Exploring Intended and Unintended Reactions to Healthy Weight and Lifestyle Advertisements: An Online Experiment

Background To address concerns that healthy weight and lifestyle campaigns (HWLCs) could have unintended psychological or behavioral consequences, this study tested reactions to TV advertisements from two HWLCs: LiveLighter® (employs graphic health effects messaging) and Swap It Don’t Stop It (employs animation and light-hearted messaging). Methods An online between-subjects experiment tested reactions to one of five advertisements: “Toxic Fat”; “Sugary Drinks” (both from LiveLighter); “Become a Swapper”; “How to Swap It” (both from Swap It); and “HSBC Bank” (control) among 2,208 adults from Western Australia and Victoria, Australia. Responses assessed were cognitive and emotional reactions, behavioral intentions, internalized weight bias, antifat attitudes, self-esteem and body dissatisfaction. Results The HWLC advertisements prompted favorable cognitive reactions and weak to neutral positive and negative emotional responses. HWLC advertisements promoted stronger intentions to engage in adaptive lifestyle behaviors compared with the control advertisement. Intention to engage in maladaptive behaviors (e.g., skipping meals) was low overall and did not differ by condition. Compared with the control condition, participants who saw LiveLighter “Sugary Drinks” showed weaker disagreement with antifat attitudes; however, mean antifat attitude scores were still at the low end of the scale. HWLC advertisements did not promote internalized weight bias, reduced self-esteem or body dissatisfaction compared with the control advertisement. Conclusions Overall, HWLC advertisements performed favorably compared with the control advertisement and showed no clear evidence of adverse impacts. Findings suggest HWLC advertisements may not promote negative psychological and behavioral consequences and can continue to be used in obesity prevention efforts.

[1]  Michelle I Jongenelis,et al.  Outcomes of exposure to healthy weight and lifestyle advertising: An experimental study of adults from the United Kingdom , 2021, Preventive medicine reports.

[2]  Alejandra Jáuregui,et al.  Recall of government healthy eating campaigns by consumers in five countries , 2021, Public Health Nutrition.

[3]  Natasha Varshney.  Cancer Research UK’S obesity campaign in 2018 and 2019: effective health promotion or perpetuating the stigmatisation of obesity? , 2020, Journal of Medical Ethics.

[4]  A. Bauman,et al.  Results of a mixed methods evaluation of the Make Healthy Normal campaign. , 2020, Health education research.

[5]  A. Bauman,et al.  Can Reducing Childhood Obesity Solve the Obesity Crisis in Australia? , 2020, Obesity.

[6]  C. Apovian,et al.  Joint international consensus statement for ending stigma of obesity , 2020, Nature Medicine.

[7]  R. Pearl,et al.  Weight stigma as a psychosocial contributor to obesity. , 2020, The American psychologist.

[8]  M. Wakefield,et al.  Association of the LiveLighter mass media campaign with consumption of sugar‐sweetened beverages: Cohort study , 2019, Health promotion journal of Australia : official journal of Australian Association of Health Promotion Professionals.

[9]  Ross A. Hammond,et al.  The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission report , 2019, The Lancet.

[10]  L. Hardy,et al.  Sustained low consumption of fruit and vegetables in Australian children: Findings from the Australian National Health Surveys , 2018, Health promotion journal of Australia : official journal of Australian Association of Health Promotion Professionals.

[11]  J. Browne,et al.  You wouldn't eat 16 teaspoons of sugar—so why drink it? Aboriginal and Torres Strait Islander responses to the LiveLighter sugary drink campaign , 2018, Health promotion journal of Australia : official journal of Australian Association of Health Promotion Professionals.

[12]  S. Grant,et al.  Weight stigmatisation in antiobesity campaigns: The role of images , 2018, Health promotion journal of Australia : official journal of Australian Association of Health Promotion Professionals.

[13]  R. Pearl,et al.  Weight bias internalization and health: a systematic review , 2018, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[14]  S. Noar,et al.  Perceived Message Effectiveness Measures in Tobacco Education Campaigns: A Systematic Review , 2018, Communication methods and measures.

[15]  A. Bauman,et al.  Impact of the Make Healthy Normal mass media campaign (Phase 1) on knowledge, attitudes and behaviours: a cohort study , 2018, Australian and New Zealand journal of public health.

[16]  D. Berry,et al.  Impact of weight stigma on physiological and psychological health outcomes for overweight and obese adults: A systematic review , 2018, Journal of advanced nursing.

[17]  L. Biener,et al.  Fear, Sadness and Hope: Which Emotions Maximize Impact of Anti-Tobacco Mass Media Advertisements among Lower and Higher SES Groups? , 2018, Journal of health communication.

[18]  A. Fried,et al.  Public health and obesity prevention campaigns – a case study and critical discussion , 2018 .

[19]  M. Wakefield,et al.  Controlled cohort evaluation of the LiveLighter mass media campaign’s impact on adults’ reported consumption of sugar-sweetened beverages , 2018, BMJ Open.

[20]  A. Bauman,et al.  A Systematic Search and Review of Adult-Targeted Overweight and Obesity Prevention Mass Media Campaigns and Their Evaluation: 2000–2017 , 2018, Journal of health communication.

[21]  Cat Pausé.  Borderline: The Ethics of Fat Stigma in Public Health , 2017, Journal of Law, Medicine & Ethics.

[22]  S. Pettigrew,et al.  Features of alcohol harm reduction advertisements that most motivate reduced drinking among adults: an advertisement response study , 2017, BMJ Open.

[23]  J. Smyth,et al.  Experiences of Weight Stigma in Everyday Life: Implications for Health Motivation , 2016 .

[24]  A. Bauman,et al.  Impact of the Swap It, Don’t Stop It Australian National Mass Media Campaign on Promoting Small Changes to Lifestyle Behaviors , 2016, Journal of health communication.

[25]  Z. Sui,et al.  Discretionary food and beverage consumption and its association with demographic characteristics, weight status, and fruit and vegetable intakes in Australian adults , 2016, Public Health Nutrition.

[26]  J. Manson,et al.  Determinants and Consequences of Obesity. , 2016, American journal of public health.

[27]  H. Dixon,et al.  Identifying effective healthy weight and lifestyle advertisements: Focus groups with Australian adults , 2016, Appetite.

[28]  Amanda Hinnant,et al.  Stigmatizing Images in Obesity Health Campaign Messages and Healthy Behavioral Intentions , 2016, Health education & behavior : the official publication of the Society for Public Health Education.

[29]  J. Yang.  Of markets and rights: Discourse in the 2008 and 2013 Global Action Plan for the Prevention and Control of Noncommunicable Diseases , 2016 .

[30]  M. Wakefield,et al.  Population-based evaluation of the ‘LiveLighter’ healthy weight and lifestyle mass media campaign , 2016, Health education research.

[31]  Sarah E. Vaala,et al.  Weight Stigmatization Moderates the Effects of Sugar-Sweetened Beverage-Related PSAs Among U.S. Parents , 2016 .

[32]  B. O'Hara,et al.  Finding the keys to successful adult-targeted advertisements on obesity prevention: an experimental audience testing study , 2015, BMC Public Health.

[33]  Ross A. Hammond,et al.  Smart food policies for obesity prevention , 2015, The Lancet.

[34]  Deborah Lupton.  The pedagogy of disgust: the ethical, moral and political implications of using disgust in public health campaigns , 2015 .

[35]  M. Wakefield,et al.  Evaluation of the LiveLighter “Sugary Drinks” mass media campaign , 2014 .

[36]  S. Emery,et al.  Televised obesity-prevention advertising across US media markets: exposure and content, 2010–2011 , 2014, Public Health Nutrition.

[37]  B. Swinburn,et al.  Relationship between raised BMI and sugar sweetened beverage and high fat food consumption among children , 2014, Obesity.

[38]  Carol T. Miller,et al.  The ironic effects of weight stigma , 2014 .

[39]  R. Puhl,et al.  Public reactions to obesity-related health campaigns: a randomized controlled trial. , 2013, American journal of preventive medicine.

[40]  J. Nonnemaker,et al.  Perceived Effectiveness of Cessation Advertisements: The Importance of Audience Reactions and Practical Implications for Media Campaign Planning , 2013, Health communication.

[41]  R. Puhl,et al.  Fighting obesity or obese persons? Public perceptions of obesity-related health messages , 2013, International Journal of Obesity.

[42]  Y. Kashima,et al.  Assessing the effectiveness of antismoking television advertisements: do audience ratings of perceived effectiveness predict changes in quitting intentions and smoking behaviours? , 2013, Tobacco Control.

[43]  Matthew C Farrelly,et al.  Promotion of smoking cessation with emotional and/or graphic antismoking advertising. , 2012, American journal of preventive medicine.

[44]  K. Brownell,et al.  Positive media portrayals of obese persons: impact on attitudes and image preferences. , 2012, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[45]  A. Bauman,et al.  Evidence, ethics, and values: a framework for health promotion. , 2011, American journal of public health.

[46]  Robert C Hornik,et al.  Use of mass media campaigns to change health behaviour , 2010, The Lancet.

[47]  J. Latner,et al.  Understanding Self‐directed Stigma: Development of the Weight Bias Internalization Scale , 2008, Obesity.

[48]  K. Curriculum,et al.  Australian Dietary Guidelines , 2006 .

[49]  I. Ajzen.  The theory of planned behavior , 1991 .

[50]  I. Ajzen,et al.  Understanding Attitudes and Predicting Social Behavior , 1980 .

[51]  D. J. Lee.  Society and the Adolescent Self-Image , 1969 .

[52]  E. P. Abril,et al.  Outcomes of Healthy Eating Ad Campaigns: A Systematic Review. , 2019, Progress in cardiovascular diseases.

[53]  I. Pratt,et al.  Physical activity and screen-based recreation: Prevalences and trends over time among adolescents and barriers to recommended engagement. , 2018, Preventive medicine.

[54]  R. Pearl,et al.  Measuring internalized weight attitudes across body weight categories: validation of the modified weight bias internalization scale. , 2014, Body image.

[55]  C. Crandall.  Prejudice against fat people: ideology and self-interest. , 1994, Journal of personality and social psychology.