"What do you want to do? Do you want to have people lose their legs or do you want to show them what happens so that they won’t lose their legs?" This was what New York City Mayor Michael Bloomberg had to say in response to outcries over the City Department of Health’s (DOH) new ads that graphically connect obesity with negative health outcomes including limb amputation (a procedure sometimes required in severe cases of diabetes). It is just one in a series of ads that DOH has recently released with facts about why people should avoid sugary drinks and cut down their portion sizes, and many have criticized these ads as being too negative or even counterproductive. Yet the DOH is not the only organization coming under fire over its controversial ads to fight obesity. In a part of what may be a growing national trend, a campaign from a hospital in Georgia has also created a stir with its commercials intended to raise parents' awareness of childhood obesity issues. These ads bluntly depict overweight children asking into the camera, "Why am I fat?" or stating they have, "something called hypertension."
Both the DOH and the Atlanta children's hospital, Pediatric Healthcare of Atlanta, have separately defended their ads, saying the shock factor was very much intentional. As Linda Matzigkeit, vice president of Pediatric Healthcare of Atlanta, stated in an interview, "It has to be harsh. If it's not, nobody's going to listen." Perhaps Matzigkeit’s approach is so extreme because we live in a country where an estimated one of every three adults is considered obese and the average citizen is 23 pounds overweight.
If the national obesity problem truly is so pervasive, then what is the problem with grabbing people’s attention through these types of ad campaigns? Health experts have used the term “fear appeals” to describe “persuasive messages that emphasize the harmful physical or social consequences of failing to comply with message recommendations.”[1] According to Diana Johnson, a Health Educator at Bronx Heath REACH, an organization aimed at eliminating disparities in health outcomes in the southwest Bronx, one largely accepted theory is that fear appeals only work when there are equally strong efficacy messages that accompany them. In other words, if fear or threats are used in a campaign, there must be an equally powerful “solution” to go along with the message, otherwise people feel overwhelmed and shut down. For many New Yorkers, however, the image of someone with a diabetes-induced amputation accompanied by advice to order smaller drink sizes does not hit the mark. In fact, New York Faith and Justice (http://nyfaithjustice.org/), a Bronx Health REACH Legacy project grantee working to advocate for the Farm Bill to be changed to include nutrition education at SNAP (food stamp) recertification sites, is unlikely to use the image of the amputee in its program materials because it, “may be too graphic and turn away some of the members from participating in the workshop.”[2]
The reactions to the Georgia campaign directed at obesity in children have been, in many ways, even more polarizing than to the amputee ads in New York. In response to the Georgia campaign, Dr. Miriam Labbok, director of the Carolina Global Breastfeeding Institute at the University of North Carolina at Chapel Hill told ABC News, “Blaming the victim rarely helps. These children know they are fat and are ostracized already.”
In many ways, however, Dr. Labbok’s comments about victim blaming apply to both ad campaigns. When we focus on the individual people who are obese, but who live in areas with little to no outdoor spaces to exercise, we are overlooking the fact that local governments allowed for these types of infrastructures to take hold in the first place. When we chastise the parent who buys a hamburger and fries, a whole meal for two or three dollars, we are ignoring the fact that these foods are being sold at below-market prices thanks to antiquated federal subsidies given to industrial farms. At what point do we need to stop spending countless dollars on getting individuals to change their “poor lifestyle habits,” and start looking at the systemic policies that have allowed for this epidemic to grab hold of our nation?
[1] Hale, Jerold L., and James P. Dillard. "Fear Appeals in Health Promotion Campaigns: Too Much, Too Little, or Just Right?" Designing Health Messages: Approaches from Communication Theory and Public Health Practice. Ed. Edward Maibach and Roxanne Parrott. Sage, 1995. 65-80.
[2] Howard-Norman, Regina. "NYC DOHMH: Cut Your Portions. Cut Your Risk." Message to Kelly Moltzen. 10 Jan. 2012. E-mail.
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