Archive for the ‘Nutrition’ Category

In our attempts to encourage people to lead healthier lives, we often make the mistake of bombarding them with facts and stats, do’s and don’ts, assuming the problem is a lack of knowledge. But let’s be honest – most people know that French fries are not the healthiest food in the world, fruits and vegetables are good for you, and that you really ought to exercise regularly.

So, what’s the problem? One aspect of the problem is of course the systems level issues of food access, cost, time and space to be active, etc. that we have mentioned before.

Another aspect though is one of attitude and culture.

Feel Rich, which launched in December, is attempting to address just this (sidenote: the organization’s CEO and others involved were on a SXSW Panel just this past weekend).

Feel Rich’s goal is the creation of a health and fitness culture born from the urban and hip-hop community’s love and respect for music, movement, and entertainment. Their message: health is the new wealth.

As opposed to your typical public health campaign centered on facts, stats, and do’s and don’ts, Feel Rich is attempting to first foster a desire for health (in other words, crafting an attitude and creating a culture that sees health as critical and desirable as wealth), engaging urban youth in a meaningful way that speaks to their interests. In Feel Rich’s own words – “It’s health on your terms, fitness in your style, and food choices that make sense on the streets where you live.” It’s also about making health and wellness cool.

I think it’s an exciting and inspiring approach, and the way the Feel Rich movement taps into attitudes (not just information), reminds me of the baby carrots campaign I’ve written about before. After all, whether we’re talking about the junk food industry, big tobacco, or pretty much any other product we see commercials for, appealing to emotion and attitudes is the way advertising is done. It’s long past due that prevention and health promotion advocates started utilizing this powerful strategy.

Feel Rich ties this powerful appeal to attitude and culture with empowering information on food, fitness, and health, and an array of videos and stories to engage and inspire their audience.  And with over 3 million YouTube views, it looks like they are doing just that.

I’ll close with some food for thought on this topic from David Katz’s most recent Huffington Post article:

“What if health were more like wealth?

  • If health were like wealth, we would value it while gaining it — not just after we’d lost it.
  • If health were like wealth, we would make getting to it a priority.
  • If health were like wealth, we would invest in it to secure a better future.
  • If health were like wealth, we would work hard to make sure we could pass it on to our children.
  • If health were like wealth, we would accept that it may take extra time and effort today, but that’s worth it because of the return on that investment tomorrow.
  • If health were like wealth, society would respect those who are experts at it.
  • If health were like wealth, young people would aspire to it.

This post is cross-posted at http://occupyhealthcare.net 


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I have written about the behavior shaping role of the entertainment and news media before, but of course, marketing plays a huge role too. And the behavior shaping role of marketing has been in the spotlight this past month, specifically in the context of marketing of junk food to children. Between the continual delays and watering down of what are alreadycompletely voluntary recommended nutrition standards for marketing foods to kids (composed by the Federal Trade Commission’s Interagency Working Group on Food Marketed to Children) and the release of a study revealing that popular cereal brands “pack more sugar than snack cakes and cookies”, it seems like a good time to take a closer look at the world of fast food and junk food marketing to kids.

As the Prevention Institute points out:

*The food and beverage industry spends approximately $2 billion per year marketing to children.

*The fast food industry spends more than $5 million every day marketing unhealthy foods to children. 

*Kids watch an average of over ten food-related ads every day (nearly 4,000/year).

*Nearly all (98 percent) of food advertisements viewed by children are for products that are high in fat, sugar or sodiumMost (79 percent) are low in fiber.

In a study comparing the nutritional content of food items observed during advertisements (during 84 hours of primetime and 12 hours of Saturday-morning TV broadcast during the fall of 2004) to the recommended daily values, researchers found that a diet consisting of observed food items would provide 2,560% of the recommended daily servings for sugars, 2,080% of the recommended daily servings for fat, 40% of the recommended daily servings for vegetables, 32% of the recommended daily servings for dairy, and 27% of the recommended daily servings for fruits.

This disproportional marketing of foods high in fat and sugar might be concerning in and of itself – but the real problem is that it’s working. Beyond the evident fact that childhood obesity is an enormous problem in the United States, numerousresearchers and government agencies have found specifically that marketing and advertising of foods does in fact impact children’s food preferences, as well as purchase requests directed to parents and short- and long-term dietary consumption.

Moreover, in recent years, researchers at the Yale University Rudd Center for Food Policy and Obesity have concluded that “the traditional models used to explain advertising effects have overemphasized the importance of children’s understanding of persuasive intent”, echoing an Institute of Medicine Report which points out that although the most common models used to explain the effects of food marketing assume a conscious and rational path from exposure to behavior via persuasion, more recent psychological models suggest repeated exposure to food advertising can lead directly to beliefs and behaviors without active, deliberate processing of the information presented.

In this context, branding and cues such as cartoon spokescharacters, colorful packaging, and pictures have been identified as important in this link between food advertising and beliefs and behaviors. Studies have shown that children 3-5 years prefer the taste of baby carrots, milk, and other products out of a McDonald’s bag and that kids 4-6 years prefer the taste of graham crackers and gummy fruit snacks with Dora, Shrek or Scooby Doo on packaging.

If that’s not worrisome enough, the Prevention Institute has more statistics for us:

*Nearly 40% of children’s diets come from added sugars and unhealthy fats.

*Each day, African-American children see twice as many caloriesadvertised in fast-food commercials as White children.

*Even five years after children have been exposed to promotions of unhealthy foods, researchers found that they purchased fewer fruits, vegetables and whole grains, but increased their consumption of fast foods, fried foods and sugar-sweetened beverages.

*By 2030, healthcare costs attributable to poor diet and inactivity could range from $860 billion to $956 billion, which would account for 15.8 to 17.6 percent of total healthcare costs, or one in every six dollars spent on healthcare.

So what can we do? I think the solution lies in not only in trying to limit the marketing of unhealthy foods to children but also in tapping into their strategies (which clearly work) to promote healthy options to kids. As the Institute of Medicine points out, the field has “underutilized the potential to devote creativity and resources in promoting food, beverages, and meals that support healthful diets for children”. One of the few examples I’ve come across: the recent baby carrots campaign, which “takes a page out of junk foods’ playbook and applies it to baby carrots” with Doritos-like packaging, seasonal tie-ins like “scarrots” during Halloween, and TV spots that portray baby carrots as extreme and futuristic.

We have a responsibility to be creative and tap into strategies that work when it comes to marketing healthy foods – not just preach and list facts (since we all know how appealing kids find that technique).

We also have a responsibility to step up and speak up against the massive junk food and fast food industries in their aggressive marketing to children – the Prevention Institute has a great video and easy action items on this front.

Check it out and add your voice to the discussion!

(This post is cross-posted at http://occupyhealthcare.net)

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Note: This post is cross-posted at Occupy Healthcare – be sure to check out the other posts there, and check out #occupyhealthcare on twitter too, the movement is growing! 

In my last post, I wrote about the importance of occupying an array of fields that impact our country’s health. Lest this task seem too daunting to be accomplished, I thought I’d take a moment to highlight some success stories on this front.

Access to healthy foods is an important determinant of health and an important factor in health inequities. The Food Trust, a non-profit based out of Pennsylvania, is tackling this problem, aiming to make healthy food available to all. Among their many innovative projects is the Pennsylvania Fresh Food Financing Initiative, a grant and loan program to encourage supermarket development in underserved neighborhoods throughout the state, an idea that is now being replicated nationally. Some other creative developments in the field of nutrition and healthy food access: taking a page out of the junk and fast food industry’s book, with their billions spent on marketing, and branding baby carrots in a way that’s fun and exciting; and tapping into behavioral economics to redesign cafeteria lunch lines in a way that increases purchase of healthy foods and decreases purchase of unhealthy foods (an inexpensive and effective approach!).

Given that homicide and suicide are among the leading causes of death among those age 1 to 34, violence prevention is another key aspect of attaining the health our society deserves. Chicago-based CeaseFire combines research and street outreach to track violence, interrupt and intervene (with well-trained professionals from the communities they represent with a background on the streets), and engage in longer term risk reduction and behavior and norm change. Even more exciting – it’s working.

Neither access to healthy foods nor neighborhood safety – not to mention walkability, pollution-free environments, and a host of other things – is possible without intelligent and innovative urban planning. Thankfully, we have the likes of The Congress for the New Urbanism working to promote walkable, mixed-used neighborhood development, sustainable communities and healthier living conditions.

And while our national political discussion is so bogged down by discussions of whether to help low-income individuals and families that we haven’t had a conversation about how best to help them, organizations like the Family Independence Initiative, which was featured in the New York Times this past summer, are taking an approach radically different from our typical social service model, tapping into the strengths and support systems of low-income families, allowing them to determine their own paths and advance together. This too, has been shown to work.

Across all of these health-related issues, the media plays a role in shaping behaviors and norms, and Hollywood, Health, and Society is bridging two drastically separate sectors with its work to provide entertainment industry professionals with accurate, timely, and engaging information and case examples for health storylines, as well as study the content and impact of these storylines.

Of course, just because it’s not all about healthcare doesn’t mean healthcare isn’t at the table – healthcare providers can play just as important role in prevention and promotion as they do in treatment, and places like the Codman Square Health Center make that crystal clear. A community health center in one of the most impoverished areas of Boston, the Center provides a range of public health and community services (ranging from computer classes and financial help to fitness opportunities and hands-on cooking classes, not to mention youth services, civic engagement initiatives, and a close linkage with the Codman Square Academy charter school).

So, as daunting as the task of occupying for health seems, there are many people in many places doing amazing things. To quote the founder of the Codman Square Health Center: “We need to create integrated systems that promote community and health values. Like all change such cultural shift will take a generation or more to accomplish. But I am reminded of the story President John F. Kennedy told of the French leader who asked his gardener to plant a rare tree on his estate. ‘But the tree won’t bloom for 100 years’ the gardener said. The response: ‘In that case, plant it this afternoon.’”

So here’s to starting planting – and occupying. Cheers.


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This past Thursday, Michelle Obama unveiled the USDA’s new MyPlate icon  (to replace the food pyramid we all learned about growing up, which has long been criticized, as well as the newer MyPyramid).

A quick note on the actual content of the MyPlate icon – while I think the idea of having half your plate be fruits and vegetables is an important one and one I’m happy to see emphasized, I worry about “grains” and “proteins” – some grains are better than others and does everyone know what constitutes proteins? I think one of the best guidelines for what to eat in terms of comprehensiveness is The Healthy Eating Pyramid (and indeed, its creators were quick to point out that though a major improvement, MyPlate “still falls short on giving people the nutrition advice they need to choose the healthiest diets”), but I realize The Healthy Eating Pyramid is too much information to make for a truly useful icon, particularly for kids. My other content concern regarding MyPlate – where is water?? We really need to emphasize the importance of water intake (especially in place of sugar sweetened beverages!) and I think that’s something the USDA could easily have done here but failed to do.

On the health communications side, the icon is a wonderfully simplified what-to-eat tool that very directly connects recommendations to our decision-making by using what we all eat on – a plate. The website seems easy to navigate, provides useful explanations of the different categories of foods on the plate, and interactive tools to plan and track what you eat. I was also excited to see useful and fun use of twitter – “snap a photo of your next meal and share with us on Twitter using the hashtag #MyPlate”.  Some quick googling suggests the icon has been met mostly with praise – from the food service industry to produce industry to nutritionists and communications experts. Half your plate should be fruits and vegetables is a very simple message, and those are often the ones that work best.

Whether or not this simple message will actually change behavior is another question altogether…To change behavior, communication in of itself is rarely, if ever, enough. One very practical linkage I’d like to see is the sale of “MyPlate”s and the use of “MyPlate”s in schools. Behavior economics research has shown that physical indicators like the size of your plate and having partitioned plates with specific sections for specific foods can actually have a huge impact on what people choose to eat (e.g., Pedersen et. al.’s 2007 study found using a portion control plate – pictured here – was effective in promoting weight loss and decreases in need for medication in obese patients with type 2 diabetes). Then of course, there are the broader issues of food cost and access, taste preferences, etc. – but this is just one campaign, and we can’t expect it to address everything.

Another note on the health communications side – I read some of the comments on the USDA’s youtube video introducing the MyPlate icon (when will I learn reading comments is a bad idea?) and found a slew of comments expressing outrage and disgust at the $2 million that went into developing the icon, the accompanying website, and the campaign overall.

Do people have any idea how much the food industry invests in advertising? According to Advertising Age, U.S. food, beverage and restaurant industries spend over $12 billion a year on “measured media” advertising alone (TV, radio, magazine, newspaper, billboard, and Internet ads), not to mention product placement in toys and games, and the use of characters and celebrities.

Public health has to compete, and when we do, we get slaughtered for wasting taxpayer money. I’m not advocating for careless use of funds. Nor am I saying this campaign was necessarily worth the $2 million – that will depend on what evaluation of the campaign suggests as to its effect. But developing effective communication tools and campaigns takes resources – and whether it’s the junk food industry of cigarette companies, groups with interests opposing those of the public health community spend a lot more money than public health will ever have. It infuriates me when people attack public health spending as fruitless or excessive without thinking about what the impact could be or what forces public health interests are fighting against. (On the flip side, it infuriates me when money spent on public health or other good causes is assumed to be money well spent – we do have a responsibility to be effective and cost efficient with money from donors, taxpayers, etc. and this is not always the case).

Outrage over the money spent on health communications campaigns like this one reminds me of a scene in West Wing when someone from the Justice Department approaches Josh and Leo requesting more money for a lawsuit against big tobacco and is met with an incredulous we already gave you $30 million, how can you possibly need more?. He responds: “We have 31 lawyers on a case against 5 tobacco companies, just one of which has 342. We won’t count the 13 subsidiaries that have mounted their own defense. Tobacco has spent 380 million dollars to the government’s 36, so when I come here asking you for money, it’s not because the Justice Department blew its allowance on videogames!”

Later, Josh talks about how this is a “phenomenally important case…[and] we’re fighting it with paper clips and a slingshot.”

We’re fighting it with paper clips and a slingshot – true of many a public health fight.

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