Promises: Educating to Change Behaviour

The theme of reversing obesity with education has also been developed by the New Zealand Food Industry Group (FIG), which was established in 2004 to represent food manufacturers and retailers, and the marketing and media industries that work with them. The FIG argue that obesity is a complex multifaceted issue (FIG, 2006b), that food marketing has little direct influence on behaviour (FIG, 2006c), and that individuals are responsible for managing their own diet and weight (FIG, 2006d). To support

consumers as they assume this responsibility, FIG members have offered to provide education and information programmes that will inform consumers’ dietary choices and thus reduce the burden of obesity (FIG, 2005; 2006b; Irwin, 2005b).

Education interventions seek to impart new knowledge, but lacks the explicit exchange that is central to a marketing transaction: “…education refers to messages of any type that attempt to inform and/or persuade a target to behave voluntarily in a particular manner but do not provide, on their own, direct and/or immediate reward or

punishment…” (Rothschild, 1999, p. 25). The logic underpinning education strategies is that consumers are self-interested, and will use new information in a rational manner to inform their decision making to attain the best outcomes for themselves and their families over the long term (Lynch & Wood, 2006). Policies designed to provide consumers with access to better information are a common type of education intervention, and Helweg-Larsen and Collins (1997) summarise the reasons why education is a popular intervention:

There are a number of philosophical and practical reasons for using

information-based approaches to changing health-related behavior. The idea that people will change their behavior when they are informed about the logic of doing so is consistent with the Western worldview, which places individualism, enlightenment, and reason at the center of its value system. Knowledge-based behavior change is, in theory, internalized. Thus, the new behaviors will last longer, display a greater resistance to extinction, and generalize across more situations than will new behaviours arising from other

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forms of social influences (e.g., reward, coercion, and compliance with authority figures) (p. 23).

Education programmes are arguably the easiest form of intervention to introduce and least likely to be met with resistance from key stakeholders or the general public, therefore the development of these is likely to continue (Seiders & Petty, 2004). However, education is viewed as a weak and superficial public health intervention (Rose, 1992), as it does not manipulate the consequences of various actions and often achieves disappointing results. For example, a review of government sponsored nutrition education in the United States concluded that it had no tangible effect on the eating behaviour of children, even though attitudes towards fruit and vegetable consumption improved (Mendoza, 2007).

Two high-profile diet and health-related education programmes related have existed in New Zealand for several years – ‘5+ a day’ and ‘Push Play’ – and these provide further evidence for the weak efficacy of education campaigns. The 5+ a day programme, launched in 1994, aims to promote consumption of at least two servings of fruit and three servings of vegetables every day. Push Play encourages New Zealanders to do a minimum of 30 minutes moderate activity most days. The messages in both campaigns are promoted through integrated advertising, an annual month long campaign, and online.

Both programmes have arguably had limited success in changing people’s behaviour even though cognitive measures such as attitudes, beliefs, and intentions have shown marked improvements. Knowledge of the 5+ a day message is very high (Ashfield- Watt, Stewart, & Scheffer, 2004), but even self-reported fruit and vegetable consumption (which is likely to be inflated by social desirability bias) suggests the proportion of people whose behaviour fits the recommended pattern is much lower (Mann, Parnell, Wilson, & Scragg, 2004). Similarly, between 1999 and 2002, knowledge of the Push Play exercise message doubled, recognition of the logo trebled, and the number of people stating an intention to become more active increased from 1.8 to 9.4 percent. However, there was no sustained increased in physical activity among New Zealand adults during this period (Bauman et al., 2003; see also McClean & Teague, 2004). So while consumers’ knowledge of the recommended behaviour increased for both

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campaigns and led to greater intentions to adopt recommended behaviours, this did not translate into actual behavioural change.

As outlined in §2.5.1, marketing initiatives deliver additional incentives to act in a timely manner, whereas education offers only a promise of potential future payback (often weakly stated), perhaps many years away. For example, educational messages in the 5+ a day campaign inform consumers that eating fresh produce may provide ‘health

benefits’ and ‘protect against aging’, which are unquantifiable and distant prospects that are unlikely to outweigh the immediate sensory gratification or costs associated with other food choices. Furthermore, education messages often encourage people to make voluntary sacrifices by forgoing the less healthy but immediately rewarding choices without substitution or perceptible gain (Rothschild, 1999). For example, consumers often believe that foods’ tastiness and healthiness are negatively correlated, and therefore perceive healthier choices as less appealing because they will not taste as nice as other options (Raghunathan, Walker Naylor, & Hoyer, 2006). Thus, choosing healthier foods may be associated with sacrificing immediate sensory satisfaction for a somewhat vague and distant reward of reduced disease risk.

However, researchers have found a positive correlation between health knowledge and the use of nutrition information and product health claims, which ostensibly suggests that education programmes may encourage consumers to scrutinise their purchase options more carefully (Szykman, Bloom, & Levy, 1997). The food and advertising industries cite lack of adequate nutritional education as a causal factor contributing to unhealthy diets and weight in New Zealand (FIG, 2006a), and therefore strongly support increased nutrition education and consumer-friendly point-of-purchase information. This stance is somewhat supported by a recent literature review, which indicates that New Zealand and Australian consumers do not use the Nutrition Information Panel (NIP, see Figure 7 in §4.2.1) to inform food purchasing decisions, as they find it confusing and difficult to interpret (Ni Mhurchu & Gorton, 2007).

The FIG (2005; 2006b) suggests that increased consumer education and enhanced access to nutrition and health information on the front of food packaging would assist people to improve their diets and manage their weight to prevent obesity (FIG, 2005). In both New Zealand and Australia, food industry representatives support the widespread adoption of a consistent front-of-pack nutritional labelling that communicates how

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products fit with recommendations for nutrient intake, the Percent Daily Intake (PDI) labelling scheme (AFGC & NZFGC, 2008; FIG, 2006b). However, stakeholders from public health and consumer groups have expressed concern that this format is too complex to serve as a useful educational tool.

As Petty, Barden and Wheeler (2002) note, many researchers have concluded that simply increasing knowledge is not enough to induce behaviour change. For example, an in- store nutrition education experiment by Jeffery, Pirie, Rosenthal, Gerber and Murray (1982) produced significant improvements in nutrition and diet-disease knowledge among consumers exposed to the intervention, but this was not reflected in their food purchase patterns. Rothschild (1999) discusses the effect that competition and choice variety have on consumers’ behaviour, which may explain why, when education improves knowledge, it does not necessarily result in healthier actions:

When competition is passive, education may be sufficient; as the competition of other behavioral options, or of apathy, intensifies, a more obvious

exchange will be needed, and marketing should be called on. As the power of the alternative behavior choice intensifies even more, marketing no longer will achieve the desired result, and the force of law will become appropriate (Rothschild, 1999, p. 33).

To assist policy managers contemplating which intervention to use, Rothschild (1999) integrated his framework with MacInnis, Moorman and Jaworski’s (1991) work and created a prescriptive grid that linked interventions to situations. The variables that mediate behavioural action and determine the likely success of the three types of intervention are discussed in the following section.