Challenging Dogma - Spring 2011

Wednesday, May 11, 2011

Let's Move! Over-emphasizes Individual Choice and Under-utilizes Modern Psychological Theories to Address Childhood Obesity - Kathryn Rodgers

Michelle Obama's “Let's Move!” campaign reaches out to children, parents, teachers, chefs, and government officials to combat the childhood obesity epidemic in America. However, its approach to reach these individuals is largely fact-based, and it fails to address fundamental social constructs that contribute to the problem. At present, The First Lady's campaign's biggest achievement is its contribution to awareness of the issue. However, more awareness is not needed. Constant media coverage floods Americans with information about the childhood obesity epidemic, such as the television show “Honey We're Killing the Kids,” and daily newspaper headlines that read: “Child Obesity Risks Death at Early Age, Study Finds (1).” Around 30% of all American children between two and nineteen years of age are classified as obese or overweight, and 17% of all American children in this age group are classified as obese (2). It is also well known that obesity is a significant risk factor for developing other diseases, such as type 2 diabetes, heart disease, hypertension, stroke, liver disease, and certain types of cancers, to name some (3). Awareness campaigns have already been effective; 80% of all Americans recognize that childhood obesity and its health consequences are a concerning problem in this country (4). However, such campaigns are not sufficient to combat the obesity epidemic. The public health field needs to move away from “filling education gaps” and instead use modern solutions for modern problems. The traditional behavioral models that shape public health interventions need to be updated.

The nation's banner approach to address the growing obesity problem is Michelle Obama's “Let's Move!” campaign, which has the ambitious goal of “solving the challenge of childhood obesity within a generation (5).” This paper will critique three of the social-behavioral approaches that govern the presentation of information on the “Let's Move!” website and suggest alternative methods to make this public health intervention successful.

“Let's Move!” is Modeled on the Health Belief Model

“Let's Move!” ignores the fundamental social causes of childhood obesity by ascribing to the Health Belief Model. The Health Belief Model was developed in the 1950s by a group of U.S. Public Health Service social psychologists, and it is one of the oldest and most popular individual behavioral theories used in public health (6). The model appeals to individuals to change their behavior based upon a cost-benefit analysis. The focus is on individuals' motivational attitudes toward a health outcome by recognizing their personal susceptibility and the potential severity of experiencing the health outcome. The individual then weighs the barriers and costs of achieving the health outcome against the benefits of avoiding the health outcome. The goal is for individuals to permanently change their behavior to prevent the health outcome. The problems with this approach are that it relies solely on the individual to change, despite their circumstances, and it assumes that people make rational cost-benefit decisions about their health. The following figure illustrates the early formation of the Health Belief Model (6):

The “Let's Move!” homepage showcases five tabs that are a near perfect fit to the original Health Belief Model diagram (7):

The health outcome is childhood obesity in this case, and “Learn the Facts” provides information about who is at risk and the detrimental health outcomes for those who are obese. “Eat Healthy” and “Get Active” display the benefits of living a healthier life, and the barriers, (daily exercise and consistently preparing healthy meals) to avoid obesity. The costs to the individual are presented on the “Take Action” page by demonstrating the necessary steps to successfully prevent obesity. The hope is to have readers make their way through each page in order, ending on the “Join Us” page, and then commit to behavioral changes.

The most basic flaw of the Health Belief Model is that it places the responsibility for change with the individual. A psychological phenomenon called the Fundamental Attribution Error states that people are likely to blame another person's faults for weaknesses in their personality, instead of their environment (8). The “Learn the Facts” page is fault to the Fundamental Attribution Error by stating that personal choices, such as riding the bus to school as opposed to walking; spending time playing video games; and eating too many snacks are the reasons for the tripled rate in childhood obesity in the past 30 years (5). From a sociological perspective, lifestyle is considered a “socially determined pattern of consumption or marker of status, which suggests that one's lifestyle is not within one's personal control (6). However, “Let’s Move!” does not take into account societal circumstances that we cannot control, such as agricultural subsidies, companies' investments, or socioeconomic factors that influence people's access to nutritious food. The “Learn the Facts” information about the cause of obesity does not acknowledge that for some children, walking to school is not a possibility. It may not be feasible for a child to walk along a highway or through a dangerous neighborhood to get to school. Additionally, “Let's Move!” does not address households in which parent(s) are working multiple jobs and cannot devote sufficient time to work on healthy habits with their children. The “Let's Move!” campaign attempts to educate its target audiences by listing the proximate causes of obesity and instructing them to make changes to isolated behaviors. The assumption that individuals have total control over their choices is the cardinal defect of the Health Belief Model.

Leaving the Fundamental Attribution Error out of the equation, The Health Belief Model is still flawed. Although this model can be useful for one-time behaviors, such as getting vaccinated, it is not an appropriate model to use for long-lasting changes. The core breakdown of this model's approach to childhood obesity is that it assumes an individual reading the website will make permanent changes in their lifestyle. People have the best of intentions, and even if they click “Join Us” to sign the pledge, there is no guarantee that their motivation will last through their lifetime, or even throughout the next day. Even if an individual had ideal access to nutritious food and time to exercise, it is unrealistic to expect that children or their parents will rationally analyze every food and exercise choice with equal scrutiny at each time they are hungry or feeling too tired to exercise. Psychologist George Loewenstein discovered that state-dependent mindsets differ based on the situation (9). He describes an individual’s decision making states as either “cold,” meaning rational or “hot,” meaning irrational (9). For instance, in a rational or “cold” state of mind, a person may vow to make healthful diet changes. However, when that same person is in a “hot” state, say they are incredibly hungry and tired after a busy day, they may reach for a bag of chips, despite their certain knowledge that making a salad would be healthier. Human nature does not provide us with the ability to make rational decisions on a consistent basis. The Health Belief Model ignores the impact of societal circumstances that influence an individual's ability to control their own lifestyle, and it wrongly assumes that humans are always capable of making rational decisions.

“Let's Move! Induces Psychological Reactance

The instructive manner in which the campaign is presented does not appropriately appeal to the target audience. Psychological Reactants Theory explains why this intervention is not persuasive enough, and may even turn people away. The first image on the homepage of the “Let's Move!” website is a still-frame of The First Lady speaking about the one year anniversary of the campaign. She is sitting very still in a wooden chair inside the White House, wearing a closed-mouth smile and a white, high-neck blouse. Her speech is stoic and congratulatory toward the campaign's own efforts, including government officials and the passage of congressional acts. She emphasizes Americans’ individual responsibility to raise healthy children and encourages more involvement. Although she is an attractive spokesperson, there is little else that makes her compelling to her audience. Psychological studies by Dr. Paul Silva on message delivery have shown that messages are better received when the communicator of the message displays similar characteristics to the recipient (10). Jack Brehm developed Psychological Reactance Theory, which states that “interpersonal similarity can reduce reactance by increasing compliance and by reducing resistance (10).” Obesity disproportionally affects children of lower socioeconomic status. One in three low-income children aged 2-4 are obese or overweight, compared to one in three children aged two to nineteen being obese or overweight in the general population (11). By seating herself inside the White House, she is making herself about as unfamiliar as possible to the affected children and their parents. She also glaringly fails to acknowledge her own challenges and efforts to ensure healthful lifestyles for her own two children. Her lack of relatable characteristics and uncharismatic demeanor makes it difficult to pay attention, much less relate to The First Lady.

Psychological Reactance Theory also illustrates that an adverse reaction can be elicited when people's freedom to make autonomous decisions is threatened (10). The authoritarian message of decisions children and their parents should make, is the basis of the Republican Party's criticisms of the “Let's Move!” campaign. Republican spokespeople are worried that the government is attempting to tell Americans how to live their lives and raise their children (12). The predictable reaction to the threat of freedom is anger. Despite the near unanimous agreement that the nation's childhood obesity epidemic needs to be addressed, the campaign has lost people's interest by overtly telling people what they should and should not do.

“Let's Move!” Creates Negative Racial Labels

The way in which “Let's Move!” stratifies obesity statistics and risk factors by race and ethnicity and creates negative labels. The dangers of creating labels for children are well known; labeling can “preserve a social hierarchy by keeping minority group children from opportunities and delay needed social reform (13).” Racial labels have been shown to influence health outcomes, which may be caused by institutional or internalized racism (14). The very first paragraph of information on the “Learn the Facts” page of the campaign's website highlights the higher rates of childhood obesity in minority groups. Nearly 40% of children are overweight or obese in African American or Hispanic communities (6). Showcasing stratified statistics based on race only creates negative labels for these children to identify themselves and others. The danger of labels is twofold. It forms stereotypes and it may also prime children to internalized racism. Internalized racism is defined as “acceptance by members of the stigmatized races of negative messages about their own abilities and intrinsic worth (14).” If Hispanic children are told that they are more likely to be obese than their non-minority counterparts, they may internalize this negative information as a problem with their race or ethnicity. Aside from racism, these statistics may create expectations that are fulfilled, thus confirming the statistics' own accuracy, a psychological phenomena called a self-fulfilling prophecy (15). The children who are told they are more likely to become obese are prone to meet those expectations. The African American children who hear that they are at risk of being overweight may fulfill that expected role and become overweight as a result. Overweight children already face bullying at school; one study found that obese children in the 6th grade were 60% more likely to be bullied than other non-obese children (16).

The focus on race's effect on obesity, combined with the entire campaign's presentation under the Health Belief Model, implies that there must inherently be something about African Americans and Hispanics that either makes them unable to “learn the facts” about obesity or control their diet and exercise. The insinuation that people are simply uneducated about what it means to be healthy is ignorant on the campaign's part. The racial statistics about obesity ignore all of the other factors other than race, such as socioeconomic status, access to food, and even where neighbors grocery shop, all of which may influence a person's access to healthy food and daily exercise (17). A peripheral link on the campaign’s website recognizes that the psychological stress of social stigmas and its effect on self-esteem is an additional impact on children with obesity. It should take additional steps to avoid providing more ways for social stigmas to take hold.

Proposed Interventions to Bolster “Let's Move!” Effectiveness

The three critiques described above can be rectified by using alternative social-behavioral approaches and changing the framework of campaign's current behavior models. The sources of America’s food are businesses and corporations. Replacing the individual-based Health Belief Model to an approach that focuses on food companies and retailers would appropriately eliminate the reliance on individual choice to solve childhood obesity. Walmart is a great example of a company that has recently partnered with the First Lady to change their retail environment in order to promote healthier choices for their shoppers. However, this change is not described on the “Let's Move!” website. A new agenda directed at food manufacturers and sellers, such as Walmart, would be a more tangible plan that can actually change people's access to healthy foods. “Let's Move!” would garner more interest in the campaign by working within the framework of psychological reactance. There are multiple examples of very compelling media that would better reach the campaign's target audience, such as Beyonce's new music video that partners with “Let's Move!” called “Move Your Body.” Replacing the boring images and videos of Michelle Obama on the website with influential media would be a great place to start. Eliminating the racial labels of obesity, and instead showing that all efforts have equal success across race would reduce stereotypes and the negative consequences of them. These proposed changes could completely replace the five tabs on the website's homepage. The new homepage would have three imaged tabs that read: “Move your Body with Beyonce,” “Find Your Favorite Healthy Foods at These Stores,” and “See Who Else is Moving.” An example prototype is shown below:

“Let's Move!” needs to bring corporate behavior, as opposed to individual behavior, to the forefront of the campaign's presentation. Given that individuals' choices are largely dictated by their environment, the most obvious way to bring about individual change is by modifying the environment. Since the underlying social and economic structures are entrenched in society, it is more feasible to change corporate practices to promote health behaviors than to change the fabric of society (18). In a similar manner to how the anti-smoking public health campaigns targeted cigarette manufacturers as the responsible party to make a change, the corporate contributions to the childhood obesity epidemic should be addressed. Although this may initially seem like a politically contentious and near impossible task for the government to accomplish, Walmart has shown that it can be done within a free market system.

Michelle Obama has already taken a step in the right direction by working with the superstore chain Walmart. Walmart stores now have fully stocked grocery stores in addition to the general goods that “mart” stores typically sell. The superstore is the nation's largest grocery chain, serving about 140 million customers a week (19). The company has partnered with “Let’s Move!” by adopting a five year plan to reduce the amount of fats, salt, and refined sugars in the food they sell (20). Additionally, Walmart will develop “health seals” to label their food. Part of Walmart's plan to increase healthy food access is to open more stores with access to affordable healthy food in rural areas as well as small stores in cities (20). This is great example of how other grocers can advertise their stores to the masses, while boosting their image of standing next to The First Lady's efforts to create a healthier nation of children. Instead of telling her audience to “Eat Healthy,” Mrs. Obama can instead point to businesses that are showing commitment to the campaign's goals and even help people to get their local grocer to offer healthier food choices through signing letters to voice their consumer desires.

Since “Let's Move!” is already partnered with Walmart, it would be ideal if the two organizations could collaborate to produce a shopping list for the week, complete with healthy, simple recipes for the whole family. If Walmart could have a sanctioned section of the store with the week's grocery-list items rotating through each week, it would attract people's attention inside the store. It would be even more effective if Walmart could have special discounts on some of those items for the week. “The target groups identified by Wal-Mart’s market researchers are Hispanics, African Americans, “empty-nesters/boomers,” affluent, suburban and rural shoppers, according to [company president] Castro-Wright (21).” Walmart's customer base of Americans of all racial and socioeconomic backgrounds makes it an ideal venue to influence a huge number of people.

“Let's Move!” Should Focus on Efforts to Reduce Psychological Reactance

Beyonce's new flash workout video “Move Your Body” should be the flagship song of the “Let's Move!” campaign. There were over two million views of the YouTube video within the first six days of its posting. Beyonce is an incredibly popular celebrity, and putting her dance on the homepage of the “Let's Move!” website would attract potentially millions of viewers. Given that most people are already very familiar with Beyonce and associate her with fun and entertainment, she does not elicit psychological reactance by communicating the message to exercise, or “move your body.” The video itself does not tell viewers what to do, instead it invites them to join in and dance with a catchy hip-hop beat and Beyonce's famous dance moves. Unsurprisingly, the video for the choreographed routine already has almost three hundred thousand YouTube views. However, Beyonce is nowhere to be found on the “Let's Move!” Youtube channel. The dismal viewership on the “Let's Move” channel reveals an average of about four thousand views per video. The most viewed video is a cartoon of utensils singing about eating breakfast.

Beyonce's video starts with a quick beat set by a boy tapping his pencils in a school cafeteria while other students in line for school lunch are seen eating apples, bananas, carrots, a fruit cup, and a small serving of spaghetti. A young overweight boy grabs the cafeteria’s attention as the song starts by moving his arms and stretching to get ready to dance. Other students join in clapping their hands, and Beyonce bursts out of the cafeteria kitchen in short shorts and high heels starting to lead the dance. This is a great example of how to reach an audience and avoid psychological reactance. Beyonce is dancing with the students, and her lyrics say things like, “This is how we do/Jump a couple to the right/To the left, let's move” and “Can you dougie with me?/Throw your own lil swag on this swizzy beat.” Although Beyonce has the same fundamental message as Michelle Obama, which is to motivate children to exercise, Beyonce's execution is far more effective. Already, elementary and middle schools have started to upload their own videos of children dancing to her song in the classroom and in physical education classes (22). The children look like they are having fun, and viewers’ comments on the YouTube video of Welch Middle School say things like, “Man, I wish our P.E. lessons were like this...” and “GREAT JOB YOU ALL!!!....Man I wish we had Beyonce when I was in P.E....maybe then I would've participated more...haha.” This is the exact reaction that the campaign needs; children want to be a part of this dance workout.

Highlight the Equality of Success

Instead of using statistics to educate and motivate its audience, “Let's Move!” should develop a social network to connect and feature a variety of children who are enjoying dancing, being active, and sharing their favorite healthy snacks. Showing the personal success stories of Hispanic and African American children working to becoming healthier would be a more effective motivational tool than simply showing numbers of their obesity risks. The link on the website with this content would be under “See Who Else is Moving!” Videos of children of every race and ethnicity should be broadcasted in order to break down the labels and stereotypes that exist about race and rate of obesity.

Social networking websites are widely used in America. Marketing a “Let's Move!” social network to appeal to its target audience would be a supportive meeting ground for people to talk about their questions, successes, and challenges. A social networking site would also be an appropriate platform for children and parents (although not necessarily together) to share recipes and preparing their favorite healthy foods. Although there is an entire television network to cooking food, the majority of celebrity chefs are Caucasian, and they perform in a staged, prep kitchen. “Let's Move!” could post cooking demonstrations in a believable format and also allow people to post their own cooking videos. Cooking demonstrations would be useful since many Americans do not know how to cook a variety of healthy meals. Some delicious examples could be as simple as “ants on a log” for a snack, spiced and mashed sweet potatoes, an egg frittata, pan fried vegetable patties, eggplant parmesan, guacamole, stir fry, creamed corn, or pasta with a vegetable sauce. There are so many easy, delicious dishes that could be advertised on the “Let's Move!” website. Healthy eating shouldn't be overshadowed by common food plugs for nutrition, such as blasé lettuce, apples, or carrots. The important thing to show is that there is no racial difference to becoming healthier, and everyone can be a part of the “Let's Move!” movement to dance (or another fun activity) and eat delicious food.


The entire nation's childhood obesity epidemic cannot be placed on the shoulders of individuals’ decisions to change their lifestyle. Although it is ultimately individuals who consume food and are active or inactive, the societal structure in which we exists largely determines the choices we will make. Any change that can be made to the environment that will open opportunities for healthy behavior should be explored. Walmart creating a more healthy retail environment is a great example of the positive impact a company can have. “Let's Move!” would benefit everyone by moving toward an approach that appeals to businesses to promote a healthy lifestyle.

Psychological theories can contribute valuable methods to better reach the American audience. Recognizing that humans don't always make rational decisions is crucial to developing an approach that is dependent upon choice. Currently, “Let's Move!” assumes that people who read the campaign materials will rationally start to change their behaviors. Again, creating more opportunities for healthy changes by altering the environment is a great way to create an approach that takes into account human psychology. Additionally, connecting with viewers is key, both through positive familiarity, such as Beyonce, and in ways that don't elicit reactance by threatening anyone's freedom.

Treating everyone with equal importance is an important way to gain people's trust. “Let's Move!” needs to avoid racial statistics, and instead focus on people of all races who are currently finding ways to stay active and eat delicious food. The campaign should highlight that the fun and excitement, as well as health benefits, of dancing and cooking can be appreciated by everybody across all demographics.


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21. Walmart to Drop One Size Fits All Approach. CNBC.

22. Beyonce's Let's Move Flash Video Plea from Welch Middle School.

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