label guides

Obesity Reduction Campaign

Deirdre A Dingman

Final Project

HEA 609

May 4, 2006

I understand and have abided by the UNCG academic honor code.

Deirdre A Dingman

Obesity Reduction Campaign

Statement of the Problem: A measure of weight, obesity is the point where one is said to have increased risk for certain adverse health outcomes, which include heart disease, stroke and diabetes. (Centers for Disease Control and Prevention, 2006). In Forsyth County, NC one out of five residents is considered to be obese (BRFSS, 2001). The above mentioned illnesses cause premature death and disability (World Health Organization, 2002). From 1990-2002 there has been no improvement in obesity numbers for the county and over 20 percent of the residents of Winston Salem, the county seat, are obese (BRFSS). Nationally we have a combined overweight/obesity rate of approximately sixty percent (Ad Council, March 2004). It is important to target the Southeast as there is a concentration of overweight persons in what the National Heart Lung and Blood Institute calls the Stroke Belt. North Carolina is one of 11 states so named (NHLBI 2006). Though being overweight is not color specific, more black Americans die from the diseases related to obesity while women of both black and white races die from heart disease at a greater rate than males (American Heart Association, 2006).

Theory of the Problem: Obesity is related to an abundance of unhealthy, cheap food and a change in the amount of physical activity all persons engage in (WHO, 2000). The Ad Council describes it as having food excess with higher sugar and fat content, inappropriate portion sizes and caloric density (Ad Council, March 2004). Thus it may begin as a problem of the built environment. In this environment the food manufacturers are increasingly being called to account for their actions. Just last month, April 2006, a report from London’s City University tested the response to the WHO call for action and found that the major companies, i.e. Kraft, Coca Cola, Burger King, Wal-Mart and more had not responded appropriately. A reporter quoted in that story said, “Their performance is by and large pathetic (Reuters, 2006).” This can explain how people became fat but I believe that the Extended Parallel Process Model (Witte et al, 2001) can explain why people remain so. The majority of people do not feel that obesity in itself is a risk for death and they have become complacent with their weight without feeling susceptible to serious threat and many have no tool to efficaciously address the problem. The EPPM includes constructs of the Health Belief Model, Social Learning Theory and Theory of Reasoned Action. It includes Social Marketing and Social Influence theory as well. And with this issue it cannot be stressed enough that environment and policy have a profound effect both locally and globally. Perhaps by using the EPPM to focus, educate and engage the “victims” a bit of reciprocal determinism will occur with food manufacturers and their trade associations. Consumer groups who are already addressing this issue, such as Public Citizen and Center for Science in the Public Interest may get a boost from a change in normative beliefs of the general population. And as the 2006 City University report states, “eventually the companies will wake up.”

Planned Intervention: I will use social marketing in a campaign to first educate the consumer in an alert that being overweight is a problem. The purpose is to increase feelings of susceptibility and in fact it will be a serious fear message. This ad will be televised and placed on city bus after a focus group of the target population confirms the intent to educate and scare is realized. My logic model will show activities and means to evaluate both short and long term goals. After getting the populations attention, education on understanding food labels will take place. (It is possible that an ad with a real person who has had a health scare and begun choosing her foods through awareness of their content would be a better choice or next step. I know such a person.) The USDA has spent time and money to revise these content labels so that product info on select nutrients is available. I will highlight serving sizes and what to look for on a label by developing a label guide. This label guide will be distributed at Point of Purchase where an interactive lesson will also take place. The label guide will also be tested prior to a broad distribution. I intend to do a pre and post test in store survey in order to validate the program as data driven and pursue funding for statewide implementation. The CDC has recently provided grants for community based programs such as these, and the Ad Council has its Small Steps campaign that also strives to lower obesity through better nutrition. These agencies may be involved in the actual program. The population lives within Winston Salem or Forsyth County with in 30 miles of the Wal-Mart on Kester Mill road.

Contributing factors to the problem can include: being unaware of the bad or unhealthy components of some foods, uncomfortable with food labels, not understanding serving sizes, feeling overwhelmed with weight and choices. Though I do believe that there is a component of complacency and misguided acceptance of extreme weight, I also believe that without concrete skills and self efficacy as encouraged in all the above mentioned theory, change will not occur. Thus the methods are to acknowledge a real and significant level of threat and then to teach a skill with an interactive activity and to extrapolate this skill of label reading into a social norm. It is in this phase that a long term effect could be that food manufacturers respond with their own policy changes in the demand consumers place on them for healthy alternatives and thus a systems change on multiple levels could occur.

Addendum: In keeping with the marketing wheel and processing this intervention throughout planning, the Media Campaign was adjusted. It now addresses not only the lack of knowledge that obesity is a health risk in and of itself, but adds a component in response to breaking research that indicates a majority of obese people do not realize they are!

References:

Ad Council. 2004. Obesity Prevention. Washington, DC: The Ad Council. Available: http://www.adcouncil.org/default.aspx?id=68 [accessed 02 March2006]

AHA. 2006. Risk Factors You Can't Control. Dallas, TX: American Heart Association. Available: http://www.americanheart.org/presenter.jhtml?identifier=3017031 [accessed 01 April 2006]

BRFSS. 2004. SMART: Selected Metropolitan/Micropolitan Area Risk Trends

Select Health Risk Data. Atlanta, GA: National Center for Chronic Disease Prevention and Health Promotion Behavioral Risk Factor Surveillance System. Available: http://apps.nccd.cdc.gov/brfss-smart/SelQuestion.asp?MMSA=96&yr2=2004&VarRepost=&cat=XX#XX

[accessed 01 April 2006]

CDC. 2006. Overweight and Obesity Health Consequences. Atlanta, GA: Centers for Disease Control and Prevention. Available: http://www.cdc.gov/nccdphp/dnpa/obesity/consequences.htm

[accessed 01 April 2006]

Holton. 2006. Food companies criticized over health commitments. Reuters Inc. Available on line

http://news.yahoo.com/s/nm/20060404/hl_nm/food_report_dc

McMahan, S., Witte, K., & Meyer, J. (1998). The perception of risk messages regarding electromagnetic fields: Extending the Extended Parallel Process Model to an unknown risk. Health Communication, 10(3), 247-259.

NHLBI. 2006. NHLBI Stroke Belt Initiative. Bethesda, MD: National Heart, Lung, Blood Institute. Available: http://www.nhlbi.nih.gov/health/prof/heart/other/sb_spec.htm

[accessed 01 April 2006]

WHO. 2002. The World Health Report 2002. Reducing Risks, Promoting Healthy Life. Geneva, Switzerland: World Health Organization.

WHO. 2000. Obesity, an epidemic. Geneva: The World Health Organization. Available: http://www.emro.who.int/nutrition/PDF/Obestity_Epidemic.pdf

[accessed 01 April 2006]

Witte, K., Meyer, G., & Martell, D. (2001). Effective Health Risk Messages: A Theoretically-Based, Step-by-Step, How-To Guide on Developing Persuasive Communications that Work. Newbury Park, CA: Sage.

Logic Model A1

Social Marketing Wheel One A2

Social Marketing Wheel Two A3

Bus Wrap and PSA Graphic A4

Label guide Tool A5

Logic Model for Label 101 Campaign

Goal(s): Improved nutrition and weight reduction in the obese of Winston Salem

INPUTS

OUTPUTS

OUTCOMES

Theory and Belief

HBM

SLT

EPPM

TRA

Ecological

Increased awareness of

Threat

Increased belief that threat can be controlled

Increased capacity to control

Social Norming

This includes the use of Social Influence and Social

Marketing

Interactive and process driven data

ACTIVITIES

PARTICIPANTS

SHORT TERM

MEDIUM TERM

LONG TERM

1) Media Campaign

TV and Bulletin board

Health message

On risks associated with

obesity

2) Walmart demo and distribution

“label reading 101”

Teach key label measures for healthy eating, demonstrate in store with actual foods

Distribute label reading guide

Phase one:

Focus group of 6-8 target group volunteers

Phase two:

TV ad for local station viewing area

(choose two different time spots)

Bulletin Board / via WSTA bus

Phase one:

Pre test of lesson and materials with volunteers from the store…

Phase two:

Walmart Shoppers at Store #____

w/in Winston Salem

4 interventions

1)Increased awareness of obesity risks

_____________________

2) Reading label comfort

Increased level of susceptibility and desire for change

_____________________

Reading of labels increases, improved eating occurs

Reduction in number of obese in WS drops from one in five to one in ten

___________________

Systems change at POP, food production, within individual, family and community (re: label reading is a norm, environment response is healthier foods)

OUTCOME MEASURES

Focus group determines readability and reachability

Modifications made

Comfort with and increased knowledge on label facts

What in a food is healthy , what amounts are suggested, etc.

Pre and post test telephone survey of 50 random digit dialing pooled from zip codes in listen area

List the health consequences of obesity

Expect number to increase after campaign

Pre and post tests onsite

Week prior to intervention start and one week after all completed

Review BRFSS data for obesity numbers

Retest comfort level of label reading in broader telephone survey one year after intervention

[WSTA Bus Wrap]

Label Wise and Healthy

Ingredients are listed in order of amount, i.e. first item is what makes up the most of the food, and so on.

DANGER WORDS: sugar, syrup and any words with –ose- Also avoid, partially hydrogenated oils. These words are warnings for high calories and low nutrients. Also, the longer the list, the more processed the food is and processed isn’t healthy.

What Makes a Food Healthy? Here are Per Serving guidelines:

Less than 400 calories, 3 g of total

fat, 1g of saturated fat

and 0 TFAs.

Monounsaturated & Polyunsaturated

are healthy fats. You want less

than 140 mg of sodium, less than 8g

of sugar, and over 5 g of fiber.

Know how many servings you’re eating! Measure, multiply if necessary.

CDC, Kraft, USDA, ADA, Wal-Mart

Label Wise and Healthy

Ingredients are listed in order of amount, i.e. first item is what makes up the most of the food, and so on.

What Makes a Food Healthy? Here are Per Serving guidelines:

Less than 400 calories, 3 g of total fat, 1g of saturated fat and 0 TFAs.

Monounsaturated and Polyunsaturated are healthy fats. You want less than 140 mg of sodium,

less than 8 g of sugar, and over 5 g of fiber.

Know how many servings you’re eating! Measure, multiply if necessary.