Caitlin Murphy

PBH 650 – Health Communication

The Battle against Obesity

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Executive Summary

The Battle Against Obesity campaign is created to combat the overwhelming

number of children and adolescents that are obese throughout the world. Over the last three

decades, childhood obesity has more than doubled in children and tripled in

adolescents(Sanyaolu, 2019). I am here to discuss how concerning the current obesity rates are

more specifically in the US and the affect that will have on the younger generation not just now

but also in their future. These children will experience physical, psychological/mental struggles

short term and long term if the health issue continues. I will recap current efforts and three cases

through research on the topic of adolescent obesity while evaluating their effectiveness and

applying that to my health communication campaign. Later in the paper I will utilize

questionnaires based on the theory of planned behavior to evaluate effectiveness of the

campaign. Being that the younger generation is so technology driven, I will create an application

to deliver my health communication message based on national/state guidelines of healthy

recommendations for the adolescent population. With collaborative efforts and evidence based

practice we plan to promote “Best Health Saves you from Obesity Life” in our call to action to

tackle the obesity epidemic.

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 TABLE OF CONTENTS
TITLE PAGE…………………………………………………………………………………….1

EXECUTIVE SUMMARY……………………………………………………………………...2

TABLE OF CONTENTS………………………………………………………………………..3

UNDERSTANDING THE HEALTH ISSUE…………………………………………………..4

THEORY APPLICATION…………………………………………………………………….12

MESSAGE DEVELOPMENT…………………………………………………………………14

CHANNEL AND TOOLS……………………………………………………………………...17

REFERENCES………………………………………………………………………………….20

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 (1) Understanding the Health Issue

Excess weight during childhood and adolescents continues to be a major health concern

around the world. It has become so concerning to the point that the World Health Organization

established a goal of no increase in obesity for children by 2025 in their 6 global nutrition targets

(Di Cesare, 2019). According to the Center for Disease Control and Prevention(CDC) fast stats

webpage, in the United States 21.2% of adolescents age 12-19 have obesity (CDC, 2022).

Almost ¼ of the entire adolescent population is obese in America. The driving force behind this

increase in obesity rates are related to excess food consumption and reduced physical activity (Di

Cesare, 2019). That being said, it’s not the only factor to take into consideration. Obesity can be

genetic, which isn’t the child’s fault. When one parent presents with obesity, it is more likely the

child to also become obese. If both parents are obese the odds are even more likely that the child

will be obese too (Sanyaolu, 2019). Stress can affect eating habits, resulting in overeating and

high caloric food consumption, not sleeping or even decreasing physical activity. On top of that,

we are living in a world of immediate satisfaction. The fast food accessibility has put the nation

at a disadvantage. The food is less expensive, high in calories, and quick to acquire. It’s easier

and less expensive to get, so many people justify eating that over fueling your body properly. It

requires, money, time, and effort to maintain healthy eating habits. Technology has added to the

sedentary lifestyle among Americans alarmingly so. Compared to children in the 1900s, children

are spending more than 6 hours per day on social media(Sanyaolu, 2019). Instead of being active

outside, children and adolescents stay indoors inactive while overeating.

The COVID-19 pandemic has enhanced all of these factors to a whole new level. “Large

scale quarantine and home confinement will impose new and unfamiliar stressors on children,

thereby worsening the childhood obesity epidemic”(Storz 2020). That’s exactly what the

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pandemic did, and more. The psychological and social struggles lead to depressing states of mind

encouraging more unhealthy food intake. During the quarantine children were probably limited

to unfavorable diets and financial limitations, again relying on processed foods and

nonperishable items. If that wasn’t enough, the shut down and quarantines required social

distancing and isolation. Restricting peoples’ ability to be active at all. Obesity rates are at an all

time high after arguably one of the most stressful years to date. All stakeholders and health

professionals must take action to minimize the impact of the COVID-19 pandemic on childhood

obesity.

Child and adolescent obesity can largely impact their mental health, physical health, and

can even affect the next generations. Children that are obese are at risk of developing

asthma(Sanyaolu 2019, p.6) A research study found that the obese children over a 9 month

period had a higher number of days of wheezing in addition to more unscheduled emergency

hospital visits. Another trial listed in the same article mentions that weight loss in obese patients

with history of asthma attacks were able to minimize and control the asthma attacks

significantly. As mentioned previously, adolescents with obesity are also obese as adults

(Reinehr 2018, p2). Carrying that into adulthood puts you at risk of heart disease later in life as

well as type 2 diabetes, risk of cancer, stroke, and pulmonary diseases. Obesity in adults leads to

a risk of dying earlier than an adult with normal BMI. The same article brings up a Harvard

Growth Study that “Overweight in adolescence was associated with a doubled risk of mortality

from all causes and mortality from coronary heart disease compared with normal weight in

adolescence”(Reinehr, 2018, p2). To be more gender specific, men who were obese in adulthood

are at risk of colorectal cancer and gout, while arthritis was increased among women.

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 There are psychological and mental health risks in addition to just the physical concerns

when talking about obesity in adolescents. For starters their social life is challenging. Children

and adolescents who are obese have a tendency to be bullied by their peers. Reported poor self

esteem, depression, and negative mood all align with obese adolescents(Reinehr 2018, p 2). This

group is also at more risk of engaging in an eating disorder verses those without childhood onset

obesity(Sanyaolu 2019, p.6). For people who are obese and experience this isolation, body

dissatisfaction, depressive symptoms and negative self esteem end up emotional/uncontrolled

eating, decreased physical activity, avoiding healthcare services and even more weight gain. Due

to the stigma that is widespread people who are obese end of internalizing their feelings and

actions thereby creating additional barriers toward behavior change. The combination of the

physical and mental health challenges pertaining to obese populations result in overall poorer

quality of life compared to more average weighted people.

To better address the adolescent obesity issue it’s important to discuss which specific

groups have the highest burden of obesity. The consideration worth mentioning in this paper are

the socioeconomic disparities. One way to reduce obesity risk is to improve one’s nutrition

and/or snacking behaviors. Adolescents from lower-income households consume; significantly

more calories, higher sugar intake from snacks and sweetened beverages, less fruits and fiber

from snacks compared to those from higher income backgrounds(Gangrade, 2021 p.7).

Socioeconomic status(SES) reflects greatly on an adolescents food consumption due to

affordability as well as accessibility. Obviously higher income families can afford the more

expensive while nutrition friendly snacks such as fruits and vegetables, compared to a family of

lower SES can only get to the department store with no fresh ingredients and nutrient poor

food/beverages.

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 The second youth obesity prevention strategy would be to increase physical activity. SES

can enable or hinder a persons’ physical activity levels. Adolescents’ average engagement in

active transportation(walking biking, skateboarding, etc) was 23% higher for those living in

higher walkable neighborhoods compared to lower walkable neighborhoods(Sallis, 2018 p49). In

fact, those higher income areas also participate in more sports teams/physical activity class

outside of school setting compared to lower income areas. The adult and youth in low walkable

areas spend more time in cars to travel, or indoors(watching television, video games, etc).

Specifically, the lower income neighborhoods are spending 26 more minutes per day partaking in

sedentary activities(Sallis 2018, p51). The lower income neighborhoods are less likely to afford a

sports team/activity classes outside of school and their neighborhood isn’t conducive to active

lifestyles. It goes to show how socioeconomic disparities create environments that either promote

opportunities to eat healthy and be active or restrict the two. Overall, suggestions are to target

health promotion interventions to the lower income neighborhoods.

Keeping the focus on addressing children and adolescent obesity concerns I plan on

creating and implementing a program through the school system. If not in school, this generation

of students spend most of their time on some sort of media platform. That being said, a health

communication campaign that utilizes technology is of importance as well. I evaluated three

different studies done beforehand with similar intent to combat the adolescent obesity concerns. I

will take my findings and implement some of the effective strategies into my Battle Against

Obesity campaign.

SHAPE Act Campaign - Georgia

The first effective campaign that I found was the creation of a fitness assessment for

children in Georgia (Corso 2020). This implementation was based on the Fitness Gram (Pacer

Test, 1- mile walk/run, muscular strength, endurance, flexibility, and body comp/BMI) but called

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SHAPE Act. This took place during the students’ physical education class, so it was

administered by professionals in the field. 931,000 students were enrolled from elementary

school and middle school across Georgia. The school was required to report the individual

testing results to the parent/guardian of each student including the child’s fitness zone. The

student was ranked either green(healthy) or yellow/red(needs improvement) depending on

severity. The individual reporting is meant to increase parents’ awareness and personal

responsibility to take action in their child’s health. Surveys with questions were meant to

evaluate the effectiveness of the campaign on; awareness of the act and FitnessGram activities;

changes in the family’s or child’s diet or physical activity or use of medical care based on

assessment results (as suggested by the information provided in the FitnessGram); and

perceptions of schoolbased BMI screening and fitness assessments. For parents who received

results, 65.0% reported talking to their child about the report; 43.7% reported talking to the

child’s physician. Fewer than one third of parents reported receiving the FitnessGram results,

suggesting a need for improving the reporting of individual-level fitness screening results.

Although most parents in this study were in favor of nutrition education and physical activity

opportunities for their children in schools, fewer parents were in favor of mandatory BMI

screening as a state policy(Corso, 2020p.2).

“Move More, Get More” Campaign - Kansas

What I liked about this second campaign was that it not only encouraged physical activity

but it also brough healthy eating and proper nutrition into question. Move More, Get More is a

health intervention taking place afterschool for 9 months in the Kansas City Public School

District(Grimes, 2022). These middle schoolers were offered 2-3 sessions per week with an

opportunity to be physically active through a variety of activities while also assessed on nutrition

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behaviors. Produce kits were distributed weekly to all middle schoolers containing at least one

healthy meal for a family of 5 which allowed groups that maybe couldn’t afford it beforehand a

chance. The physical activity portion of the program wanted to provide an opportunity for team

competition as well as acquiring sports skills to not just be active now but to be able to continue

the active lifestyle through their gains. The nutrition portion of the program aimed to increase

fruit and vegetable consumption to be able to meet the national guidelines. There were incentives

given to increase motivation, encourage participation and to collect data for evaluation of the

effectiveness of the program through completing questionnaires. This program evaluated

students’ current activity and nutrition status, educated the group on state/national

recommendations to aspire to reach. This article does not provide specific information on the

results being that the study was so recently completed. A few things that this campaign did

already; provided more knowledge and skills for adolescents in the national/state

recommendations on physical activity and nutrition, more opportunities to be physically active

outside of the school setting and more availability to healthier food consumption. If the

intervention proves to be effective in increasing physical literacy, physical activity and

fruit/vegetable consumption it should certainly be implemented across many other areas.

“Let’s Move” Campaign- Michelle Obama

The third campaign that I chose to reflect on is Michelle Obama’s “Let’s Move” anti-

obesity initiative during her time as the First Lady to President Barrack Obama. It’s purpose was

to encourage healthier food options in schools, more visible food labeling for products being

purchased, and more physical activity for children(Tucker, 2013). Michelle’s health

communication campaign was a great start to spreading knowledge and skills to all people across

the nation while using Disney, NBC, Viacom and other media companies. In fact, the website

‘letsmove.gov’ was created for parents to be able to download recipes and exercise plans free of

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charge. Recognizing the world is technology driven now, and children spend much of their time

watching television the campaign certainly chose the correct channel to get the message across

for their audience. My one critique on the platform and message provided is that the last time the

update to the website was 2017. It is now 2022, and there has been no updated or current

information provided. I wish the entire campaign stayed involved to keep the website to date

with constant filtering of knowledge and skills beyond Barrack Obamas presidency. I also liked

how the campaign recognizes that everyone has a role to play and action to take in addressing the

obesity incidence among adolescents. There is no one person to blame; schools can promote

more physical activity and healthier food options, parents can encourage lifestyle changes to

become healthy habits at an early age, health professionals can open the discussion among the

entire population which could all carry into their communities(Backstrom, 2020). The school

vending machines removed most of the very unhealthy food/beverage options and switched them

for more nutritious alternatives which is a positive step. The school breakfast and lunch in my

high school is free for all students! This is a huge gain for students that may have consumed an

unhealthy if any meal during the school day. In addition to the need for more cultural and

economic recognition regarding access and availability to healthy foods there are some other

findings within the “Let’s Move” campaign that should be improved to reach the ultimate goal of

minimizing childhood obesity rates. Primarily, the encouragement of eating and exercise being

the answer. It’s undeniable that proper diet and adequate physical activity are two areas that a

person can control. But, there needs to be the recognition of other factors to consider besides the

overeating, unhealthy nutrition and sedentary behaviors are the only actions at fault. There are

many aspects out of the child and even parents/community control. For example, there are

genetics that come into play with health conditions or environmental limitations prohibiting the

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ability to maintain an active and healthy lifestyle(disabilities/handicap, lack of knowledge,

physical activity opportunities, etc.) Instead of putting your limited messages and resources on

the individual behavior change you should reflect on the health disparities that created the

inequalities among people(Jette, 2016 p15). Second, the body size and movement comparison to

overall health. The overemphasis on body shape, weight, and fitness can lead to negative

outcomes in the future. This campaign promotes health professionals taking the children’s’ body

mass index(BMI) as a proper standard to compare obesity rates. This is concerning because fat

activists and similar professionals have shown that body size, weight and BMI has very little

relationship to overall health(Kulbaga, 2017 p.4). This campaign also put an emphasis on

physical education and standardized testing. This brings up another comparison which is

inaccurate through the standardized fitness testing. Not every active child can run a timed mile or

perform a specific number of push ups and sit ups. Rather, the focus should be on availability to

facilities before and afterschool with supervision so that physical activity is a safe and reliable

option for students(Kulbaga, 2017 p.9). This campaign privileged certain bodies and those with

available resources. There needs to be a shift in perspective on reducing fatphobia, increasing

body diversity in the media and recognizing that body size is just one of many factors that go

into consideration of overall health. In addition, health disparities and inequalities among

populations need to be shared as well By doing so, I think there could be a more productive

campaign to reach the more vulnerable consumers.

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 (2) Theory Application

Theory of Planned Behavior

The theory of planned behavior is used quite often in the communication and public

health realm. Theory of planned behavior is based off of behavior change and in order to achieve

that you need intention. The younger generation is way more independent than we give them

credit for, so we need to motivate the youth to want to take action in their life. Three categories

have to be addressed to create behavioral intention; attitudes, subjective/social norms, and

perceived behavior control/beliefs. First you need to assess the students’ attitude on the topic.

That can represent either a positive or negative evaluation of behavior. Subjective norms refer to

social pressure to do or not to do the action at hand. Perceived social pressure is the ease or

difficulty of a behavior that directly or indirectly affects said behavior. People decide to act when

they deem it to be positive and believe that they are influencing and important people who think

that they should perform that behavior and perceive that they have control over doing

it(Mazloomy, 2017 p15). Do they actually plan on taking action and changing the behavior? The

‘Get Healthy Philly’ campaign messages were designed to reduce sugar sweetening beverage

consumption to minimize obesity completely. It was meant to raise parent awareness about the

high levels of sugar in the drinks to hopefully take action(Bleakley 2018, p410). Through a series

of telephone surveys they were able to ask questions about sugary drinks and how themselves,

their children would feel about replacing sugary drinks and what the outcome would be. It also

asked if the parent intended on removing sugary drinks at all in their child’s life. Similar to the

Get Healthy Philly Campaign, ‘Swap it, Don’t Stop it’ wanted to encourage making small,

achievable healthy choices by swapping unhealthy behaviors with a better alternative(O’Hara

2016). Rather than trying to completely eliminate the behavior. It utilized television, radio,

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magazines and other technology platforms. First it consisted of a self report on their own fruit

and vegetable consumption. Then they asked about how they perceived the idea of minor shifts

in their lifestyle and how the family would perceive it. Lastly did the person intend on making

small strides towards healthier living. The last campaign I found applicable to my adolescent

obesity health communication discuss the importance of not skipping meals. There were

messages designed to improve healthy eating habits aiming to change our attitudes and

perceptions toward specific eating behaviors so that we will adopt better habits. (Lindsay 2017).

Children with obesity are at risk of adult obesity, if we can educate and improve the

health of families before they even start having children this can help reduce the increasing rate

of childhood obesity in the United States. I want to provide parents and caregivers with proper

education on the causes and consequences of childhood obesity can help prevent childhood

obesity by providing health education curriculum to influence children and adolescents to create

effective habits that will last. Through theory of planned behavior and technology platforms I

hope to reach families and change attitudes and subjective norm for intention to maintain an

active and healthy lifestyle through a pre-post questionnaire(Andrews, 2010). This would take

place in a online survey through the app that students downloaded.

Attitudes

Assessed through the child’s position on being able to acquire fruits and vegetables, limiting

sweetened drinks, and being active regularly. How important are these things to you? (Being

nutritious and physically active is very important to me.)

Subjective Norms

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Assessed through items that asked children what people are important to them and whose

opinion they valued about needing to consume fruits and vegetables, limiting sweetened drinks

and being physically active regularly. (Do my important people think that I should take all of

these actions?)

Perceived Behavioral Control

Assessed through questions asking if they are able to eat more fruits/vegetables, drink less

sweetened drinks and be active daily. (Am I able to do all of these things to prevent myself from

being overweight?)

Behavioral Intention

Assessed through final thoughts if they intend to eat more fruits/vegetables, drink less sweetened

drinks, and be more active. (Do I want to take action and actually try to complete these tasks?)

Students will complete a pre-questionnaire and a post questionnaire through the app to gather

date and evaluate if the health communication campaign is effective. We hope that over the

entire health education course students’ behavioral intention eventually changes.

(3) Message Development

Childhood and adolescent obesity has increased at an alarming rate over that last two

decades (Bendor, 2020). Almost ¼ of the entire adolescent population in America are obese

(CDC, 2022). Aside from the immediate physical health concern for the adolescents, it can also

affect their adulthood and offspring (Reinehr 2018, p 2). Not just physical, but as a result of

being an obese adolescent there are mental health challenges such as poor self-esteem,

depression, and even bullying. Attached is a health communication campaign that can properly

address the battle against obesity among our adolescent population. We ask everyone within

families, schools, and the entire community to take part in minimizing the troubling epidemic of

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obesity(Miller, 2018). We know it’s essential for us to educate the youth on the danger of these

health behaviors, prevention methods, and behavior changes so that they can make an educated

choice on their current and future actions. All of this starts in the classroom with this campaign.

Being a current PE teacher and soon to be health education teacher it’s the best way to launch

this campaign with hopes of it expanding into families and the community. Below are more

specific objectives using the SMART system. All objectives fall under three overarching

parts(Educate, Motivate, and Support). For every objective there will be a strategy to achieve

each one through the campaign in class.

Goals and Objectives

Educate: One of our overarching goals is to increase student knowledge on the physical and

mental risks related to; obesity, improper nutrition, sedentary activity, and the actions one can

take to prevent/change their current health status.

- By the end of the program, at least 75% of students will know that the Center for Disease

Control and Prevention (CDC) recommends at least 60 mins or more of moderate to

vigorous intensity physical activity daily.

- By the end of the program, at least 75% of students will know that The U.S. Department

of Agriculture (USDA) recommends minimum daily intake of 1.5 cups of fruit and 2.5

cups of vegetables for females(14–18yrs) and 2 cups of fruit and 3 cups of vegetables for

males(14–18yrs).

- By the end of the program, at least 75% of students will know that U.S. National

Academies of Sciences, Engineering, and Medicine recommend 8 glasses of water a day.

Motivate: Our second overarching goal is to inspire students to limit the unhealthy/fast food

consumption among students and inactive lifestyles. We want to provide healthy alternatives and

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opportunities to be active that don’t require adult supervision and/or financial requirements.

After the program students will have the information to be able to resist their own curiosity and

peer pressure to stay on electronics for hours on end and continuously consume unhealthy foods.

- During the program, 100% of students will practice socially acceptable refusal skills.

- Throughout the duration of the program, 100% of students will have access to facilities

afterschool to maintain a physical lifestyle for at least 1 hour.

Support: The final overarching goal is to promote a positive and supportive environment for

students to learn. This will provide them confidence in themselves and their knowledge/skills to

be able to make behavior changes towards healthier living if they choose to.

- During the program 100% of students will self reflect on their own mental health(weak,

average, strong) and identify their own positive qualities(3).

Strategic Approach

Students in class will have journal entries once a week on; self reflections, goal setting activities.

Each week there will be a different message to get across. They will have to submit that to their

health teacher for credit, but it’s not to be shared with the class which allows for vulnerability

and honest responses. These strategies were utilized from a mindfulness article shedding light on

the importance of mental health interventions to address the adolescent obesity epidemic(Keck,

2021). Students will practice these skills during discussion and role play activities in the

classroom. Students will be exposed to ways to be active that don’t require parent supervision

nor a payment fee. Afterschool activities will be offered in the building with adult facilitation.

For example; weight room access in building, open gym sessions and tournament gameplay

through a variety of activities as demonstrated in the ‘Move More, Get More’ initiative(Grimes,

2022). Students will acquire this knowledge in class first and will have to complete a checklist

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daily to remind them of the goals set by qualified professionals. One case study suggested that

sending messages of healthy habits to adolescents can hold students accountable inside and

outside the classroom (Lindsay 2017).

Core Message

This Battle Against Obesity campaign was created to provide easy access to health

information and healthcare resources for all students in the Pine Bush School District.

Technology has added to the sedentary lifestyle among Americans, and more specifically our

younger generation. Instead of being active outside, children and adolescents stay indoors

inactive while overeating. Through a variety of platforms and activities over the entire course of

the health education class the goal is to promote, inform, and inspire the Pine Bush

students/staff/community about the need to combat obesity rates among the youth and promote

responsible choices in an effort to create a healthier world. The slogan created for our campaign

is “Best health saves you from obesity life”. Our call to action if for all health professionals,

community members, students friends and families come together to combat the adolescent

obesity epidemic. Now that we have the objectives and strategies to make this campaign

successful it’s time to discuss the effective platform to share the message for the younger

generation.

(4) Channels and Tools

Being that our target group is specifically middle school/high school students, we may

want to utilize social media and more up to date technology. If children are spending more than 6

hours per day on social media we should try to incorporate these advances rather than shutting

them out completely (Sanyaolu, 2019). The campaign plans to create a free app that students will

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download on their electronic devices being that 88% of adolescents(12-17yrs old) own a

smartphone and 100% have a social media account. There will be links to resources backing the

recommendations that they suggest. There will be information regarding the health risks of being

obese (short term and long term). This app would contain a checklist to ensure that each

participant is held accountable to reach their goals. The checklist will have (a) Complete at least

1 hour of physical activity, (b) Drink 8 glasses of water, (c) Consume 2 cups of fruits and

vegetables. It will track how many days you complete each goal consecutively and by the end of

the course whoever has the most days will win! Extrinsic motivation will be used through the

health education class mandate to download the app and try to make these minor changes in

behavior at first. By continuing these behaviors for a longer period of time we will hope students

transition from the “need to” complete the tasks into “want to”. As a result the students in turn

become intrinsically motivated to continue the healthier habits outside of class and in their future

(Hofeditz, 2017).

Why Obesity?

The Battle against Obesity campaign is meant to strengthen children’s knowledge and

skills so that they have the tools to be able to take action in their life. We will do this by building

students awareness, enhancing their self esteems, and providing alternatives to turn to when

temped to remain inactive and continue unhealthy eating habit. By mandating this in health

education curriculums it’s forcing students to learn and attempt to apply the behavior changes in

their own way. Eventually the hope is for students to bring home their findings to educate,

motivate and support people at home and in the community to take action as well. We purposely

based the recommendations off credible and reliable sources that provided up to date research for

success in the target group(CDC, USDA, and U.S. National Academies of Sciences,

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Engineering, and Medicine). We also utilized ideas from other Obesity prevention programs

previously used to make our intervention the best it can be. Technology is an undeniable

resource that needs to be implemented when trying to create change among the adolescent

population which is why we chose to make a free app (Chung, 2021). The main focus for the

youth is first to understand are the health effects related to obesity. Socially, middle school and

high school are huge transitional phases in any persons’ life. At this point in a person’s life a lot

of decisions that are made guide them to the path they will take in the future. A majority of

children spend their time in school. Teachers, administrators, staff all impact the lives of these

children whether they realize it or not. School systems have a huge platform to educate students

on knowledge, skills and resources to live a healthy lifestyle. As a current educator the best

approach was to start the campaign in the classroom to promote that “Best health saves you from

obesity life”. In due time adolescents will be able to advocate for change in their generation the

best way possible in the Battle Against Obesity.

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