Developing community and statewide initiatives to combat obesity has been described “as American as second helpings of apple pie” (Levitz & McKay, 2013). Checking in on this trend, the writers noted that while there have been a few successes, more often local and state leaders are trying to figure out how their projects did so poorly. They note 10% participation rates, weight loss of 3 pounds per person over 8 weeks, achieving only 6% of a collective weight loss goal, and the “fizzling out” of a 1-year citywide challenge.
Thre are the usual suspects behind these disappointing results: everyday hassles that preclude making more
healthy eating choices or increasing physical activity levels, the temptations
of fast and convenient food outlets, and the lack of money to adequately
promote the program. In response to these failures to initiate and sustain
behavior change, several cities have turned to local ordinances to post calorie
counts in certain restaurants or are building more hiking and bike trails. One
could conclude that broad-based weight loss initiatives are not worth the
effort and that time and effort is better spent issuing regulations and
changing the environment. I believe that these community and state efforts need better marketing of weight management.
Developing programs to reduce obesity at scale means thinking about the problem as a wicked one. As I've talked about before, wicked problems have at their core the need for large scale behavior change. Wicked problems also require multi-faceted solutions, and not one-shot wonders - whether these are weight loss challenges or state-of-the-art walking trails and exercise facilities. Rather than thinking about an either-or approach to improving the public health in a city or state, I encourage leaders to consider a strategy that balances behavior change with regulatory and environmental prompts and supports for these changes. Another way of thinking about this is that we need to generate both demand for weight loss and stimulate supply of ways to achieve it. Unfortunately, most states and cities choose one or the other.
Increasing demand and supply for losing weight is the marketing challenge for public health programs at the local, state and national level. My experience and related research suggests the following roadmap for creating a second-generation of public engagement and participation efforts around weight management.
1. Set realistic expectations. Especially if this is your
first effort, unrealistic metrics (anything that includes the word “all” or
“everybody”) will undermine program planning, staff morale and participant
engagement. Think of your initial efforts as a prototype, not a full-fledged
program. Take your initial results to set benchmarks for the next one. Similarly, set a
5 to 8 week period for your campaign to focus everyone's attention, avoid the
“fizzle” or fatigue factor, and to set achievable weight loss goals of 1-2 pounds
(0.5-1kg) a week for participants.
2. Understand your priority group. Weight-loss campaigns will appeal to certain types of people including, obviously, people who perceive themselves as needing to lose weight. However, every program feature you plan will affect its appeal to certain groups. For example, linking to many group support programs will be more appealing to women; individual and team-based competitions may engage more men; the nature of incentives and grand prizes will attract people with those types of interests; recruitment primarily through worksites leaves out other segments of the community; etc. Best practice would be to involve people who are your core priority group in the planning of the program so you can get inputs and immediate feedback in designing the key program elements.
3. Use incentives to promote participation and success. Incentives for weight loss do not need to be viewed as undermining intrinsic motivation for making healthier choices. Rather, what is more often found is that incentives are a great aid in attracting attention from media and intermediaries to promote the program. Grand prizes, chosen through a lottery of successful campaign completers (we used a 1-2 pound weight loss multiplied by the number of weeks of the campaign as the criteria for success), are also helpful in gaining and focusing the attention of specific segments of the community – think of the different types of people who would be attracted to a weight loss campaign that had grand prizes of $1,000 cash, or weekend retreats for two at local spas, or lifetime memberships to fitness clubs.
4. Build supply and demand. The default strategy for most of these campaigns is to focus on individual responsibility and behavior change. I suggest you consider all of your local assets and focus on the marketplace for healthier behaviors. Design the campaign to increase demand for healthier food choices and access to physical activity facilities. But also build in from the beginning the participation of local restaurants, physical activity businesses and nonprofit organizations, and other groups who can support people in their efforts to lose weight (i.e., meet the demand the campaign is generating). Having supportive businesses offer reduced-cost or limited-time free access to their offerings on a trial basis generates prospective customers for them and opens up alternative behaviors for people wanting to manage their weight.
5. Localize, localize, localize. Even in smaller communities, holding events in specific geographic areas can help the campaign reach and touch people more effectively. In our Lighten Up campaigns, many aspects from recruitment to weekly walking events to final “weigh outs” were planned to minimize cost of participation. Worksites, religious organizations, fire stations, government offices can all be used to ensure there is a hyper-local presence of the campaign in people’s lives.
6. Pay attention to time. Campaigns that have finite start and finish points are easier on everyone. We found that 5-6 weeks is about what many community organizations, businesses, participants and our own staff could manage to keep up the energy and maintain focus. Some professionals get concerned that such limited time will not be enough for many people who want to lose significant amounts of weight. We agree and build into these campaigns options for people who want to continue in more structured exercise and weight loss situations.
7. Monitoring and evaluation. It is also essential to have at least an initial and final campaign weight measurement that makes the participant’s commitment to the campaign public (though they don't have to disclose their actual weight to anyone). Making a decision to lose weight during the campaign while standing on one's bathroom scale is very different from showing up and weighing-in where you work, worship, learn or play. Similarly, the weigh-out is another public affirmation of one's desire to manage their weight. These book-end events provide program planners with the opportunity to collect pre- and post-campaign data. There are also many ways to use websites, social media and mobile technologies for participants who wish to self-monitor and report eating and physical activity behaviors on a daily or weekly basis. However, I would be against making this response burden a requirement for campaign participation.
8. Leadership. People who are involved and visible in the campaign need to be from the peer groups and constituencies that form the core of the priority group. Elected officials often want to be seen as the leaders of these efforts. Yet, not everyone in the state or community will appreciate or be drawn to particpate by his or her presence. It is important to have the visible and on-going involvement of local campaign organizers, personalities from the media, religious and business leaders, and other people who are attractive and appealing to your priority group.
9. Get the healthy involved. Fortunately, not everyone in
your community needs to lose weight. But that should not preclude them from
being involved in the campaign. One of the more successful strategies we
developed was to have a “buddy program” in which these people could formally
adopt or sponsor a family member, friend or co-worker who was engaged in the
campaign. We would provide these buddies with materials to increase
their understanding and use of various social support techniques that help
facilitate behavior change for weight loss. In some campaigns buddies
were also eligible for grand prizes if their sponsored participant lost weight. There are people who are quick to point out that buddies could game the system by
sponsoring more than one weight loss participant and thus increase their
chances of winning. Such are the ways of changing social norms in a positive
direction! As far as we were concerned, the more participants they recruited and personally supported to lose weight, the better for all of us.
Now it’s up to you.
Del Prete, L., English, C., Caldwell, M., Banspach, S.W. & Lefebvre, R.C. (1993). Three-year follow-up of Pawtucket Heart Health's community-based weight loss programs. American Journal of Health Promotion; 7:182-187.
Levitz, J. & McKay, B. (2013). Can a whole city stick to a diet? Fat chance. The Wall Street Journal (January 23): pp. A1, A12.
Litchfield, R.E., Muldoon, J., Welk, G., Hallihan, J. & Lane, T. (2005). Lighten Up Iowa: An interdisciplinary, collaborative health promotion program. Journal of Extension; 43:
Nelson, D.J., Sennett, L., Lefebvre, R.C., Loiselle, L., McClements, L. & Carleton, R.A. (1987). A campaign strategy for weight loss at worksites. Health Education Research; 2:27-31.