Examining the Design Principles Behind Unsuccessful “Fear-Based” Anti-Obesity Health Communication Campaigns
This article was written by Hannah Barr, Research Assistant at Communication and Culture, LLC. Hannah Barr is a psychology researcher holding a BFA in Art Studio, a BA and MA in Experimental Psychology, and a Graduate Certificate in User Experience from The University of Alabama in Huntsville. She has an enduring passion for understanding human interaction with design.
Just as health communication campaigns can achieve success when supported by good design choices, they can be hindered by poor design choices.
Before designing a health communications campaign, it is especially important to understand what doesn’t work. Researching and understanding detrimental design choices will tell you what to leave out of your campaign.
This week, we are discussing the fear-based “Strong4Life” childhood obesity awareness health campaign. This campaign included print and television advertisements with obese children and overly severe messages about the effects of obesity.
As seen below, print advertisements included messages such as “Fat prevention begins at home. And the Buffet line,” “It’s hard to be a little girl if you’re not,” and “My fat may be funny to you but it’s killing me.”
With bright red warning signs and cruel language choices, it's easy to see why the "Strong4Life" campaign created harmful dialogue surrounding childhood obesity.
The videos were just as harsh. While no longer available online, some of the contents were documented by Business Insider. The videos included statements such as “Being fat takes the fun out of being a kid,” “Stop sugarcoating it, Georgia,” and “I don't have to be around other kids, because all they want to do is pick on me.” (Stampler, 2012).
These cruel ads were intended to be a wake-up call for parents who were unaware or in denial of the dangers of childhood obesity. However, critics argued that the ads stigmatized obesity (Grinberg, 2012). In other words, this campaign could have conveyed the message in a more constructive way.
Hurting More than Helping?
Showing obese individuals in such a harsh light paves the way for harmful stigmatization. The phrases used in the “Strong4Life” campaign play into stereotypes of people with obesity.
For example, “Fat prevention begins at home. And the Buffet line” implies that the child in the ad is a glutinous stereotype, and “It’s hard to be a little girl if you’re not” shames body shape.
Playing into these stereotypes and shaming both reinforce the stigma surrounding obesity (Westbury et al., 2023). Additionally, a poll of 1,050 people conducted by the Obesity Action Coalition, a nonprofit dedicated to respect, treatment, and prevention of obesity, found that more than 80% of people believed the campaign was offensive and more hurtful than helpful (Georgia Strong4life Campaign, n.d.).
Visual Design
Even without their tactless messaging, the “Strong4Life” campaign communicates fear through visual design alone. The large red “WARNING,” the black and white photography and videography, and the somber children all play a role in the ads’ ability to strike fear.
The “WARNING” in large red font is eye-catching and bold. It evokes warning labels you might see on biohazards, cigarettes, or other dangerous items. The placement of these “WARNING” labels over images of children (rather than images of unhealthy foods or activities) attributes the danger to the children rather than other potential causes of obesity.
The use of black and white photography and the shallow field of view in the “Strong4Life” campaign take focus away from any background elements, leaving the viewers to focus on the children’s sad faces.
Black and white photography leaves viewers with less information to process and removes the interference that color may otherwise have on emotional responses to an image (Freeman, 2013). Black and white photography also has a strong history in documentary photography and is often associated with shots of war, depression, famine, and the like (Freeman, 2013). Finally, the shallow field of view creates a blurred background, eliminating any distractions from the children or the messages themselves.
These features of black and white photography serve to amplify the negative messaging of the “Strong4Life” campaign.
An Important Topic, an Insensitive Approach
The “Strong4Life” campaign may have increased awareness of the dangers of childhood obesity (Lewis, 2012). The Health4Life Clinic saw increases in visits for children facing obesity-related health issues (Grinberg, 2012). Given all the reporting and media criticism of the campaign, it is no surprise that it became so widespread. However, it is possible that its insensitive approach could have caused some damage as well.
Stigmatizing ads are only equally effective as ads with more neutral or uplifting content for motivating behavior change (Puhl et al., 2013; Horn & Jongenelis, 2022). However, viewers of stigmatizing ads are more likely to feel that they are not capable of making the changes necessary to prevent obesity (Puhl et al., 2013).
These findings imply that stigmatization in ads might actually be making it more difficult for viewers to engage in the health activities the ads are trying to promote. Furthermore, supportive and encouraging obesity prevention ads have been shown to minimize weight stigma and negative emotions (Horn & Jongenelis, 2022). Given this information, it makes a lot of sense to take a more sensitive approach.
Some suggest tackling the issue of obesity not by singling out or shaming individuals, but by looking at the systemic causes of obesity and reinforcing positive health behaviors (Westbury et al., 2023). The idea is to put the focus on being healthy, rather than not being obese (Puhl et al., 2013).
This more sensitive approach focuses on addressing the root causes of obesity without ignoring the health risks, rather than only bringing awareness to the dangers. The focus shifts from fear-based targeting of individuals to a positive “what can we do?” approach. For example, Westbury et al. (2023) suggest that educational interventions are less successful and that money is better spent increasing access to healthy foods and investing in city plans that facilitate safe, active lifestyles.
Takeaways
While the “Strong4Life” campaign may have had good intentions in preventing childhood obesity, it became a very controversial campaign due to its insensitivity in messaging and imagery. The campaign, designed around melancholy images of obese children and messaging that played off of stereotypes, could have been effective without being offensive and potentially harmful.
So, what can we learn from the “Strong4Life” campaign? Here are a few takeaways:
Playing into stereotypes may increase stigma.
Ascribing dangers to individuals rather than conditions can be harmful.
Visual elements such as black-and-white photography and warnings may amplify fear-based messaging if not used carefully.
Stigmatizing ads may make it more difficult for viewers to engage in healthy behaviors.
Supportive and encouraging ads are associated with less stigma and negative emotion.
Focus more on healthy behaviors and what people can take action on rather than focusing on a condition and why it is dangerous.
Where possible, it is better to fund initiatives that improve access to healthy lifestyle choices rather than funding educational campaigns alone.
Join us next Friday for the next post in our series: “How Qualitative Research Methods Could Have Improved the Unsuccessful “Just Say No” Anti-Drug Health Communication Campaign.”
