Mass media advertising, particularly commercials promoting healthy weight and lifestyles, is a widely used strategy for preventing non-communicable diseases. However, concerns have emerged regarding the potential for these advertisements to be stigmatizing and contribute to negative outcomes. This article explores the effectiveness of weight loss commercials, considering both their potential benefits and drawbacks.
The Role of Weight Loss Commercials in Public Health
Overweight and obesity are significant risk factors for various non-communicable diseases, including type 2 diabetes, cardiovascular disease, and certain cancers. Addressing lifestyle determinants, such as poor diet and physical inactivity, is a global public health priority. Healthy weight and lifestyle advertisements (ads) are a potential means of targeting these determinants at the individual level, forming an essential part of prevention efforts.
Globally, 52% of adults are overweight or obese, a figure that has tripled in the last three decades. A comprehensive approach to prevention, directing efforts to all levels (individual, community, public policy), is needed. Healthy weight and lifestyle ads have been highlighted as a potential means of targeting the lifestyle determinants of overweight and obesity at the individual level and constitute an important part of prevention efforts.
Potential Negative Impacts: Weight Stigma and Psychological Effects
Despite their potential benefits, healthy weight and lifestyle ads may promote weight stigma and lead to negative outcomes. Weight stigma is associated with less acceptance of overweight, decreased motivation to maintain a healthy diet and exercise, reduced self-efficacy for healthy behavior changes, and engagement in weight gain mechanisms.
Given the potential risk of promoting weight stigma, ads targeting weight and lifestyle behaviors require thorough evaluation. Research assessing such ads on their potential to result in weight stigma and other negative outcomes is limited. Separate studies found that image stills and message slogans from a healthy weight ad were rated as highly stigmatizing and negatively impacted health behavior intentions and self-efficacy. In one study, ads that explicitly referenced obesity reduced self-efficacy and increased weight-stigmatizing attitudes.
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Examining the Nuances of Advertising: Message Content and Execution Style
Ads can differ in both message content (what is communicated) and execution style (how it is communicated). Research assessing the characteristics of healthy weight and lifestyle ads that are likely to be most effective but least stigmatizing is limited. One study found that graphic ads featuring messages relating to the negative health consequences of overweight and obesity are considered by adults to be more effective than ads using other messages (e.g., support and encouragement) and styles (e.g., animations). By contrast, other studies have found that ads featuring hopeful and empowering messages induce the highest intention to comply with the health message being communicated and are considered most motivating and favorable.
It's also important to note that those who consider themselves to have overweight or obesity may respond to weight- and health-related content differently than those who consider themselves to be a healthy weight.
A Study on the Cognitive, Psychological, and Behavioral Outcomes of Weight Loss Ads
A study was conducted to compare healthy weight and lifestyle video ads differing in message content and execution style to a control ad and to each other on a variety of cognitive, psychological, and behavioral intention outcomes. The study also aimed to assess whether weight status or self-perceived weight moderated the relationship between exposure to a healthy weight and lifestyle ad and (i) perceptions of stigma, (ii) psychological outcomes, and (iii) behavioral intentions.
The study involved 1,098 adult residents of the United Kingdom (50% female, Mage = 35.21 years) who viewed one of four video advertisements: one control advertisement and three healthy weight and lifestyle advertisements that differed in message content (negative health impacts, support/encouragement, and social norms) and execution style (graphic, animation, and depicted scene).
Compared to those in the control condition, those exposed to a healthy weight and lifestyle advertisement reported significantly higher scores for (i) perceptions of weight stigma, (ii) negative emotions, and (iii) intentions to engage in adaptive lifestyle behaviors. There were no differences observed between conditions for maladaptive behavioral intentions, internalized weight bias, anti-fat attitudes, and body dissatisfaction. The advertisement featuring a supportive/encouraging message and animation style performed most favorably.
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Deceptive Advertising Practices in the Weight Loss Industry
Dishonest advertisers often make false promises to entice consumers to buy their weight loss products. These false claims include:
- Losing weight without dieting or exercising.
- Not having to watch what you eat to lose weight.
- Permanent weight loss through product use.
- Losing weight simply by taking a pill.
- Rapid weight loss within a short timeframe (e.g., 30 pounds in 30 days).
- Guaranteed effectiveness for everyone.
- Weight loss through patches or creams.
Any promise of miraculous weight loss is untrue. There is no magic way to lose weight without a sensible diet and regular exercise. No product will let you eat all the food you want and still lose weight. Permanent weight loss requires permanent lifestyle changes, so don’t trust any product that promises once-and-for-all results.
Products promising lightning-fast weight loss are always a scam and can ruin your health. Even if a product could help some people lose weight in some situations, there’s no one-size-fits-all product guaranteed to work for everyone. Everyone’s habits and health concerns are unique. Nothing you can wear or apply to your skin will cause you to lose weight.
Recognizing Fake Stories Online
Scammers often create fake "news" reports about an ingredient found in a diet pill, claiming it is effective for weight loss. They may even add public photos of reporters to make you think the report is real. They also write glowing online reviews themselves or pay others to do it, or they just cut and paste positive comments from other fake sites. Scammers use images showing dramatic weight loss, but these images are just stock or altered photographs, not photos of people who actually used the product they want you to buy.
Other Products to Watch Out For
Electronic muscle stimulators may temporarily strengthen, tone, or firm a muscle, they haven’t been shown to help you lose weight. If you decide to join a gym, make sure you know what you’re agreeing to. Not all gym contracts are the same, so before you commit, read the contract and confirm that it includes everything the salesperson promised. Also find out if there’s a “cooling-off” or trial period, and check out the cancellation policy.
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Home exercise equipment can be a great way to shape up - but only if you use it regularly. Some exercise equipment ads promise you can shape up and lose weight quickly and without much effort. The truth is that to get the benefits of exercise, you have to do the work. If you decide to buy exercise equipment for your home, first check out online reviews to see what other customers’ experiences have been. And find out the real cost of the equipment.
"Free" trial offers are often not free at all. Many people who have signed up for “free” trials for weight loss products have wound up paying a lot of money and have been billed for recurring shipments they didn’t want. The FDA has found tainted weight loss products. In recent years, the FDA has discovered hundreds of dietary supplements that contain potentially harmful drugs or other chemicals not listed on the product label.
Weight Loss Content in Magazines: Articles vs. Advertisements
Magazines are a commonly used source for health and fitness information. A study evaluated the prevalence of articles and advertisements featuring weight loss content and products in mainstream US-based health and fitness magazines, as well as assessed weight loss themes presented.
Among the 31 issues of the five US-based women’s magazines examined, 39 articles (4.8%) related to weight loss were identified with 14 identified weight loss topics. The most prevalent article topics covered were exercising/workouts (32.0%) followed by dieting (18.6%). The most common product advertised was weight loss pills (46.0%).
Articles presented information about exercise and dieting, whereas advertisements supported potentially harmful health beliefs and behaviors. A number of studies have examined the effects of magazine readership on outcomes such as body image and disordered eating habits and suggest that triggers in editorial content and advertisements can adversely affect behavior and health. For instance, body types utilized in editorial content and advertisements have been shown to influence adult and adolescent females’ body image and eating habits.
One study found that women who were shown advertisements with thin models had more weight-related anxiety about their appearance and body dissatisfaction than those in the control group. Female participants in a separate study were assessed for their levels of exposure to magazines and television. While both media channels were associated with body dissatisfaction, only magazines were directly associated with the internalization of thin ideals.
Although the majority of the editorial content promoted healthy behaviors such as exercising to lose weight and reducing caloric intake, the motivations utilized to encourage these behaviors were appearance-based. A 2003 study found that advertisements including “before” and “after” pictures were associated with anti-fat bias and beliefs that weight is easily controllable.
Purchasing weight loss products can be driven by health-oriented motivators. There is substantial evidence that print magazines have a negative influence on body image and disordered eating behavior particularly in adolescent girls who are generally more at risk for eating disorders and youth and adults who are already exhibiting disordered eating cognition and behaviors.
The majority of topics in the articles addressed exercising, exercise plans and workouts (32%) followed by dieting/eating less/food choices (18.6%). Burning calories and eating nutritious foods/having balanced meals (8.7% and 8.5% respectively) accounted for a small fraction of the topics of the weight reduction articles. We identified 87 advertisements for weight loss products (4% of 2073 advertisements). Of those products advertised, general weight loss pills were found to be the most commonly promoted products (46%). Fat burners were also frequently advertised (14.9%) followed by hunger reduction strategies (10.3%) and fat blockers (6.9%). Obtaining a sense of achievement (25.2%) was the most commonly identified theme among the weight loss product advertisements. An emphasis on “before and after” weight loss (20.7%) was second most common.
Themes commonly noted in the advertisements for weight loss products appealed to appearance-based motivations that may have deleterious effects on women’s weight loss perceptions and behaviors. The results of this study are of particular concern considering that weight loss products account for the highest proportion of fraud claims to the FTC.
These magazines can be more proactive in promoting healthy weight loss themes presented in their articles’ content and by their advertisers. They can, for instance, be more selective about advertising products and strategies that focus on healthful eating and exercise behaviors that are supported by the scientific literature. In addition, advertised products and article themes should align with and promote weight loss goals that are obtainable and sustainable.
The Potential of Online Advertising for Health Promotion
Before online advertising, it was only possible to empirically test public health campaigns by randomizing small numbers of participants and to examine a few outcome measures. This makes it difficult to test to whom different forms of advertisement are best targeted.
Medical researchers use predictive analytics to mine databases of genetic information in order to target treatments to individuals who are more likely to respond to them. Similarly, private advertisers use predictive analytics to mine multiple sources of sociodemographic and behavioral data to better target individual consumers with the goal of changing their behavior.
Ethical concerns arise for a number of reasons. Online ads targeted using data analytics can influence emotions and behaviors. First, advertisers can make educated guesses or small-scale tests about who might respond most to a given advertisement based on common search terms by topic. Then, advertisement can be randomized to be shown to users of search engines that search for such terms.
Randomization can also provide causal information on how different sub-groups (e.g., young women) respond to an advertisement relative to others. Online advertisements have been shown to increase sales both for online display ads and in brick-and-mortar stores.
A Randomized Controlled Trial of Online Public Health Ads
A study conducted the first fully randomized online public health communication’s campaign which tracks not only click response to ads, but also the searches made prior to and post advertisement display. Professionals from J. Walter Thompson (JWT), a leading advertising firm in New York City, developed a series of online ads aimed at improving exercise and eating behaviors among search engine users (“users”) who are overweight. These ads were experimentally tested using a series of 10 RCTs, each for a different textual advertisement paired with unique click through content. The impact of the ads on changing health behaviors as measured by future health-promotion searches was explored.
The experiment ads were shown 265,279 times and clicked 1024 times. During the month of the RCT, a total of 505,693 non-exposed users made at least one query such as the ones which triggered a campaign ad in the treatment population. The majority of users were between the ages of 35 and 64, and females were more likely to see the ads than males.
Exposure to campaign ads significantly increases the likelihood of future target searches by 15%, especially in the absence of prior target searches. Stated differently, 48% of people who were exposed to the ads made future target searches, compared to 32% of the controls (a 50% increase).
Predictive Analytics and Targeted Advertising
A model was constructed to predict future target searches in the treatment population. Using only respondent characteristics (both behavioral and demographic) produced a model with an R2 of 0.414. When only previous query topics were added, the R2 was 0.410. When both were added, the R2 was 0.491.
Exposure to more than one ad increases the chance of a keyword search by 11%. Females were much less likely than males to perform a future search for keywords when exposed to an advertisement.
Implications for Public Health
People who view online health promotion advertisements are much more likely to perform searches related to health promotion than those who were assigned “status quo” advertisements. The experimental effect sizes were large, with 48% of those with exposure to the text messages (and in some cases, the landing pages) more likely to perform future health-related searches while only 32% of the matched control group performed such searches.
At the population level, searching for specific health behaviors is associated with performing these behaviors in the physical world. It is possible to alter the behavior of those with enough interest to conduct a search online, and show that it is possible to test such behavioral changes experimentally. With online advertisements, it is possible to systematically target users with advertisements to which they are most susceptible, thereby eliciting behavior change.
Our identification strategies can, in theory, be used to continuously refine, randomize, and test the targeting algorithms on different user types. The targeting algorithms can use the information to be “stepped up” until there is evidence that the user changes his or her behaviors.
Given that different audiences respond very differently to a given advertisement, it is important to consider the demographic characteristics of the viewers.
This also raises significant concerns for health departments and other agencies that could greatly benefit from access to the data underlying the health advertisements. To best understand how to target users and change their behavior, it would be useful for them to have access to identified data that could be linked across multiple sources of big data. Clearly, cooperation between ethicists, big data companies, governmental bodies, and academia has great potential to advance population health. It is technically possible to launch an online campaign that effectively improves health behaviors, and corporations that promote an unhealthy diet or a sedentary lifestyle can potentially be outbid or outmaneuvered.
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