The second (June 2021) workshop began with a session that provided a high-level perspective on health communications and how they relate to data-driven and innovative approaches for achieving sustainable systems-wide changes to reduce the prevalence of obesity. A presentation on the topic was followed by a moderated discussion and question-and-answer period with participants. Angela Odoms-Young, associate professor and director of the Food and Nutrition Education in Communities Program and New York State Expanded Food and Nutrition Education Program in the Division of Nutritional Sciences at Cornell University, offered introductory remarks prior to the presentation.
Odoms-Young explained that because obesity is a condition associated with a multitude of genetic, behavioral, and environmental factors, the development of effective solutions requires a nuanced and strategic approach that reflects this complexity. She pointed out that people understand and perceive the world through mental models, and these mental models influence their perceptions of the relevance of efforts to address obesity and its determinants. She added that people’s mental models shape how they simplify complexity and what connections and opportunities they see with respect to obesity’s causes and consequences, and understanding these models can therefore point toward promising population-level solutions.
Odoms-Young emphasized the value of discussing what is known and believed about obesity and how that information is communicated, received, processed, and internalized. She maintained that these processes shape beliefs about sustainable systems-wide changes and solutions for reducing the prevalence of obesity. She offered examples of several questions that reflect this observation:
- How do public policies concerning obesity reflect the complexity of what is known about its causes and effects?
- How do public perceptions of obesity and people who have obesity lead to public support for or opposition to specific types of obesity-related policies and programmatic interventions?
- How do public health narratives and framings reinforce or combat obesity stigma and weight bias?
- How do anti-Black or anti-Indigenous narratives coexist with thinking related to obesity stigma, and how can obesity solutions align with narratives of social justice, antiracism, and liberation?
- What strategies work for equitably engaging communities and supporting community-driven leadership in communication about obesity and its solutions?
WHAT IS MEANT BY HEALTH COMMUNICATION?
Jeff Niederdeppe, professor in the Department of Communication, director of the Health Communication Research Initiative, codirector of the Center for Health Equity, and associate dean for faculty development in the Jeb E. Brooks School of Public Policy at Cornell University, discussed the role of health communication in the context of sustainable systems-wide changes to reduce the prevalence of obesity.
According to Niederdeppe, health communication is an interdisciplinary approach to the theory, research, and practice of (1) understanding when and how communication shapes population health and, informed by that understanding, (2) developing effective communication to promote population health. He emphasized that health communication occurs at many different levels—interpersonally, within groups and networks, in health care organizations and between health care practitioners and people, in policy-making forums, in the mass media, online, within and between institutions, and in society as a whole. He suggested, therefore, that health communication could likewise be leveraged at multiple levels as part of systems-wide strategies for reducing the prevalence of obesity.
Niederdeppe discussed how health communication has shaped public understanding of obesity. In one survey focused on the extent to which Americans view a variety of actors as responsible for addressing obesity in the United States, 88 percent and 87 percent of respondents, respectively, named individuals and parents (in the context of childhood obesity); fewer respondents named other actors, including health care providers (57 percent), the food and beverage industry (53 percent), schools (50 percent), and government (23 percent) (Wolfson et al., 2015). Niederdeppe noted that these data are from 2012, but that more recent data echo those findings.
According to Niederdeppe, the view that obesity is a personal problem to be solved primarily at the individual level is shaped by multiple powerful forces. These forces include political groups that highlight individual responsibility, deregulation, and limited government; the food and drink industries, which emphasize personal choice and self-regulation with little if any oversight; and an entertainment industry that sells false images of the “ideal” body. Niederdeppe also pointed to an overemphasis on the medical definitions and health care costs associated with treating obesity. These forces operate within a broader context of structural racism, he maintained, which is embedded in discourse and policies that generate obesogenic environments in communities of color through such mechanisms as economic oppression, zoning laws, and neighborhood segregation.
According to Niederdeppe, these forces and this context have also shaped public beliefs about how to address obesity and the ways in which people with obesity are viewed. He pointed out, for example, that high
levels of blame and stigma are directed toward people with obesity, and that systems-wide, evidence-based public policies designed to reduce prevalence of obesity have garnered substantial opposition. He added that individual-level interventions to improve diet and promote physical activity are often emphasized in approaches for addressing obesity.
Building on his point about the emphasis on individual-level behaviors, Niederdeppe discussed the effects of communication interventions to promote behaviors related to diet and exercise. He stressed that massive amounts of exposure to messaging are needed to create change at a population level, and even then, the effects of such messaging on behaviors tend to be small and short lived. As an example, he shared results of a study examining percentage changes in grocery store sales of products high in trans fats occurring around the time of the release of a widely publicized report on the dangers of trans fat consumption (Niederdeppe and Frosch, 2009). The researchers observed a substantial reduction in purchases of such products immediately and up to a week after the report’s release, and then a steady diminishing of those effects 2 and 3 weeks later as media coverage of the issue subsided. This kind of pattern is consistently reproduced in communication campaigns, Niederdeppe observed.
Niederdeppe went on to assert that communication interventions tend to increase rather than reduce inequity. He cited as an example messaging about tobacco use, for which investments of hundreds of millions of dollars have been made. Referencing data on the prevalence of cigarette smoking, he pointed to similar rates among population subgroups with various levels of educational attainment in the 1960s, but widening gaps in rates among the same subgroups during the following several decades (Drope et al., 2018). Such patterns of widening inequity occur repeatedly, he explained, because populations that have difficulty implementing behavior changes as a result of economic, social, and structural factors are typically less likely to benefit from an infusion of health promotion messages.
Niederdeppe shifted to the final portion of his presentation, in which he discussed the emerging evidence base on the effects of communication interventions focused on promoting systems-level changes to reduce the prevalence of obesity and on spurring other structural changes to promote population health. According to Niederdeppe, strategic communication can promote systems-level thinking and interventions and increase public support for such evidence-based policies. With respect to obesity prevention, he referenced messaging efforts in which he had been involved that increased public support for a penny-per-ounce tax on sugar-sweetened beverages, community-level strategies for reducing the number of food deserts, and restrictions on food and drink marketing to children.
Niederdeppe next highlighted three characteristics of effective communication strategies, starting with the recognition that audiences are
not monolithic. In effective strategies, he explained, the objective of creating environments that promote health and social equity is often accompanied by a focus on promoting evidence-based, systems-level policies at various levels across sectors and involves multiple strategic elements. A strategy might, for example, focus on engaging the public, either to persuade those potentially opposed to a proposed policy or to mobilize those who already support it, such as by applying pressure on decision makers to enact it. Other strategies might focus on decision makers directly, Niederdeppe continued, whether to persuade them to support the proposed policy or to mobilize and spur action among those already inclined to favor it. Strategies that target a particular group spill over to other groups, he acknowledged, but he stressed that effective communication strategies are tailored to the specific groups they are intended to reach.
Niederdeppe turned to the second characteristic of effective communication strategies: that they center the policy solution, not the health problem. When public health researchers generate evidence supporting the health-promoting potential of a policy or intervention, he remarked, they typically develop a communication strategy that focuses on the projected health impacts. In his experience, Niederdeppe observed, this is often an ineffective strategy at best or a counterproductive one at worst, a point he illustrated by showing a picture of a billboard featuring a close-up photo of a concerned physician, with text urging viewers that childhood obesity is not to be taken lightly. Not only does that message medicalize the problem, he explained, but it also fails to account for the possibility that other less stern, more hedonistic messages may be contending for attention in the same public information environment—in this example, a second billboard positioned immediately below the first one advertising fast food.
Starting with the policy solution and working backwards allows different kinds of values and beliefs to come into play. In some cases, he elaborated, values and beliefs about the social impact, the economic impact, or the institution and process associated with developing a particular systems-level policy drive support for or opposition to the policy. Health impacts play a role at times, he conceded, but he cautioned against assuming that they always drive policy support or opposition, even though public health and medical actors may emphasize those impacts in their communications.
Finally, Niederdeppe cited as a third characteristic of effective communication strategies recognition that different messages may or may not resonate among different social groups. He reported results of a study of parents who reported annual household incomes of less than $40,000 in which the researchers assigned various levels of strength to different messaging strategies designed to boost support for increasing prices on sugary drinks according to the racial/ethnic identity of respondents (Cannon et al., 2022). A message focused on supporting community efforts to improve
children’s health had similar appeal across the three racial/ethnic groups, he observed, whereas a message about standing up to the sugary drink industry’s targeting of Hispanic/Latinx children was perceived to be stronger among Black and Hispanic/Latinx parents versus White parents. When the message was about standing up to the sugary drink industry’s targeting of children from lower-income families, however, its appeal increased among White parents. Niederdeppe emphasized the principle conveyed by this example: the importance of understanding the perspectives of diverse audiences before implementing communication strategies to promote evidence-based health policies. Understanding this principle can help communicators anticipate how their messages will resonate among different groups, he asserted, which in turn helps differentiate strategies aimed at mobilizing audiences who support a policy from strategies aimed at persuading audiences who oppose it.
AUDIENCE DISCUSSION
Following his presentation, Niederdeppe responded to two questions about communication strategies for systems-wide changes to reduce the prevalence of obesity.
Challenges to Effective Communication about the Need for Systems-Wide Changes
In response to Odoms-Young’s question about the biggest challenge to effective communications on the need for systems-wide changes to reduce the prevalence of obesity, Niederdeppe offered two thoughts. He pointed out, first, that there will always be groups that are resistant to proposed changes in systems, institutions, or structures, particularly when those changes are perceived as threatening power structures and economic interests. He called for recognizing these “often powerful and well-funded forces,” noting that they may be a moving target depending on the policy or intervention being proposed. He added that they often dramatically outspend public health efforts to promote structural changes to address obesity on countermessages opposing the changes.
Niederdeppe’s second thought was that the creative and innovative nature of some systems-level changes means they may not initially have the strongest possible evidence for implementation. Policies are implemented differently across communities, he elaborated, where they may have different parameters or make different compromises based on a particular community’s needs and interests. As a result, he explained, a policy that has been tailored to a particular community may not have the same effect in a different setting. He urged a willingness to try innovative and promising solutions, even though they may not yet have been thoroughly studied.
Communication Strategies to Change the Perception of Obesity’s Origin
A participant suggested that shifting the perception of obesity from having a behavioral origin to being a disease state could alter the bias and stigma directed at people with obesity and increase support for treatment. Niederdeppe agreed that it is important to shift society’s perception of obesity away from a problem that is primarily personal in nature, but appealed for framing it as a broader societal problem with a medical component. He cautioned against “overmedicalizing” the problem, explaining that people usually think of treating clinical problems with medical treatments focused on individual bodies, whereas obesity’s drivers go beyond the realm of health care.
This page intentionally left blank.
