A Critique of the New York City Department of Health and Mental Hygiene Pouring on the Pounds Campaign - Lauren DeBerry

Obesity
During the past 20 years there has been a dramatic increase in obesity in the United States (1). More than one third of U.S. adults, more than 72 million, people and 17% of U.S. children are obese. From 1980 through 2008, obesity rates for adults have doubled and rates for children have tripled (2). If current trends continue, it is estimated that 75% of Americans will be overweight or obese by 2015 (3). The prevalence of obesity is a serious public health concern because of its health and economic consequences (4,5). Obesity is a major risk factor for cardiovascular disease, certain types of cancer, type 2 diabetes, and lifetime morbidity (4). The medical care costs of obesity in the United States are increasing with the increase rate of obesity. In 2008 dollars, these costs totaled about $147 billion a large share of which is being paid for by Medicare and Medicaid (5). The Center for Disease Control and Prevention (CDC) states that obesity results from an energy imbalance. This involves consuming too many calories and not getting enough physical activity (6). According to government surveys, the number one source of calories in the American diet is sugar-sweetened beverages, representing 7 percent of the average person’s caloric intake and up to 10 percent for children and teenagers. These calories are worse than useless because they are empty, and contribute to a daily total that is already too high (7,8,9). In 2009, the New York City Department of Health and Mental Hygiene implemented the Pouring on the Pounds campaign in order to highlight the health impact of sweetened drinks (10).

Pouring on the Pounds
New York City is comprised of five counties, Bronx, Kings, New York, Queens, and Richmond (11). The 2008 age adjusted estimates of the percentage of adults who ware obese in these counties were 28.3%, 24.2%, 16.1%, 23.5% and 24.6% (3). In an effort to highlight the health impact of sweetened drinks and address this increasing rates of obesity, the New York City Department of Health and Mental Hygiene asked New Yorkers “Are you pouring on the pounds?” The agency’s public-awareness campaign was comprised of posters in the subway system and a multilingual Health Bulletins and public service announcements. Sugary drink consumption was chosen as the area of focus for this campaign because research has shown that more than 2 million New Yorkers drink at least one sugar-sweetened beverage a day, adding as many as 250 empty calories to their diets, which puts the human body at increased risk for a multitude of diseases (5). The campaign urges people to drink lower-calorie alternatives or limit their portions. The campaign attempted to disgust and shock people into changing their consumption of sugar-sweetened beverages to water, seltzer, unsweetened tea or low-fat milk instead (11).
The pouring on the pounds campaign is deeply rooted in the health belief model. The health belief model stipulates that a person's health-related behavior depends on the person's perception of four critical areas: the severity of a potential illness, the person's susceptibility to that illness, the benefits of taking a preventive action, and the barriers to taking that action (12). The New York City Department of Health and Mental Hygiene expected to change New Yorker’s drinking habits by simply educating the public on their susceptibility to obesity and the severity of obesity. Although this was a good starting point in developing the campaign they missed the mark on a few important issues; the campaign did not fully express the benefits and barriers/cost of removing the benefits of removing sugar sweetened beverages from your diet, the campaign ignores advertising theory, and the campaign does not account for behavior influenced by context.

Benefits and Barriers
As previously discussed, The New York City Department of Health and Mental Hygiene Pouring on the Pounds campaign focused on one’s susceptibility to and the severity of obesity. The campaign’s signature image was a bottle of soda, “sports”drink or sweetened iced tea turns to a blob of fat as it reaches the glass. They also showed images of the amount of sugar in sugar sweetened beverages, an obese person in a wheelchair, a man in cardiac arrest, and a foot mangled by diabetes (10, 13). If the NYCDHMH was following The Health Belief Model these images were necessary, however, images of the perceived costs/barriers and benefits should have been included as well (12).
The most important barriers to address when attempting to switch someone from sugar sweetened beverages to healthier alternatives are the ability of the alternative choices and the social and finical cost of the switch. The campaign never shows a person making the healthy choice and therefore never highlights the ease to making said choice. If a person does not regularly consume water, seltzer unsweetened tea or milk they may be unaware of its wide availability. Most stores, restaurants and vending machines that sell sugar sweetened beverages also sell the alternatives suggest although the option my not be as clearly advertised (example vending machines that list water as the lowest option).
The campaign dose not address the financial cost of switching from sugar sweetened beverages to healthier options. Since the beginning of the recession the media is constantly discussing the increased cost of living. One of the many way they express this is with stories about the increase cost of milk, one of the suggested healthy drinks in the campaign (14,15,16,17). If the campaign want to succeed in switching New Yorker to healthy drinks they must express its effect on the on the consumers wallet.
Another flaw in the campaign is it does not the social cost of removing sugar sweetened beverages from one’s diet. Sugar sweetened beverages are embedded traditions In the United States. Manufacturers of sugar sweetened beverages have associated themselves with everything from sporting events to Christmas (18,19). This makes the perceived cost breaking life long habits and violating social norms. Although the campaign aims at changing life-long habits, if fails to connect healthy habits to the activities usually associated with sugar sweetened beverages in order to display the new habit will not conflict with social norms.
Pouring on the pounds never expresses the benefits of switching sugar sweetened beverages for healthier options. The campaign mention the avoidance of weight gain obesity and diabetes but never mentions how switching can change one’s life (10,11,13). The campaign never mentions that removing one can of soda a day can result in losing 10 pounds a year (19). The ads also fail to mention the many health and beauty benefits of drinking water and milk. By omitting these benefits The New York City Department of Health and Mental Hygiene misses out on providing an enticing promise to their audience.

Advertising Theory
The manufactures of sugar sweetened beverages have used advertising and marketing theory to sell their products for years. The New York City Department of Health and Mental Hygiene wants its campaign to compete with them therefore they should use advertising and marketing theory as well. The Pouring on the Pounds campaign does a good job with branding. The campaign used its catchphrase “Are you pouring on the pounds?” and its signature image on most of their materials making the campaign recognizable to the viewer. The campaign also used the diffusion of innovations theory well by having their videos on the Internet enabling them to go viral, but it can be found lacking many other important elements of advertising theory (10,20). The campaign fails to use core values to create universal appeal and lacks a promise.
The core values that work for persuading the American public are: family, love, success, hard work, freedom, fairness, belonging, attractiveness, sex, youth, rebelliousness, and power. Companies like Coca Cola and Pepsi have used theses values time and again to sell their sell their product (21-26). Some of the common core values used in sugar sweetened beverages advertisements are belonging, attractiveness, sex, and youth. The Pouring on the Pounds campaign does not use one of these values in fact they show images of young attractive people drinking the very drinks they are trying to discourage people from drinking (13). If the campaign utilized the core values they would have a more convincing argument and would likely reach more people.
According to David Ogilvy, a prominent copy writer from the 1960s, the key to a successful advertising campaign is its promise (20). The promise is made by the messenger about the idea they are selling. The audience is driven by the promise. Strong promises usually include one or more of the core values of the audience. The stronger the promise the more effective the effective the campaign (20,27). Considering the Pouring on the Pounds campaign was trying to compete with sugar sweetened beverages advertising campaigns it is a surprise they choose to not include a promise in their posters and video. NYCDHMH could have promised New Yorkers happiness, belonging, attractiveness, sex, youth or love among many other things to encourage people to drink healthier beverages. The pouring on the pounds campaign has an advantage over the sugar sweetened beverages makers in that their promise can be backed up with real proof, another key part of advertising theory. The NYCDHMH already has scientific studies at their disposable showing the health and beauty benefits of increased water consumption and decreased sugary drink consumption.

Behavior in Context
NYCDHMH assumes with its Pouring on the Pounds campaign that behavior is planned and rational. The campaign expects that by viewing their ads, people will be disgusted or shocked and decide to eliminate or reduce sugar sweetened beverages from their diet. This idea may work for people in who are consuming beverages when they are not thirsty or hungry but will not be as effective for those who are. During exposure to the ad, people might discard their beverages or avoid drinking sugar sweetened beverages for a few hours but what happens when that person develops the desire to quench their thirst (28,29)? The campaign disregards the concept that human behavior is dynamic and that it is influenced by context (28,29). Many things including hunger, thirst, and sexual desire can induce a hot state. In a hot state people’s behavior is instinctive unreasoning and irrational (28,29).
Research has shown, instinctive factors can change desires rapidly as they are affected by changing internal and external stimuli (28). For example, a person can see the Pouring on the Pounds ad in the subway on their way to work and decide to stop drinking sugar sweetened beverages. Later on their lunch break when they are hungry and thirsty, the person goes to a deli to get lunch. Seeing the vast variety of drinks offered as well as enticing images, they may forget their desire to remove sugar sweetened beverages from their diet. Exposure to images and menu options at the store or restaurant will now influence their purchasing behavior. This concept suggests that the environmental context has a greater impact on eating and drinking habits. The Pouring on the Pounds campaign would have a greater impact on viewers if they sought to intervene when the viewer is in the hot state.

Improving Pouring in the Pounds
Although the pouring on the pounds campaign had a few flaws it would be advantageous for the New York City Department of Health and Mental Hygiene to address those flaws rather than develop a new campaign. Because the brand messaging was well developed, it would be helpful to consumers to identify the campaign to keep the tag line.
In addition to the posters and videos the campaign already used, the campaign should develop a new series of videos that the highlight the benefits of reducing consumption of sugar sweeten beverages . The first video show a man in the convenience store reaching for a water or other unsweetened drink in slow motion. As the man gets closer to the water, you see him becoming slimmer illustrating the weight loss achievable if you do not drink sugar sweetened beverages. As the video is running a voice will be heard saying “Removing sugary drinks can result in 10 pounds weight loss.”Then the tag line will appear as well as a prompt to friend the campaign on Facebook. The second video will be set in an office. It can show three co-workers in the break room getting ready for lunch. Two of them, a thin and attractive man and women, will have reusable bottles of water one filling his up with the cooler. The third work, chubby, will be digging around in his pockets for money before asking the others for a dollar to buy a soda. As the women reaches into her purse she will smile say “It’s a good thing I’m saving so much money bring my own water to work. You should try it. ”and laughs. The soda drinker takes the money and says “Thanks boss” The next screen will show the average savings you can make by switching from sugary beverages to unsweetened beverages. Then the tag line will appear as well as a prompt to friend the campaign on Facebook. The next video could show a groups of happy fit young adults wearing matching team uniforms carrying a large trophy grabbing water and milk from the cooler pushing aside the sports drinks and sodas. As the camera pans out, you see the losing team drinking sports drinks. The announcer will say another benefit of drinking unsweetened beverages “Drinking low fat milk can help you build strong bones and keep you lean.” Then the tag line will appear as well as a prompt to friend the campaign on Facebook. The final video will show a young women walking along the refrigerated aisle in a bodega. She continual walks past cooler after cooler of soda and fruit punch. Finally she reaches the cooler with the water and as she reaches for a bottle her hand brushes against another had. She looks up for find a handsome man holding a bottle of water. He smiles a knowing smile at her and they begin to talk. The announce will say “Replacing soda with water can help you stay hydrated and you complexion looking young.” Then the tag line will appear as well as a prompt to friend the campaign on Facebook.
In conjunction to the new videos there will be a Facebook campaign. Facebook is important to the campaign because of it make the messenger seem more like the viewer and allows for grater access. Using Facebook allows the campaign to provide a community for people to discuss ideas and information about the campaign and its ideas. The campaign can use Facebook send out facts and reminders about sugar sweetened beverages and advertise events relating to the campaign. Facebook is unique in that it can provide an online community setting even for those who do not have regular access to computers. African-Americans and English-speaking Latinos are among the most active users of the mobile web (30). These ethnic backgrounds also have disproportionate rates of obesity. By utilizing Facebook the campaign can reach more people than by using the government run website as Facebook had applications for most mobile phones.
One of the events that will be advertised on facebook will the the trade in your sugar events. The campaign will go to both busy tourist locations and areas populated by office workers. Here they will have young happy attractive people in Pouring on the Pounds t-shirts asking people to trade in their sugar sweetened beverages for recommended drinks or reusable water bottles labeled with the Pouring on the Pounds tag line on one side and a fact about sugar sweetened beverages on the other. Some of these can be done as flash mob style surprising unsuspecting workers during their lunch break while others will be advertised on the facebook page. If they events are successful they could be filmed and aired in the vein of the truth campaign advertisements (31) .
The final improvement to the campaign would be the placement and content of the print advertisements. The NYCDHMH chose to run the ads in the subway system where people are not allowed to eat. They should place the in locations where people would be likely to see them as they were one their way to eat such as billboards close to fast food restaurants or posters in delis. The Pouring on the Pounds campaign should also run its commercials during eating hours so people at home can be reached in the hot state as well.

Defense of the improved Pouring on the Pounds
Each of these improvements address the what was missing in the campaign. The new commercials clearly discuss the benefits of the behavior change and each video can address the many different benefits both health the beauty of switching from drinking sugar sweetened beverages to unsweetened beverages. The advertisements also subtly show and dispel the perceived barriers to the switching from drinking sugar sweetened to unsweetened drinks. By showing people saving by money by not drinking sugar sweetened beverages and by showing that in stores filled with sugar sweetened beverages you can still find healthy options as in the second and fourth videos, The barriers are proven wrong with out specifically calling the barriers to the mind of the viewer and turning them off to the message.
Each commercial uses advertising theory. The commercial promises the viewer attractiveness. The second commercial promises wealth and belonging while also highlighting the core value of power since the boss is drinking water she brought from home. The commercial with the team uses the core values of happiness youth attractiveness and success. The promise of being a winner should compel the viewer to change their behavior. The final commercial employs the core values of youth, attractiveness, love and sex to show the viewer that replacing sugar sweetened beverages from their diet can be beneficial to their life. As the campaign continues the NYCDHMH can add new commercials to that highlight other key core values keeping the campaign in touch with New Yorkers’values and targeting new demographics.
The use of Facebook, in addition to providing increased access, creates a community. This will tap into the viewers’core value of belonging as well. Using facebook correctly can also keep followers informed on the issue as well as provide reminders of the need for behavior change.
Finally by placing the strategically placing advertisements in and around places of consumption the new campaign can reach viewer in the hot state where they are more less rational and forget previous messages to attempt to enact behavior change. The new Pouring on the Pounds Campaign also reaches people in the hot state by asking them to trade in their beverages during their lunch breaks.
The New Pouring on the Pounds campaign should be successful. If The New York City Department of Health and Mental Hygiene took advantage of its many different resources and employed the use of different behavior change theories they will be successful in any campaign they attempt.

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