An Atlanta billboard campaign designed to draw attention to chilhood obesity has backfired rather badly for the Stong4Life advocacy group:
The campaign has drawn strong criticism for stigmatizing overweight children rather than attempting to address the issue through more positive means. We could draw some interesting parallels here between the medical professions fondness for coercive and negative role modeling to educate (of which it has a long tradition), but more interesting is the relationship of this case to evidence based practice (EBP).
If we consider that EBP is represented by the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients (Sackett et. al, 1996), then we can clearly see the scientific evidence supports the case that childhood obesity is bad for children’s health. It results in obesity and increases the risks significantly of many other childhood illnesses.
However, the evidence in EBP is not just medical, it represents the collection, interpretation, and integration of valid, applied empirical experience from research-derived, clinician-observed and patient-reported evidence. The aim being that the best available evidence, cost-effectiveness, practical patient circumstances and preferences are all considered in care decisions to maximize the quality of care we deliver. This is a tall order, but the EBP is clearly focused on patient preferences and needs as well as medical evidence. This seems to be something that the Strong4Life group did not consider, as there is a lot of evidence that this type of sterotyping can be counterproductive. Media stereotypes are a fact of life, especially in the advertising and entertainment industries, which need as wide an audience as possible to quickly understand information. Stereotypes give audiences a quick, common understanding of a person or group of people but stereotypes are frequently problematic. They can reduce a wide range of differences in people to simplistic categorizations: transform assumptions about particular groups of people into “realities”: be used to justify the position of those in power: perpetuate social prejudice and inequality, and as seems to be clear from this case often the groups being stereotyped have little to say about how they are represented.
Opponents to the advertisments have noted there are many studies that suggest the perception that obesity is mainly a matter of personal responsibility as opposed to understanding the complexity of the phenomenon, and this can increase negative stereotypes about overweight people.The evidence here would seem to suggest this is not an approach that is going to prove helpful to obese children.
There are clearly other ways to do this.
In the UK in the 1980’s we had a (rather abstract) HIV/AIDS campaign that used giant stone slabs (or tombstones) as a visual icon. The government funded campaign sent leaflets to every household in the UK and new diagnoses of HIV,dropped by a third in three years. Admittedly this was not just due to the campaign, but there was a clear decision taken from marketing and media experts to avoid negative human images that could lead to sterotypical messages, and use alternative graphical formats and focus on outcomes the disease itself rather than the individuals afflicted by it. The actual effectiveness of this approach compared to others is debatable, but clearly it resulted in a growth in public awareness of HIV/AIDS, and it avoided stereotyping those affected by the disease.
This is just one example of effective health media campaigns, but it seems that often the drive to apply knowledge from medical science overlooks the broader psycho-social factors in actually delivering the message.
Jamie Oliver’s Food Revolution program that attempted to get healthier eating into US high schools is an excellent example of a positive program focused on children’s diets that did not stigmatize the kids, but also highlighted some of the complex socio-cultural and political aspects of childhood obesity.
So, from the science perspective where did the strong4life program go wrong? Does it represent a good application of EBP, or a bad one. I would suggest this ill-judged campaign missed the EBP boat by quite some way. Do let us know if you agree, and we would love to hear of other examples of other negative stereotyping you may have seen in public health campaigns, that represent a misguided use of scientific evidence in the media.
Sackett, D. L., Rosenberg, W. M. C., Gray, J. A. M., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: what it is and what it isn’t. British Medical Journal, 312(7023), 71-72.