reviewed journal (accepted August 4, 2011):
Whitehead, R., Ozakinci, G. Stephen, I. D. & Perrett, D. I. (2012). Appealing to vanity: Could potential appearance improvement motivate fruit and vegetable consumption?
3.1. Summary
The previous chapter found scope for improvement in contemporary dietary intervention strategies and indicated that the ability to sufficiently incentivise increased fruit and vegetable consumption is absent from typical population-level campaigns. This chapter identifies physical-appearance-based behavioural interventions as a potentially powerful paradigm in this respect. Recent attempts to use physical appearance as a motivational device will be reviewed, chiefly focusing on trials which attempt to modify behaviour and cognitions relating to sun exposure. This chapter will conclude that similar strategies targeting dietary behaviour may also be effective, as may largely untested interventions which illustrate positive, rather than negative ramifications of certain behaviours for outward appearance.
3.2. Appearance-Based Behavioural Interventions
Large cross-sectional studies reveal that men and women across age and socioeconomic groups pay close attention to their outward physical appearance (Harris & Carr, 2001). As such, appearance may be a universal motivator of individuals’ behaviour. Symptom-free individuals frequently value their appearance more than their health (S. J. Chung, Hoerr, Levine, & Coleman, 2006; J. L. Jones & Leary, 1994), this is particularly evident when considering sun-exposure behaviour. Many individuals actively seek ultraviolet (UV) light exposure to acquire a tan and improve personal appearance (Jorgensen, Wayman, Green, & Gelb, 2000; Robinson, Rademaker, Sylvester, & Cook, 1997), despite widespread knowledge that this behaviour is robustly associated with skin cancer risk (Armstrong & Kricker, 2001; Martin, 1995).
A novel intervention paradigm has recently attempted to motivate safer sun- exposure behaviour by highlighting that prolonged sun-exposure in fact has negative
consequences for long-term physical appearance (J. L. Jones & Leary, 1994; Mahler, Fitzpatrick, Parker, & Lapin, 1997). The Self-Regulation Model of Health Behavior
(Carver & Scheier, 1990), and similar evidence-based frameworks suggest that such an approach could be effective. The high value placed on own appearance may facilitate the development of a goal state, which people may strive towards using knowledge of the link between behaviour and appearance. Indeed, this approach has experienced success in motivating cognitive and behavioural changes relating to sun- exposure.
Jones and Leary (1994) pioneered this strategy by explaining to individuals in writing how outward appearance is harmed by excessive sun exposure. They found
that these messages about appearance motivated sun-protection intentions significantly more than did health-based messages (which emphasised the negative consequences of sunbathing for health). More recently, participants have been shown graphical illustrations of the negative consequences of UV light on facial appearance (Mahler, Kulik, Gibbons, Gerrard, & Harrell, 2003). This technique involves showing participants UV-filtered photographs which strikingly depict the epidermal hyperpigmentation which arises through excessive sun exposure. This approach has been successful in encouraging beneficial changes to sun-exposure intentions (Mahler, Kulik, Gerrard, & Gibbons, 2006) and is also sufficient to motivate lasting behavioural changes. Longitudinal studies indicate that safer sun-exposure behaviour is sustained for at least four months in a young adult sample (Mahler, Kulik, Gerrard, & Gibbons, 2007) and up to one year in a study of male highway workers (Stock et al., 2009). Critically, these appearance-based sun-exposure interventions illustrated the deleterious consequences of sunbathing on images of the participants’own face. This may further strengthen goal formation, and additionally increase the salience and perceived relevance of the intended health message.
A similar approach has also recently been used to target tobacco use. A number of studies have employed graphical simulations of the negative consequences of smoking on facial skin wrinkling and oral disfigurement, according to empirical measurement of these parameters (Hysert, Mirand, Giovino, Cummings, & Kuo, 2003). These illustrations have been successful in motivating adolescents to attend smoking cessation programs (Semer et al., 2005) and create lasting anti- smoking intentions (Grogan, Flett, Clark-Carter, Conner, et al., 2011; Grogan, Flett,
Clark-Carter, Gough, et al., 2011), though no investigations have verified non- smoking status using objective detection methods (such as salivary cotinine assays).
Interventions highlighting the negative impact of sun exposure and cigarette use on outward appearance may be particularly effective in reducing the prevalence of these behaviours as there is a common conception that these behaviours improve physical appearance and social image, respectively (Grogan, Fry, Gough, & Conner, 2009; Jorgensen et al., 2000; Robinson et al., 1997). These beliefs are likely to potentiate incidences of these actions, but by highlighting the deleterious
consequences of these behaviours for appearance, participants may be led to re- evaluate their performance of these behaviours. In this context, an alternate strategy involving illustration of links between healthy lifestyles and appearance benefits
could be effective in motivating the adoption of desirable behaviours. Dietary behaviour is strongly motivated by appearance (S. J. Chung et al., 2006; Hayes & Ross, 1987), hence an appearance-based intervention strategy could also be beneficial for motivating individuals to consume fruit and vegetables in line with recommendations, provided that there are demonstrable associations between healthy diet and desirable aspects of appearance.
An appearance-based intervention strategy is likely to be particularly effective in motivating behaviour change in adolescents, as a group particularly concerned about their appearance (S. J. Chung et al., 2006). Further, typical incentives to lead a healthy lifestyle focus on the consequences of behaviour for long-term health and overlook short-term incentives. This may motivate some, but behavioural economics and psychosocial research reveals that humans are particularly present-focused. Empirical evidence indicates that people prefer rewards
that are temporally proximal compared to those that are more distal, largely irrespective of relative value (Frederick, Loewenstein, & O'Donoghue, 2002). This suggests that existing population-level campaigns have not achieved necessary lifestyle improvements amongst young adults because health-based incentives are particularly distant rewards for these individuals. An appearance-based strategy is potentially capable of offering more immediate incentives, which may lead to the development of healthy lifestyle habits and a healthy lifestyle trajectory from an early age.
In addition to illustrations of outward appearance, the use of visual stimuli has recently been employed as an effective behaviour change tool more broadly. A Cochrane review found that illustrating the results of medical imaging (via techniques such as arterial scanning and computed tomography) to participants was an efficient way of motivating the adoption of relevant healthier behaviours in some situations (Hollands, Hankins, & Marteau, 2010). Further, the use of graphic warning labels on cigarette packets has been shown to increase the salience of dangers associated with tobacco use (McCool, Webb, Cameron, & Hoek, 2012; Ng, Roxburgh, Sanjay, & Eong, 2010).
As indicated by the recent success of this paradigm, the general use of images is a potentially powerful adjunct to behavioural intervention strategies. Image-based intervention messages are straight-forward to implement, may be particularly effective in communicating complex messages rapidly and as such, are likely to represent a valuable strategy for economically establishing healthy lifestyle habits.