Maybe we need shock tactics to tackle obesity
Letter from Preeti Mahankali-Rao, fourth year medical student at the University of Exeter
Readers may remember a Department of Health advert depicting an ordinary British man smoking cigarettes, while a tumour relentlessly grew from the paper. Or perhaps the image of a smoke-covered hand strangling a young child was more evocative. Regardless, such campaigns advocating smoking cessation have had inherent similarities: the content has been straightforward, the narrator’s voice sincere, the statistics sobering.
My question is why the same approach has not been used with obesity? Gentle coercion has been ineffective in tackling obesity, and with rising obesity rates this will only become a more pressing problem. A solution to this is mass-media fear factor campaigns. This method has proven efficacy; a recent randomised controlled trial showed that campaigns eliciting both fear and disgust had the greatest utility in stopping smoking. However, a shortcoming of such tactics is that they can be ineffective once the initial shock has worn off; a prolonged campaign is therefore necessary in eliciting the required paradigm shift in thinking.
Gentle coercion has been ineffective in tackling obesity
The cost efficacy of such a campaign merits discussion. Obesity is of increasing economic burden, with significant cost to both the NHS and wider economy. This is particularly pertinent given that the NHS remains in deficit for the fifth year running, an unsurprising finding for many readers. To this end, mass-media campaigns have demonstrable efficacy: NICE recently concluded that interventions aimed at a whole population, such as those to stop smoking, were the most cost-effective campaign format. From a practical perspective, more people will be affected with a hard-hitting mass media campaign than will be using one-to-one consulting room persuasion. Indeed, media campaigns have the potential to reach those who may never visit the GP conventionally.
To implement such campaigns, perhaps it is time we looked over the pond for inspiration. An American campaign recently demonstrated the clinical sequelae of obesity, using flashbacks to examine the dietary choices that led to a 32-year-old obese patient having a cardiac arrest. To this end, shock campaigns are effective: being told that obesity will lead to type 2 diabetes or coronary artery disease is simply not tangible for most patients. Seeing the effects of obesity in such a relatable manner is far more powerful, evidenced by the controversy and debate that this campaign drew.
Furthermore, the time for such a campaign is now. Smoking has been attributable to lung cancer since the 1950s, following pivotal research by Richard Doll. The link between obesity and the aforementioned chronic diseases, which increase both morbidity and mortality, has been a much newer finding. However, there was a notable lag time between evidence of the link between smoking and lung cancer, and subsequent NHS-led action to stop smoking. It is imperative that we learn from this lag time, and do not let this happen in the same way with obesity and chronic disease. It's certainly food for thought.