Big Soda and the Open Truth Now Campaign

Full disclosure: I drink soda every now and then, and I really like it! Sometimes I even sip on soda to calm an upset stomach. But knowing it is unhealthy, I try to limit my intake.

Recently, on my morning Bart commute, I have been seeing signs like this one, which reads, "Big Soda says open happiness. What's happy about diabetes?"

Image Source: https://www.facebook.com/opentruthnow

The Open Truth Now campaign, led by Youth Speaks Inc. and UC San Francisco's Center for Vulnerable Populations at San Francisco General Hospital, is riding on the heels of Berkeley's historic passage of a one-cent-per-ounce soda tax to keep the anti-soda train going.

The soda tax passed in Berkeley with a wide margin, despite millions spent by the beverage industry to prevent it, while a similar two-cent-per-ounce tax measure lost in San Francisco (with 55% of voters in favor, not enough for the 2/3 margin the measure required). While public health supporters of the measures pointed to evidence that even a small tax changes behavior (more than education typically does), many opponents felt the tax was an example of ineffective overreach by an overly controlling "nanny state."

The Open Truth campaign is now tackling the issue from a direction that many opponents to the law advocated - reaching not for our wallets but for our brains, by educating the public about critical media consumption and the health consequences of sugar intake.

Image source: http://www.opentruthnow.org

According to Dr. Dean Schillinger, "Americans' sugar consumption has tripled over the past 50 years. And sugary drinks are now the No. 1 source of calories in the American diet — and a major contributor to Type 2 diabetes. Just one 12-ounce soda has about nine teaspoons of sugar — more than the recommended daily maximum for adults and more than three times the daily maximum for kids. Just one to two sugary drinks a day increases risk for Type 2 diabetes by 26 percent."

The ads seen around San Francisco focus on youth and aim to expose the marketing practices that companies have used to target youth of color in particular. The posters allude to the serious increase in diabetes prevalence in recent years, pointing out that the happiness promised by advertisements has actually led to a scourge of illness in many communities.

In many ways, the message of these ads reminds me of the most effective anti-tobacco ads of several years ago, which I wrote about in an earlier post:

You can follow the Open Truth Now campaign on Facebook here:
https://www.facebook.com/opentruthnow

What do you think? Is education, taxation, or both the best way to limit unhealthy consumption of sugar-sweetened beverages? Will the Open Truth Now campaign make a difference?

Disney's Anti-Bullying Campaign #ChooseKindness

October is Bullying Awareness Month.

Image source:
http://citizenship.disney.com/be-inspired

While watching one my favorite ABC shows online recently, I saw an interesting anti-bullying ad put out by Disney, involving many of their stars donning t-shirts with anti-bullying messages and encouraging us to use the hashtag #ChooseKindness. Since bullying is an issue I have addressed on this blog before (read here and here), I looked into it more. As it turns out, Disney is doing an entire campaign this month around the issue. (For details, see their "Be Inspired" website.)

What I found particularly interesting is that they are not only putting out advertisements around the issue; they are also incorporating anti-bullying themes within the scripts of their television shows. Here are some sample clips I found:

Show Name: "Austin & Ally"

Show Name: "Girl Meets World"

I know that public health professionals have varying views on Disney as a whole (for example, some take issue with Disney's employment practices and affiliation with "The Other NRA"), and I am in no way trying to endorse them as a perfect company. And then, of course, there is the general philosophy (and evidence) that TV-viewing is not a particularly healthful behavior. (For more on that, see here, here, and here.)

But given the reality that kids watch an average of 4 hours of television per day,  I did want to share this one cool instance of public health social messaging making its way into mainstream media. I am thankful they are attempting something worthwhile through this campaign.

Anti-Smoking Advertisements

A few days ago, I posted about a handful of recent smoking policies that have come up in discussions with friends and family, in new campus rules, and in laws around town. As promised, today I want to talk about some interesting anti-smoking advertisements.

In my "theories of health and social behavior" class last semester, we talked about various advertising campaigns and what has made them successful (or not). Interestingly enough, studies show that some anti-smoking (and anti-drug, anti-drinking, etc.) campaigns actually increase propensities for engaging in those activities, while others effectively work to reduce them.

For example, after a major industry lawsuit in 1998/1999, some cigarette companies agreed to run anti-teen smoking advertising campaigns. The messaging in these ads may have conveyed with words that smoking was bad for you on the one hand, but the way that was done was often ineffective or even subversively promotional of smoking. Whether this was intentional or simply misguided, I cannot say, but it is definitely interesting. For example, by showing a single brave student resisting the peer pressure of everyone else smoking, the real messages interpreted by teens may have been, "You're the only one who doesn't smoke," and, "Your parents are trying to tell you what to do." Or by directly mentioning companies' brand names as the funders of the messages, the companies may have actually built more positive brand association. Especially for a target audience like teenagers, perceptions about how many other people are doing an activity, how cool/desirable those other people are, how trustworthy an industry is, and whether the teen is being "told what to do" by an adult (as compared to being given greater independence), can actively affect decisions to start or continue a behavior. This is an important reminder as a public health professional that we need to be careful with our interventions and take as much precaution as possible to prevent unintended harm. Here is an example of an ad that was evaluated to have actually produced an increase in intention to smoke among teens:

A totally different type of advertisement that we studied, which was evaluated to be more effective, involved off-beat messaging that cast the tobacco industry in a negative light. This was without ever directly telling people what to do or even mentioning the negative consequences of smoking. Check out this innovative ad:

The reason I started thinking about this topic again so recently is that I saw a series of newer anti-smoking advertisements circulating online. For example, this one has gone viral and boasts the YouTube tagline, "perhaps one of the best anti-smoking ads ever created." I am still skeptical, but it is definitely interesting. Judge for yourself:

And then there is this super  hilarious new series about people who self identify as "social smokers," comparing them to social farters, social nibblers, and social ear wax pickers. To see all three videos, click here, and to check out the campaign's facebook page, click here. Below is one of the videos:

Click here for some other creative anti-smoking print advertisements. What do you think? Will these latest ads achieve their goals to decrease smoking? Are there any unintended messages here? What are your opinions on any of the policies mentioned in my last post, or the anti-smoking movement in general?

Fotoshop

As a follow-up to my post on obesity and physical appearance, I wanted to share a video that sheds a humorous bit of light on the beauty expectations of our culture. It made me laugh and think! I hope it will do the same for you.

I came across this video while reading a very interesting article on CNN about activists who are challenging popular notions of beauty. A similar theme to the above satire pervades a short film, made by Dove, to show the transformation from natural beauty to makeup model.

As I discussed in my commentary on childhood obesity and appearance, I do believe that the media shapes our sense of what is desirable, and even our concept of what is "normal." Children are especially vulnerable to having their expectations and opinions shaped. Even subtle advertising can make a difference when we consider how often we see the same message day after day. After a lifetime of exposure, it would be naive to assume we don't soak in anything from what we see, hear, and read.

For those who are skeptics, consider this passage from "Cinderella Ate My Daughter," by Peggy Orenstein (pg 17). "...Even can-do girls can be derailed - and surprisingly quickly - by exposure to stereotypes. Take the female college students, all good at math, all enrolled in advanced calculus, who were asked to view a series of television commercials: four neutral ads (showing, say, cell phones or animals) were interspersed with two depicting cliches (a girl in raptures over acne medicine; a woman drooling over brownie mix). Afterward they completed a survey and - bing! - the group who'd seen the streotyped ads expressed less interest and math- and science-related careers than classmates who had seen only the neutral ones. Let me repeat: the effect was demonstrable after watching two ads. And guess who performed better on a math test, coeds who took it after being asked to try on a bathing suit or those who had been asked to try on a sweater? (Hint: the latter group; interestingly, male students showed no such disparity.)"

I encourage you to read the CNN article that led me to this video and other pieces about similar topics. Consider how advertising is affecting our lives, from one math test (per the studies mentioned above) to career opportunities in general, from distorted self-image to unhealthy dieting, from peer relationships in the classroom to expectations in our dating and spousal relationships. All of these aspects of life are profoundly related to our mental, emotional, and physical health.

I hope that being even slightly more aware of how these messages affect us will change both our decisions about the images we choose to allow into our minds and the way we interpret the advertising we do take in. If enough people react against the practices of our media culture, the advertisers will have no choice but to take notice!


For more information on this video, check out Jesse Rosten's website: http://jesserosten.com/2012/fotoshop-by-adobe

The Obesity Epidemic and Physical Appearance: The Heart of the Matter

"The LORD does not look at the things man looks at. Man looks at the outward appearance, but the LORD looks at the heart." ~1 Samuel 16:7b

You may have heard about the Georgia campaign against childhood obesity that has started a major conversation around the country. Many bloggers seem to have opinions about the controversial ads. Since I have written several posts related to childhood obesity, I thought I should chime in, as well.

To put it bluntly, I don't like the ads. I find them offensive and unhelpful.

The ads feature pictures of overweight children with captions like, "It's hard to be a little girl if you're not." They were intended to grab the attention of passers-by and to get a conversation started. As I mentioned in my post on Childhood Obesity and Food Insecurity, the organization that ran this campaign, Strong4Life, conducted a study which showed that 75% of parents of obese children in Georgia do not think their child has a problem. So start the conversation they did, by thrusting all the negative stereotypes of obesity even more directly in the faces of the public.

My main gripe with this ad campaign is that it fuels the negativity about physical appearance with which overweight children are almost certainly already bombarded on a regular basis.

Now don't get me wrong. I do think childhood obesity is a serious problem. I think doctors need to be straight with parents. I think parents need to come to grips with reality. And I even think it's ok to discuss your child's weight problem with him or her under most circumstances. But I do NOT think it is ok to make this an issue of physical appearance.

While the ads may have aimed to show many effects of obesity through their captions, the message they sent loudest of all was, "See the image of this body? It is not acceptable. And you need to fix it."

I believe the appropriate way to address the issue of childhood obesity is from the perspective of the health and lifestyle effects of carrying excess weight. This focus shows concern for a person's well-being, not critical or self-righteous judgment.

The Health Consequences

According to the Centers for Disease Control and Prevention (CDC), in a study of five to seventeen year olds, 70% of obese youth had at least one risk factor for cardiovascular disease. Obese adolescents are more likely to develop prediabetes, a condition of elevated blood glucose that can lead to type II diabetes. According to the Mayo Clinic, type II diabetes itself, which used to be called "adult onset diabetes," is growing in prevalence among children, largely due to the obesity epidemic.

The CDC also states, "One study showed that children who became obese as early as age 2 were more likely to be obese as adults....and are therefore more at risk for adult health problems, such as heart disease, type 2 diabetes, stroke, several types of cancer, and osteoarthritis."

The Lifestyle Consequences

Not only does a high Body Mass Index put children at risk for chronic disease, but it may inhibit them from participating in activities they do (or would) enjoy, such as sports, dance, music, and theater, which often require stamina and endurance that may be limited by excess weight. For a young adult, obesity may even affect his or her stamina or self-confidence in sex. (Now that's a good reason to get fit, right?)

Where The Ads Went Wrong

Unfortunately, the negative effects of obesity don't end there. Obese children are more likely to be bullied or to experience depression. Obese adults are more likely to experience discrimination on the job (as often as racial discrimination, according to one study, and possibly more often than age or gender discrimination).

And this is where I think the Georgia ads get the issue wrong. While I think we should be campaigning to "change" obese people for the benefit of their physical health, longevity, and a better lifestyle, I think we should be campaigning to change ourselves for the problems that result from discrimination based on physical appearance. Judging anyone by physical appearance is not a problem with the person being judged; it is a problem in our own hearts and minds. Sure, some people's appearances may be a clue as to what is going on inside their heads or hearts, but this is not a universal truth. No person's worth is based on his or her appearance, and we should not perpetuate that myth ever.

To tell our children that we agree with the world's judgement that worth can be based on appearance is a tremendous mistake. To love someone despite their imperfections is not the same as tacit approval of their every choice. It is the nature of love itself.

Some will say that obesity is lethal, so we should go to extremes to curb or prevent it, even if it means hurting someone's feelings. I would agree that a little hurt feeling in the context of an intentional and caring conversation about health is well worth it. But in my view, to bring appearance into the conversation is not simply about a little hurt feeling; it may impose long-lasting damage. It is beyond a mere temporary pain when we tell a person, with a mind and heart, that our love is contingent on a particular physique. Appealing to a child's vanity may provide short term success, but it ultimately sets the child up for long term problems. To shame a child into losing weight is putting a skewed view of personal worth on a pedestal and sacrificing the ultimate mental health of the child in order to serve the false god of physical perfection.

The Media Has The "Judgment" Thing Covered

Children are already besieged by an unending stream of messages about their physical appearance.

I recently read a book called, "Cinderella Ate My Daughter," by Peggy Orenstein. While I lamented the disorganized and desultory nature of the book to my book club friends and thought the author made some grand leaps of logic, the overarching theme of the work stuck with me. Children are exposed, almost from birth, to a plethora of marketing images that tell them they need to fit into a specific mold. For girls, this mold largely leads to the conclusion that to be cool and accepted is to be "hot." A woman's worth comes from her physical appearance.

Anyone who watched the Superbowl ads will likely recall the GoDaddy segments featuring scantily clad women enticing the watcher to go to GoDaddy.com to "see more." I would not have known that this is a domain name registration site had my husband not told me. Photographers secretly take pictures of every inch of cellulite on an actress at the beach and enlarge the images for the covers of the magazines we see in the grocery store. We even grow up watching soap and deodorant commercials that tell us if we buy the product, we can look like the model.

I am pretty sure I get the point already. My cellulite is not acceptable, my breasts aren't perky enough, and I would never be called beautiful by a major news outlet.

For a kid being exposed to this constant marketing, the idea that certain body types are more valuable may become deeply ingrained. This can lead to bullying (by the kid who thinks others are unacceptable) or a sense of shame (for the kid who thinks he or she is the unacceptable one). In some cases, both lines of thinking may be at work in the same child.

One Piece of Evidence: Eating Disorders

It's all well and good for me to say that this is having a negative impact on obese children (and on all children, really), but what is the evidence?

I submit that one important signal of the impact is the growing prevalence of eating disorders among youth. According to a study published in the American Journal of Preventative Medicine, as cited by the National Eating Disorder Information Center (NEDIC), girls who reported body-based teasing by family members were 1.5 times more likely to engage in binge eating and extreme dieting behaviors five years later. A Canadian study also cited on the NEDIC site showed that 37% of girls in grade nine and 40% of girls in grade ten wished they were thinner. Even among those considered a healthy weight based on BMI, 19% believed they were too fat and 12% reported attempting to lose weight.

According to the National Eating Disorders Association, the number of young women aged 15 - 19 diagnosed with eating disorders has risen every decade since 1930. But it is not only teenagers who are affected. Psychotherapist Abigail Natenshon was cited in a recent Parenting magazine article as saying that "the average age for the onset of anorexia used to be 13 to 17. Now it's 9 to 12, and children as young as 7 have been diagnosed." In this same article, I learned that 10% of adults with eating disorders showed clear symptoms before the age of ten, and more than 60% of elementary and middle school teachers report that eating disorders are a problem in their classroom. Did you read that? Elementary school! In a 2010 article from Health Day, I learned that the Agency for Healthcare Research and Quality found that hospitalizations for eating disorders jumped 119% for kids under age 12 between 1999 and 2006. 

 Not only that, but anorexia has the highest mortality rate of any mental illness. The South Carolina Department of Mental Health website cites a study conducted by the National Association of Anorexia Nervosa and Associated Disorders, which reported that 5 - 10% of anorexics die within ten years of contracting the disease, 18 - 20% within twenty years, and only 30-40% ever fully recover. Other sources show lower numbers - the ANAD website itself now says that the American Journal of Psychiatry (2009) concluded that the ultimate mortality due to eating disorders is 4% for anorexia nervosa, 3.9% for bulimia nervosa, and 5.2% for eating disorders not otherwise specified. One of the reasons the statistics may vary between sources is that deaths related to eating disorders may be recorded under other causes, such as heart failure. Regardless, anorexia still stands at the top of mental illness mortality.

My Take

While it is important for us to recognize and address the growing obesity epidemic in our country, it is also worthwhile to pay attention to the unintended consequences of the strong rhetoric around the issue. At the same time obesity rates are growing, so are those of eating disorders and unnecessary dieting among youth. And this is only one of the potential problems that arise with such a strong focus on physical appearance. There are undoubtedly countless other emotional, relational, and even physical effects.

By not telling obese kids that they look "different," we are not hiding the truth from them. Many children who are overweight, and even many who are not, are already keenly aware of how their bodies are being scrutinized. The magazines they read, the television ads they see, the kids who bully them, the employers who don't promote them, are all sending them that message already. It's true that some parents and kids need a wake up call from a medical professional telling them they are on an unhealthy path. But the message we need to send is to take care of your body, for your own health's benefit, for the enjoyment of life, and for the sake of the work that God has for you in your time here.

Who you are and your personal worth as a human being are not based on how you look. 

Period.