceived behavioral control: Tests of the accuracy assumption of the theory of planned behavior. British Journal of Social Psychology 2003;42:393-410.
10) Ajzen I. Perceived behavioral control, self-efficacy, locus of control, and the theory of planned behavior. Journal of Applied Social Psychology 2002;32:665-683.
11) Rogers EM. Diffusion of Innovations. 4th Edition. New York, NY: The Free Press, 1995.
12) Sanson-Fisher RW. Diffusion of innovation theory for clinical change. Medical Journal of Australia 2004;180:S55-S56.
13) Green LW, Ottoson JM, Garcia C, Hiatt RA. Diffusion theory and knowledge dissemination, utilization, and integration in public health. Annual Review of Public Health 2009;30:151-174.
14) Luke DA, Harris JK. Network Analysis in Public Health: History, Methods, and Applications. Annual Review of Public Health 2007;28:69-93.
15) Smith KP, Christakis NA. Social Networks and Health. Annual Review of Sociology 2008;34:405-429.
16) Lewis JM. Being around and knowing the players: Networks of influence in health policy. Social Sciences and Medicine 2006;62:2125-2136.

Labels: , ,


Post a Comment

Subscribe to Post Comments [Atom]

<< Home