Health & Fitness

Get the message?

TZIVIA SCHWARTZ-GETZUG leans forward, listening hard to a message from the U.S. government. On the screen in front of her, a man is walking his dog when the dog pulls away to investigate a lumpy parcel under a tree. "Leave it," his master tells him. "It's just an old double chin. Someone probably lost it playing here in the park with their kids."

"Oh my God, that is hysterical!" says the Sherman Oaks mother of three. "Very clever."

Schwartz-Getzug likes the "selling idea" of the government's new campaign to get Americans fit: that taking just a few small steps to improve diet and boost exercise can make people healthier, slimmer, even sexier. But will she — and millions of other Americans — buy the message?

This time, they might because the sellers have come prepared. Flushed with success from the anti-tobacco wars, they now know more about the American people — and how to influence them. And this time, the sellers are joining forces.

In the last 18 months, the federal government, health advocates and private companies have begun to merge their efforts against fat and inactivity. The Department of Health and Human Services has turned to a top Madison Avenue advertising firm and a leading Internet design company to create the Small Steps campaign. Media companies are rethinking their long-standing practice of marketing junk food to kids. And health advocacy organizations such as the American Heart Assn. are forming partnerships with companies willing to spread their message to a seen-it-all, heard-it-all American public.

"Very few behaviors change because someone saw an ad. You need social norms in place, environmental supports, the products, the placement, all the things that make the right decisions easy," says Carol Schechter, director of health communications for the Academy for Educational Development, a Washington, D.C.-based nonprofit organization.

Thus far, campaigns aimed at selling healthy behavior have persuaded Americans, in large part, to wear seat belts, quit smoking and refrain from drinking alcohol and driving.

But consider the 22.5% of Americans who smoke, the 18% who never wear seat belts and the 17,000 killed each year by drunk drivers, and one understands the limits of health campaigns. Listen to Americans like Schwartz-Getzug talk about the crush of demands upon them and the temptations they face daily, and one perceives a sobering truth: Marketing campaigns aimed at changing behavior face long odds.

A full-time community-relations specialist with the U.S. Jewish Federation and mother of three kids ages 5 to 13, Schwartz-Getzug can't fathom how she could find time to get to the park, much less play with her kids there. Besides, she says, "I'm not convinced that those little steps actually have an impact…. Taking the stairs certainly does something, but it doesn't replace what's really needed."

She's what New York advertising giant McCann-Erickson Worldwide calls a "jaded can't-doer" — a parent too busy to eat right and exercise and too discouraged to launch a lifestyle overhaul. Not all Americans have grown overweight or suffer the health consequences of inactivity, but many share Schwartz-Getzug's personal assessment. "I'm still relatively healthy," she says. "But I'm not in very good shape, and I don't feel very good."

A walk after dinner sounds nice, she says, but by then, it's time to get the kids to bed. The 30 minutes of exercise a day recommended as the minimum for a healthy lifestyle? "I'm always trying to figure out where to find that, and it always comes down to less sleep," she says.


Coaxing out good behavior It's clear that the straightforward approach to changing Americans' behavior will no longer work. Simply gathering the evidence, donning the white coat, warning the public and recommending a course of action won't cut it.

Today, campaigns to prevent HIV and AIDS, discourage smoking, fight obesity and urge cancer screenings use humor, sex and sophisticated market research. Public health advocates segment their markets and tailor their pitches to the sensibilities and media consumption habits of particular groups — preschoolers, teens, Latinos, African Americans, parents of school-age kids. They push fitness and health using one of the advertising profession's oldest principles: Sell the sizzle, not the steak.

These new campaigns offer encouragement by instant message, downloadable cellphone games with disease-prevention ideas, reality shows, websites with attitude and information, and potty humor for kids.

In vintage newsreel style, the Nickelodeon channel details the not-so-fine points of flatulence as part of a new campaign aimed at getting kids to link what they eat to how their bodies perform. The federal government's Small Steps campaign features sexy soccer moms and a paunchy man whose healthy choices have transformed him into a buff daddy. An anti-smoking message that ran during the Super Bowl in 2005 poked mordant fun at the tobacco industry with a parody advertisement hawking Shards O' Glass freeze pops ("Mr. Winky says, 'Talk to your kids about not licking. They'll listen.' ")

John Riley, president of Metrix Inc., a Rochester, N.Y., marketing firm, says Americans respond to messages that emphasize social acceptance and status — not scare tactics or lectures.

"We need to push that emotional button that's going to get them to pay attention with their whole body and not just with their mind," says Riley, a former New York public health official. "That's an element of social marketing that more public health people are getting comfortable with. Ten years ago they thought that was cheap somehow; they thought that was tawdry."

The U.S. government is now betting on "social marketing," especially as it tackles obesity — a threat to the public's health that can lead to diabetes, heart disease and other serious conditions and that costs the nation an estimated $117 billion annually in healthcare costs.

The fight to stamp out tobacco smoking in the United States has schooled social marketers in the techniques they will need to get Americans off the couch and away from the chips.

In three decades social marketing campaigns, backed by a relentless march of government actions against tobacco and public smoking, have helped whittle the proportion of Americans who smoke by 47%. To use a term from marketing, these campaigns' public messaging has positioned smoking, in the minds of consumers, as a habit that is socially constricting and uncool.

"Human beings are very complicated, and there are a lot of interesting barriers we set up" to justify behaviors that aren't in our best interests, says Peggy Conlon, president and chief executive of the U.S. Ad Council. "The key to advertising is not to bash them down with a battering ram but to coax out the positive behaviors." Often ads do that by appealing to some other deeply felt need — an obligation to children, perhaps, or a desire to be sexy, admired or envied.

The Truth anti-smoking campaign, aimed at teens considered most likely to take up smoking, is currently one of the edgiest public health efforts on the American landscape. In advertisements on youth-oriented outlets such as MTV and the WB, on its extensive website and from its distinctive orange truck parked outside concerts, skate parks and video arcades, Truth strikes a radically rebellious pose. It is a campaign of the American Legacy Foundation, which is funded by money collected from the tobacco industry in a landmark settlement of a suit brought by 46 states.

The Truth rarely mentions the long-term health effects of smoking in its ads, and you have to hunt for that data on its website. Such an appeal would be ineffective for the campaign's intended audience of teens and young adults, whose sense of immortality is virtually impenetrable, say the campaign's architects.

Instead, Truth — in the sartorial trappings and mumbled patois of American teens — portrays the tobacco industry as a corrupt, hypocritical institution that could be a worthy stand-in for the entire, loathsome world of adults. In short, for an audience yearning for a way to stick it to their parents, teachers or bosses, Truth positions the decision not to smoke as an act of defiance.

"We're selling rebellion," says Cheryl Healton, president of the American Legacy Foundation and a key architect of the campaign. To many adult eyes, Truth's ads are graphic, offensive or just plain incomprehensible. But they work because they engage their target audience on their own level, says Healton. "Just think how hard it is to get a health message across to someone who's 14 and thinks they're going to live forever."

A 2002 study of the Truth campaign found that its message has penetrated deeply into the culture of American teens and youth, even as smoking has declined to its lowest levels since tracking began in 1975. Healton thinks there is strong evidence that Truth has succeeded.

Today, she says, the Truth campaign is recognized by 70% to 80% of American teens, making it one of the most familiar brands.

But in many ways expunging the smoking habit through social marketing is easier than changing eating habits, experts say.

"Obesity is not tobacco," says Dr. Robert H. Eckel, a professor at the University of Colorado School of Medicine in Denver and president of the American Heart Assn. "Nobody needs to smoke, and everybody needs to eat and to move, at least some." Changing the complex stew of factors that influence how much someone will choose to eat and move "makes obesity in many ways a more difficult challenge."


Changes on every level To change behavior, action is also needed.

Motorists may be swayed by public service announcements, but buckling up is also required by law throughout the nation, and states with lax requirements miss out on key federal highway funds. Federal law requires health warnings on cigarettes, and state and local governments have adopted a wide range of smoking restrictions. Don't Drink and Drive campaigns may move tipsy motorists to give up their keys. But throughout the nation, drunk driving standards also have been tightened, as has their enforcement.

The Bush administration is betting that turning the tide on obesity can be done not through government mandates, but through voluntary industry initiatives and public campaigns of persuasion. "Change a heart, change a nation," is a favorite aphorism of Mike Leavitt, Secretary of Health and Human Services.

In March 2004, the federal government kicked off its Small Steps campaign, with pro bono help of McCann-Erickson Worldwide and the website-development firm Carton Donofrio Partners Inc. It is aimed primarily at "family builders" — parents age 25 to 49 with children younger than 18 living at home. About 38% of American households have at least one, and it's a group that spans race, ethnicity and marital status.

Diverse as this group is, however, it shares a single trait: Like Schwartz-Getzug, time for people in this group is almost entirely spoken for by the demands of work, home and kids. Although healthy eating and exercise is on their to-do lists, it often falls to the bottom and remains undone.

Working under the advertising industry group the Ad Council, McCann-Erickson has produced more than a dozen advertisements for television, radio, print media, billboards and buses. Media outlets have donated more than $150 million worth of airtime and ad space to run the campaign ads. An estimated 105 million Americans have seen the ads, and 1.2 million people have logged on to the Small Steps website — a "conversion rate … anyone in commercial advertising would love," says the Ad Council's Conlon.

In mid-2005, the Ad Council and McCann-Erickson rolled out a new crop of healthy-eating messages aimed at young kids. Known inside the industry as the "Fun With Food" ads, one features a pair of young boys lounging alongside their skateboards eating cheese sandwiches on whole wheat bread, as pigeons peck at their feet. A mighty belch issues from one of the boys, scattering the birds. "Can your food do that?" a deadpan voice-over asks.

Last month, an eminent panel of scientists urged the food, restaurant and marketing industries to launch a "massive social marketing campaign" aimed at shifting the food choices of American kids from junk food to healthier fare.

Nickelodeon was among the first companies to volunteer for that campaign. Throughout the summer of 2005, it aired advertisements urging kids to turn off the TV and go out and play. "Your ball needs you," says one ad, showing a basketball pestering a video game-playing kid until he takes it out to play. The "Let's Just Play" campaign culminated on Oct. 1, when Nickelodeon went dark for three hours, while more than 500 schools and youth groups organized special sports activities.

In October, Nickelodeon announced it had joined the American Heart Assn. and the William J. Clinton Foundation to create the Alliance for a Healthier Generation. The three will combine forces to launch a comprehensive education and advertising campaign aimed at getting kids to eat right and exercise more.

To the architects of the anti-obesity campaigns now underway, young children are an especially key target audience. Bombarded with enough effective messages, they may be the generation that turns the social tide against weight gain and inactivity, says American Heart Assn.'s Eckel.

But if that is to happen, parents such as Schwartz-Getzug must also get on board and lead by example, experts say. Some of those parents will be nudged to action by the lure of losing double chins, or love handles or spare tires — all unwanted body parts portrayed as lost in the government's new campaign. Other parents may be prodded into action by their kids, now also being targeted with get active campaigns.

But in homes such as Schwartz-Getzug's, even this two-pronged approach is facing the powerful forces of inertia. Recently the Sherman Oaks mom overheard one of the "Let's Just Play" messages on TV and, despite a to-do list a mile long, suggested a family outing.

"Yeah, OK, Mom, as soon as this show is over," the kids replied.

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Changing behavior: what works

Keep it light, keep it positive. Many years ago, the U.S. Ad Council ran public service advertisements urging Americans to be screened for colorectal cancer. The campaign showed caskets being lowered into the ground — and the ads soon took the same route.

Effective advertising campaigns don't "scare the life out of people," but empower audiences to act in their best interest, says Peggy Conlon of the Ad Council. Conlon says that a new colorectal screening ad portrays a colorectal polyp as a slow and bumbling troublemaker that, when collared early, is no threat at all.


Sell the sizzle. Whether it's steak or health, advertisers say, sex sells, and so do social benefits such as status, attractiveness and self-confidence. So sell those — not the prospect of a longer life.

In the government's Small Steps campaign, one magazine ad shows with dotted lines how the waist and thighs of an out-of-shape soccer mom can be whittled down when she gets in the habit of power-walking along the sidelines or taking a walk after dinner. As a photo of her fleshy middle is nipped from pudgy to sexy, text follows the curves, suggesting changes in the woman's self-image. "Fights urge to run on the soccer field and play forward," says the text that runs along the innermost line, in ads that appear in English and Spanish.


Offer peer acceptance to young audiences. Whether a kid is 6 or 16, no motivator is more powerful than the acceptance or admiration of kids her age or — even better — a bit older, advertising pros say. In anti-smoking campaigns, the fact that kids find smokers less attractive as friends and dates is a particularly potent lever. In a more positive way, the Truth campaign, says Carol Schechter, appeals powerfully to teens' desire to be part of a larger youth movement.


Make it immediate. Young kids live in the moment, and that's when they need to believe their reward will come if they do what the advertisement says. Marketers of toy and junk food know and follow this rule well: You eat this product, you will play better basketball as soon as you go out to the driveway; you buy this toy, and your life instantly will have all the excitement of an action video game.

For this audience in particular, "any health effect is so far in the future, it really has no relevance," says John Riley of the marketing firm Metrix.

Speak the audience's language. "Thunder thighs," "love handles" and "spare tires" may not be the way the Centers for Disease Control talks about obesity, but those are terms in which regular Americans think of their extra pounds. So, when ad copy for Small Steps TV ads was written, it touted the power of marginal changes in diet and exercise to help thirty- and fortysomethings lose those unwanted body parts.

Similarly, many of the anti-smoking advertisements that appear on MTV would be unintelligible to an adult who has no teenager living at home (and some who do). But if the message is to be authentic and believable, it must, like, come from someone who totally sounds like he spent the afternoon playing video games, dude.

La familia importa. With Latino audiences, family relations are paramount, and appeals to this audience should reflect that priority. Campaigns aimed at getting Latino parents to exercise have portrayed walking as a family affair, and for women, an extension of their obligation to their family.

Let the Web do the work. For all audiences, but for teens in particular, the World Wide Web is the place to learn and connect to an issue.

Bill Oberdorfer, the McCann-Erickson Worldwide account executive for the Fun With Food anti-obesity messages aimed at kids, says the broadcast ads can afford to be funny, cryptic and light on educational messages because all they need to do is lead kids to a website. "That's where the heavy lifting is done," says Oberdorfer. For kids in particular, many campaign websites extend and convey messages with computer games and even opportunities to chat and instant message with other kids.

The same is true of the Truth campaign, and even the Small Steps aimed at adults: Let the ad draw quarries to the website, and let the website convey the real information.

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Fitness in Finland's footsteps

Finland's public campaign to drive down one of the world's highest rates of heart disease is often cited by public health officials as a key example of what a social marketing campaign can do when backed by a wide range of government policies.

At the end of World War II, roughly 75% of Finnish men smoked tobacco, compounding the health risks of a diet high in animal fat and salt and declining physical activity. In the early 1970s, the Finnish government launched a multi-pronged effort to get Finns to stop smoking, cut back on such national staples as butter and salted fish, and get out and exercise. Companies and communities launched Nordic walking clubs, the Finnish national TV network ran "Quit and Win!" lotteries for those who stopped smoking, and schools got serious about teaching nutrition to young children. Prodded by the government, restaurants began offering salads with meals at no extra charge, and workplaces made time for group exercise.

But the Finnish government threw its weight into the campaign too, banning tobacco advertisement and smoking in workplaces, as well as tightening the nation's food labeling laws. The result: In three decades, Finland has driven down heart disease deaths by 60% and cancer deaths by 15%.

— Melissa Healy

Copyright © 2014, Los Angeles Times
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