The Food and Drug Administration's (FDA) Obesity Working Group Report
Effective consumer health messages about weight management and obesity prevention should be research-based and take into account the values, beliefs, motivations, needs and behaviors that comprise the "consumer reality" of the target audience. It is important that these messages be clear, simple, and understandable and do not undermine the credibility and impact of public health agencies.
There are six key questions to consider when developing research-based messages that encourage knowledge utilization:
- What is the purpose?
- Who is the target?
- What is the promise (i.e., motivators)?
- What is the support?
- What is the image?
- Where are the best opportunities for delivering the messages?
In determining the target audience(s) for research-based messages, it is important to consider that communication theory holds that more direct, population subgroup-focused messages typically have greater impact than messages that address a wider audience (e.g., the general public). At the same time, overweight and obesity have been identified as a national health problem, so it seems important to develop focused messages that affect large population subgroups.
Among private sector organizations, IFIC has been prominent in recent efforts to develop effective nutritional messages. IFIC uses a five-part system (Borra et al., 2003):
- Defining the relevant issues
- Developing the initial message(s)
- Examining candidate messages in focus groups
- Refining the messages
- Validating the messages in quantitative surveys
IFIC has drawn a number of conclusions from its efforts, many of which are supported by other researchers (Marietta et al., 1999; Kennedy and Davis, 2000; Borra et al., 2001; Patterson et al., 2001; Balasubramanian and Cole, 2002; Ikeda et al., 2002; Gans et al., 2002; Borra et al., 2003; Gans et al., 2003; IFIC 2003):
- Consumers will not react positively to messages unless the messages set forth concrete goals that consumers view as achievable.
- Consumers perceive general nutrition guidelines as too abstract and requiring too much planning and calculation to translate into action.
- Consumers are receptive to messages that make direct, concrete suggestions and therefore provide tools with which consumers may exercise choice. Consumers resist being told what they must do.
- Goals should be incremental rather than monolithic so that consumers can receive continuous positive feedback. Concrete and incremental goals sustain and reinforce consumers' desire for autonomy. Equally important is that setting and achieving incremental goals provides more opportunities for reinforcement (both self and external), which is important for sustaining positive behaviors. Consumers view monolithic goals as unrealistic because they would have to make substantial changes in diet and habits.
- Overemphasis on one or a few nutritional components of a diet may impede the overall goal of achieving a healthy, varied diet.
- Health and nutrition messages should be developed with an awareness of the varied cultural backgrounds found among the American public; different ethnic and cultural groups exhibit different dietary patterns and practices.
In qualitative studies, consumers claim they do not wish to spend a significant amount of time reading and comprehending labels. This is borne out by the fact that many use health or nutrient content claims as indicators as to the overall quality of the product and do not check the nutrition facts panel on the back (Roe, et al., 1999). Also, consumers appear to be confused by serving sizes, particularly by multiple servings listed on small packages, as well as by the %DV listed in the nutrition facts panel. Consumers use food labels for multiple reasons, including diet plans and pre-existing health conditions such as diabetes and heart disease, and look for macronutrients of concern. On the other hand, taste, convenience, price, mood and family preferences influence purchases and are often at odds with healthy eating. Such factors present challenges for developing effective messages.
Other findings indicate that adults do not like "diets" and do not believe they work over the long term (Borra et al., 2003). They also question whether there is any new nutrition information that they will find useful. Also, the qualitative studies found that encouraging parents and children to work together resonated, as did messages promoting better appearance(29) and self-esteem. Consumers need to hear new kinds of information, or a re-packaging of old information in new and relevant ways, that will serve as "motivation to jumpstart new thinking and behaviors."
29 At this time, FDA does not intend to use "better appearance" as a motivator for any of its obesity messages, given the larger concern about the effect such a focus may have on those with eating disorders (e.g., anorexia and bulimia).