The media and obesity

The role of the media is regularly listed as one of the reasons for the increase of obesity in Western populations. This review analyses research examining how the media have dealt with obesity, the impact media can have on obesity levels and how this may change in the future. The review points to areas of influence and intervention and highlights areas where further examination of the relationship between the media and obesity is needed. Many moral panics of the last century laid blame squarely at the door of the media. In the new millennium, the most frequent accusation has been that the media and the proliferation of television channels and different formats are ‘causing’ obesity, particularly in children. Some key texts examining social policy and the media or health and the media in the UK do not mention obesity (1,2), which is an issue that has only become part of media discourse in last few years with UK media academics only recently beginning to address it. Medical researchers have been quicker to make this link and they carry out the bulk of the research. The first study demonstrating a link between obesity and media consumption was published in 1985 and concluded that the prevalence of obesity increased by 2% in 12–17-year-olds for each additional hour of television viewed (3). Since then, the media have been regarded as one of the key contributors to the global obesity epidemic (4). Research examining the media’s role in this epidemic generally identifies the following themes. Most research attempts to demonstrate a direct effect between media consumption and obesity/unhealthy food choices. For instance, the following are typical findings: ‘In the US, the incidence of obesity is lowest in children who view less than 1 hour per day of television and highest among children who watch 4 hours or more’ (5,6). Since Dietz and Gortmaker’s 1985 research (3), large-scale US studies remain inconclusive. Some find a strong relationship between media use and body weight, while others find a weak relationship or none at all. Hastings et al. published a systematic review of the links between food promotion and children for the Food Standards Agency and concluded there was no direct effect (7). However, ‘an effect’ did exist. Media use encourages a sedentary lifestyle (8–11). Research is becoming more sophisticated, as Marshall et al. conclude: ‘Relationships between sedentary behaviour and health are unlikely to be explained using single markers of inactivity, such as TV viewing or video/computer game use’ (12). However, few studies examine whether media use displaces time spent doing physical activities and, where research exists, only a weak relationship is found. Advertising is widely held to encourage unhealthy consumption. Most research in this area examines childhood consumption of advertisements, as food is the most frequently advertised product on children’s television. In a review of over 30 years of journal articles, Coon and Tucker concluded: ‘Children exposed to advertising choose advertised food products at significantly higher rates than do those not exposed’ (13). Ofcom’s 2004 research into TV advertisements found they have a ‘modest direct effect’ on children’s food choice (14). In addition, foods featured in television fiction are most often low-nutrient drinks (coffee, fizzy drinks, alcohol) and snacks (primarily sweets or salty snacks). Consumption of (often unhealthy) snacks is said to increase during media use. Again, most research in this area has examined children’s activity. ‘Greater TV use has been associated with higher intakes of energy, fat, sweet and salty snacks, and carbonated beverages and lower intakes of fruit and vegetables’ (13,15,16). But there are paradoxes. Images of and research into obese people in the media are contradictory. Obese people are absent or ostracized in fictional formats. Obese and overweight characters tend to be unattractive, unpopular and unsuccessful (17,18). While much research in the past has studied the potential effects on females of unrealistically thin images, obesity is the far more substantial problem in Western society. The reason behind this paradox is unclear and academics agree more research is required. Public education campaigns (interventions) that use the media can be effective. Most research, however, examines how such interventions can affect children (19). Research into adult interventions shows that those who participate in mass media health campaigns tend to be women from higher socioeconomic groups who are already engaging in better health practices (20). The key findings of work to date expose a number of shortcomings related to current research into the link between media and obesity. Most demonstrates little, if any, understanding of audience theories/media studies research. Medical professionals carry out the bulk of the research work examining the link between obesity and the media and most of this research uses a heavy effects model. Finlay and Faulkner provide a long overdue critique of the lack of attention to audience reception theories in this area (21). Fenton et al. were clear that research in this area is ‘uninformed by perspectives in media sociology’ (22). For over a century, audience theories have explored the relationship between the public and the media. Theories range from positing that audiences are passive (hypodermic needle theories, where the bulk of previous research linking media and obesity is located) to theories rooted in postmodernism, which argue audiences are active and construct their own meanings of the media they consume. In between lies the bulk of media consumption theory. As Kitzinger argues: Media audiences interpret what they hear and see in the context of what they already know and what they learn from other sources . . . They are often able to analyse and deconstruct dominant themes, drawing on personal experiences, political belief or a general critique of media or government sources (23). Most research looking at the link between obesity and the media is based on children. Kline argues this is because children ‘are regarded as more vulnerable to the effects of television advertising’ (5). Research into children’s consumption of media typically fails to acknowledge that children watch significant levels of adult programmes and, as Ofcom found, most of the television advertising seen by children is outside children’s airtime (14). Agras and Mascola’s 2005 review found parental overweight as the ‘most potent risk factor for childhood overweight’ (24) – which means that only considering how to avoid childhood obesity through children’s media is, at best, short-sighted. We also need to consider the impact of Ofcom’s recommendations to remove certain advertisements during children’s television programmes (14). As a result of this decision, adults will potentially see more advertisements for junk foods as advertisers redirect their advertising budgets. In 2003, advertisers for food, soft drinks and restaurant chains spent £522 million promoting their products on television (14). It is notable that, although the total amount of food advertising has increased, that for soft drinks and chain restaurants is already in decline and, indeed, has decreased by 15% since 1999 (14). Removing advertising from television might only displace it to other areas such as radio, magazines, supermarkets, billboards, direct-to-consumer and the Internet – all of which are more difficult to regulate than television. The process of migration of advertising to other media has in fact already begun, with television advertising experiencing a 22% fall since 1999. The paucity of analysis of obesity in the news can be attributed to the emphasis on children and media and obesity. In one of the few studies looking at news, Saguy and Almeling analysed longer (500+ words) articles related to medical publications/books. They found, unsurprisingly, that journalists ‘tended to exaggerate the risks of obesity by reporting disproportionately on the most alarmist scientific studies’ (25). They blamed both scientists and journalists for ‘jointly producing’ these patterns in news. A great deal of research into obesity only examines one medium: television. This raises a number of dilemmas. Are the effects of video games, computer games and computer usage different than that of television? What role do newspapers play in providing information on encouraging weight loss and exercise? For example, both tabloids and broadsheets offer sections on health, dieting, healthy eating and fitness. The Sun publishes the Fit Squad, and the Daily Mail Good Health section frequently offers exercise tips and offers quick and easy ways to ‘swap’ calories. Newspapers and television need the huge advertising income that comes with the diet industry. There is a large economic market within the media that depends on women wanting to lose weight, and so it is in the media’s interests to encourage women to lose weight. Young people are turning away from television. Ofcom’s own research shows children continue to consume media at high rates, but not television (14). Between December 2003 and December 2005, total TV reach fell by 2.9% for 16–24-year-olds (‘reach’ is defined as at least 15 min of consecutive TV viewing in a week). It is very noticeable that most research is US-based. This work fails to take account of the effect of having a public service broadcaster as a main broadcaster as is the case in Britain. In the USA, the multi-channel universe is more established and there are more channels compared with the UK. In addition, the newspaper and magazine market is very different. All of these factors highlight how different traditions in media consumption can influence how a social issue like obesity is presented and received. Instead of trying to ‘prove’ a direct effect between the media and obesity, research should utilize more sophisticated and informed media studies theories to examine the influence of the media. A ‘new media effects’ model, based on agenda-setting theories would provide a more realistic understanding of the role of the media in the obesity epidemic. Agenda-setting theory dates back 30 years, when it was claimed that the press ‘may not be successful much of the time in telling people what to think, but it is stunningly successful in telling its readers what to think about’. Kitzinger agrees that the amount of media attention ‘correlates with the degree of salience of these issues for the public … public concern and policy attention rises and falls in response to shifts in media coverage (rather than changes in the actual size of the problem in the real world)’ (26,27). The work of the Glasgow Media Group follows this theory and demonstrates that ‘the media can be a powerful influence on what audiences believe and what is thought to be legitimate or desirable’. There are some limitations to the potential influence of the media. The media can provide knowledge and access to this knowledge, but this might not change behaviour. There is evidence that the media can increase awareness (of health-related issues) but there is less evidence that the media can stimulate behaviour change. Miles et al. conclude that behaviour changes are more likely to occur when there are multiple elements to the campaign, such as broadcast messages and provisions at local level (20). To date, most efforts relating to obesity and the media have been put into regulating advertising during children’s television programmes. There is a danger in viewing the decision to limit ‘junk food’ advertising as a panacea: these efforts will most likely have limited effects on the overall population. Efforts to regulate all food advertising, not just that aimed at children, will have a more substantial impact. In numerous surveys, members of the public state that the media are their primary providers of science and medical information (28). This being the case, there is an opportunity for public education campaigns to have a significant impact on public knowledge/behaviour. The media can have an impact but any public education campaign requires two significant commitments (although, of course, their participation cannot be guaranteed). First, these campaigns need to be long-term (longer than 1 or 2 months). Second, any campaign needs to be part of a wider campaign that includes other factors that encourage weight loss or exercise (for example, discounts at gyms, competitions). Relying only on the media does not have a long-term substantial impact. Public education campaigns to promote healthy eating might be successful, although those that encourage more exercise might be more problematic. Perhaps there is an element of naivety here, for in encouraging more exercise, the media will be encouraging their audiences to do something else besides consume their product. It is not in the interests of media companies to get their audiences to do something else and stop watching, listening, reading and so on. Any public education campaign that attempts to reduce time spent with the media needs to recognize that the media (even the BBC) will not help them do this! In addition to public education campaigns, there are opportunities to incorporate healthy eating into fictional television storylines. Research shows that the public are influenced by fictional representations (29–31). Davin’s research found audiences more likely to turn to soaps and series like ER for information rather than documentaries or more factual programming (30). There is scope for further research into adult factual and fictional programme relevant to obesity such as Fat Friends (ITV), Jamie’s School Dinners (Channel 4), You Are What You Eat (Channel 4), Honey, We’re Killing the Kids (BBC3) and Fighting Fat Fighting Fit (BBC). Overall, there are opportunities for more sophisticated long-term audience research that goes beyond looking only at children or advertising. In general, research into the relationship between adults and the media and obesity is essential to understanding the entire cycle of obesity. Useful research can analyse content in news, factual programming and fictional coverage, in newspapers and magazines and on the Internet, and how audiences use this information. Perhaps part of the problem in looking for something to blame is the concept itself. Are the media to blame or are they responsible when audiences choose to watch their programmes, play their video games or use the Internet? Questions or statements that ask ‘how much can the media be blamed?’ are too simplistic. More specific questions such as what factors influence the acceptance or rejection of a specific message need to be asked. Why do some media messages mobilize public action and others do not? Is what people bring to their understanding of stories more relevant than media coverage? Perhaps it is even relevant to question whether policymakers are simply responding to exaggerated media headlines and diverting resources from other killer diseases that are more expensive to diagnose and treat. The opportunities to explore these questions will help us understand the link between obesity and the media. No conflict of interest was declared.