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Sustainability and Childhood Obesity
Lucia A. Reisch
Copenhagen Business School
Department of Intercultural Communication and Management
email: [email protected]
Wencke Gwozdz
Copenhagen Business School
Department of Intercultural Communication and Management
email: [email protected]
Suzanne C. Beckmann
Copenhagen Business School
Department of Marketing
email: [email protected]
Abstract
Overweight and obesity, especially in children, has increased alarmingly in the past decades
with dramatic economic, social and individual consequences. Many countries have developed
action plans, yet a concerted action of all involved stakeholders is only in its beginning. In
this paper we outline the consequences of obesity in the context of the sustainability concept,
then explain the main influencing factors, and finally describe the roles of the central
stakeholders in order to sketch a model of concerted action fighting (childhood) obesity.
Keywords: diet; obesity; sustainability; physical activity; nutrition; climate
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Sustainability and Childhood Obesity
The pandemic of overweight and obesity
Obesity has been pushed into the centre of attention for the public because of its soaring rates
worldwide and its serious social and economic consequences. Increasingly, curtailing and
preventing obesity already in childhood has become recognized as a goal of a sustainable
society. Recently, many countries such as Germany (Bundesregierung, 2002), Ireland
(Comhar, 2007) and Switzerland (Swiss Federal Council, 2008) as well as the EU (European
Commission 2006a) have integrated levels of obesity as one measurable indicator in their
respective sustainability strategies with a focus on young consumers. To date, most European
countries, the US (U.S. Department of Health and Human Services, 2000), Canada (Human
Resources and Social Development Canada, 2002) and Australia (National Obesity Taskforce,
2003) have implemented national action plans to fight the rise of obesity (WHO, 2008).
Basically, obesity evolves whenever the calorie intake exceeds calorie consumption over a
longer period. This long-term energy imbalance is determined by characteristics of the
lifestyle, food intake and level of physical activity – all three are, in principle, within the
responsibility of the individual. Yet, unsustainable lifestyles become an issue for politics
when the external effects of private consumption are reflected in social costs and/or when the
life chances of future generations are at stake. The alarming trends in obesity create a need for
immediate action – especially with regard to children: more than 30 percent of all European
children are overweight or obese (European Commission, 2007) and numbers in the US and
Canada are even higher. Since obese children are more likely to become obese adults (Procter,
2007), it is high time to think about effective strategies to fight the obesity epidemic. Health
and consumer policy-makers have together started to employ the whole arsenal of instruments
(information, education, incentives, regulation, creation of supportive environments) to go
about resolving this problem. As yet, however, no downward trend in obesity is discernable.
What has become clear is that the prevention of obesity needs the concerted action of all
actors involved including children and parents as consumers, the food industry, retailers, the
media and marketers.
The purpose of this paper is twofold: first, to conceptually develop the relationships between
obesity and the four dimensions of sustainability (social, cultural, economic, and ecological)
against the backcloth of both macro-marketing literature and empirical obesity research; and
secondly, to outline and evaluate the options of different market and governmental actors to
curb childhood obesity. Implications for macro-marketing are also presented.
The four dimensions of sustainability
According to the 1998 Human Development Report (UNDP, 1998), consumption that
enhances human development must be shared (ensuring basic needs for all); strengthening
(improving human capabilities and enriching the lives of people, encouraging lively, creative
individuals and communities); socially responsible (not compromising the well-being of
others); and sustainable (not mortgaging the choices of future generations). The ongoing
obesity pandemic meets none of these criteria. Rather, it seriously affects the social, cultural
and economic sustainability of societies (Reisch, 2003).
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Social sustainability is jeopardized as social cohesion, equity and fairness erode due to the
consequences of obesity. In general, overweight and obese individuals are associated with
deteriorating health, reduced mobility, poorer employment opportunities, premature mortality
and higher living expenses resulting in an overall poorer quality of life (Government Office
for Science, 2007, Harper, 2000, Morris, 2006). Not only may obesity cause social and
financial disadvantages, there is also scientific evidence that low socio-economic status
families are more likely to be obese than any other social group (McLaren, 2007). This has
been explained by poor access to and higher prices for healthy food as well as by fewer
opportunities for physical activity (Robertson; Lobstein & Knai, 2007). Scientific evidence
backs up both causalities resulting in a vicious circle: belonging to lower socio-economic
status families increases the probability of becoming overweight or obese while being obese
decreases chances to generate well-being. Decreasing incomes – as caused by the current
worldwide financial and economic crisis – amplify unhealthy lifestyles especially at the
bottom end of the social scale.
Cultural sustainability depicts the diversity and adaptability of local cultures which are
conducive to both stability and balance (Reisch, 2005). This also applies to food cultures
which are a result of food consumption that in turn responds to biological and cultural stimuli
such as hunger or advertisements respectively. With the rise of the “McDonaldization” of
consumption, fast food and ready meals together with a high protein and meat diet, have
started to dominate food cultures worldwide (Wilk, 2006). These have been found to increase
the risk of overweight and obesity (Robinson, Bloom & Lurie, 2005). Moreover, in the public
sphere, food has become abundant and available everywhere and any time which eases
uncontrolled access and disturbs cultural meal structures and rhythms. This ubiquitousness
and omnitemporality of food has changed and homogenized national food cultures (Reisch,
2001). One indirect consequence of these changes in food culture is an anticipated decline in
life expectancy (Olshansky et al., 2005).
Economic sustainability means to maintain or increase current standards of living without
decreasing the standard of living of others and especially that of future generations. The
economic consequences of obesity are severe not only with regard to healthcare systems but
also to labour markets. National health systems – chronically underfunded anyway – bear the
burden of obesity’s many co-morbidities such as type 2 diabetes, cardio-vascular diseases and
hypertension. Moreover, statistics have shown that obese individuals have lower employment
rates due to their health status or due to other reasons such as workplace discrimination: the
productivity of obese people is assumed to be lower because of more sick days or premature
mortality (McCormick & Stone, 2007). Another aspect of economic unsustainability are
agricultural subsidy patterns that boost unhealthy foods, for instance sugar, into markets and
therefore might contribute to the rise of obesity.
Ecological sustainability is indirectly affected, since the above mentioned problems and
challenges of social, cultural and economic sustainability related to obesity bring about
impacts on the environmental dimension. The ecologically unsustainable way of producing
food to satisfy the demands of the fast food culture is one example, the value chain from raw
material to pre-processed food another.
The main influencing factors
The issue of obesity is very complex: many interdependencies between the various
stakeholders emerge and serve to complicate the identification of single causes. We focus
here on five different interrelated levels (based on Witkowski, 2007).
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Individual behaviour: As behavioural economists have pointed out, the rational consumer
that neoclassical economics portrays is seldom observed. Consumers are often aware of acting
against their own interests. This is certainly true when it comes to overweight and obesity
despite widespread knowledge about how – and why – to live healthily (Prendergrast et al.,
2008). For example, individuals’ long-term energy imbalance is neither rational nor
sustainable in the long run, but they are a matter of fact despite increased education and
knowledge of consumers. One explanation is the inconsistency between long-term (inherent)
and short-term (constructive) preferences of individuals (Scharff, 2008).
Parents as gatekeepers: As far as children are concerned, the major responsibility for obesity
lies with their parents and families as well as with secondary socialization agents such as
caretakers and teachers. All mentioned agents act as gatekeepers. This means that they have,
at least to some degree, the power to control the impact that media, retailers, food industry,
restaurants and food marketers exercise on children’s food preferences and physical activities.
Parents influence children’s health behaviour both directly and indirectly. Children of
overweight parents are more likely to be overweight themselves (Maffeis, 2000). While this
can partly be explained by genetics, it is also due to parents’ food and health regime, their
own behaviour and the values and knowledge they convey to their children concerning food
consumption. The style and contents of parental health communication depend heavily on the
parental style, on how parents act as role models and, additionally on the children’s stage of
socialization (Roedder John, 1999). Moreover, families and their environments can be rather
obesogenic or rather non-obesogenic reflecting the number of stimuli – such as facilities for
physical activities like bike lanes or playgrounds or faculties for (un)healthy food intake like
the density of fast food restaurants – that increase the risk of obesity (Lobstein et al., 2004).
However, there are limits to the extent of parents’ capability to act as gatekeepers because of
the influence of peers, food marketing practices, and existing social norms and installed
practices – such as using candies to reward children – that are seldom challenged and difficult
to circumnavigate once they are installed (Thaler & Sunstein, 2008).
Children’s purchasing power: Children today possess an increased purchasing power and
spending autonomy, which has a number of implications. Witkowski (2007) states increased
dietary intake as one consequence. Children’s purchasing power makes them very attractive
customers for the food and beverage industry leading to newly developed, specifically
targeted products that are systematically advertised. This also leads to a higher conflict
potential between children and parents in purchasing situations. Attempting to get these
advertised and thus, very attractive products, children often make use of the so-called “pester
power” which is defined as a “child’s attempt to exert control over a purchase situation as a
simple battle of wills” (Nicholls & Cullen, 2004, p.80). Pester power is not mitigated by the
industry and retailers as they have long ago recognized the potential of young consumers and
consequently invested in targeted development of products and their marketization. Some
studies even suggest that nagging is one the most successful techniques to influence parental
consumption that children apply (Gunter & Furnham, 1998).
Modern food environment: The food industry, retailers and restaurants are considered as
important factors leading to childhood obesity. They shape the context in which food choice
takes place. Behavioural economics has shown that the influence of the immediate context
(e.g., in-store marketing, product offers, built environment) has a decisive impact on
consumers’ decisions, that access and availability of healthy alternatives are crucial and that
many preferences are “constructed” right at the point of sale (“constructive preferences”)
(Thaler & Sunstein, 2008). Highly processed and prepared foods as well as the increase of
package and portion sizes over the past 20 years have made it more difficult to discover
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hidden energy (Diliberti et al., 2004). For many years, it has been debated whether consumers
actually use the nutritional information provided on the package at all and if yes, which of the
competing systems is the best. For instance, information about included fat seems to make
consumers choose lower fat alternatives (Roefs & Jansen, 2004). Latest research has shown
that consumers do indeed use provided health related on-pack product information – such as
General Daily Allowances (GDAs) or the traffic light system – but only if it is easy to
understand and eye-catching (Grunert & Wills, 2007).
Modern food marketing: The food industry has increased the number of channels used to
advertise their products to children. While television is still an attractive medium for small
children and advertisements are a successful strategy for brand building (Dammler &
Middelmann-Motz, 2002), internet games, in-school marketing and sponsoring, as well as
toys and games produced in association with food producers are increasingly used (Hastings
et al., 2003; Story & French, 2004). To increase consumption, marketers create positive
attitudes for their products and try to channel social norms of parents and children – i.e., for
instance shared beliefs about health behaviour – by strengthening already existing behavioural
patterns and convincing consumers of the product’s benefits (Grier et al., 2007). Experiments
suggest that food branding changes children’s preferences in favour of the branded food
(Robinson et al., 2007). This is problematic since the majority of advertised foods are snacks,
soft drinks and sweets that are high in fat, sugar, and/or salt (Hastings et al., 2003). In the US,
children aged two to eleven years watch about 5,500 food ads per year (Holt et al., 2007).
There is empirical evidence that the exposure to TV food advertisements leads to unhealthier
food choices (Taveras et al., 2006) and that overweight and obese children have higher recall
rates and intakes of advertised food products than normal weight children (Halford et al.,
2008).
Macro-marketing and policy implications
The factors presented above are valuable starting points to change young consumers’
behaviour into a socially and individually more sustainable direction. While the goal to reduce
obesity is broadly accepted, the motives, strategies, possibilities and dependencies of the
various actors in the food chain and in food and health politics differ. In the following we
argue that policy actions are necessary, but that they can only be effective if all stakeholders
support these policies with the means in their reach.
Parents as stakeholders: The European Commission (2007) notes that parents having the
main responsibility for their children should be able to make informed choices and transfer
their knowledge to their offspring. Hence, consumer policy should in the first place inform,
educate, empower, support and engage consumers in general and consumers in their role as
parents responsible for their children’s health in specific. There are three main strategic goals:
raise awareness of the risks of obesity, reduce energy intake and increase energy output
(Witkowski, 2007). Strengthening consumer organizations and listening to them in a constant
dialogue on the consumer interest is another relevant tool (Viswanathan & Gau, 2005).
Sometimes, it might be worth to actively steer consumption subtly – “to nudge” (Sunstein &
Thaler, 2008) - into healthier choices by shaping the consumption context, i.e., access and
defaults settings. Examples are guidelines or regulations on vending machines in schools,
smart defaults in canteens and a ban on food advertising in children’s programmes.
Food industry and retailers as stakeholders: A voluntary contribution of the food industry
could consist of shifting focus from short-term goals to an investment in long-term programs
(Layton & Grossbart, 2006) to alleviate children’s as well as parents’ consumption process of
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making healthier and more sustainable choices. The national action plans as well as food
based dietary guidelines – even if being constantly questioned and adapted – are a sound basis
for nutritional values and activities. These can be used to inform consumers in an easy and
understandable way via food labelling. Assisting the decision process of consumers, there is a
need for easy and low cost access to healthy food such as vegetables and fruits by improving
the availability by food producers as well the in store promotion by retailers (Government
Office for Science, 2007). Additionally, processed foods should be reformulated by
modifying levels of fat, sugar, or salt. Recent trends and developments of products such as
diet sodas or reduced-calorie foods illustrate the way the industry is trying to meet consumer
needs, financial targets and achieve positive, healthy product images.
Marketers and advertisers: Without any doubt, advertisements have effects on children’s
food preferences (Hastings et al., 2003) and exacerbate parents’ role as gatekeepers through
tailored appealing promotion strategies to children. Marketers are already subject to policy
regulations on national levels, but within these boundaries, they become very innovative in
discovering new channels and methods. There are attempts to force the industry to act
accordingly by regulations, but evidence of success is weak (Lang & Rayner, 2007).
Furthermore, a ban of unhealthy food advertisements would have unknown consequences
especially with regard to where the banned advertisements would go and what the
replacement for it would be (Desrochers & Holt, 2007). Thus, policy-makers seek to establish
best practices to curb food advertisements targeted at children. For instance, the European
Commission implemented a round table for this purpose where not only the policy-makers
were present, but also representatives from the European Advertising Standards Alliance and
interested NGOs (European Commission 2006b). In the US, the Council of Better Business
and the National Advertising Review Council implemented self regulated limits to unhealthy
advertisements (Desrochers & Holt, 2007). In Denmark, a voluntary code of responsible food
marketing communication to children has recently been implemented (Forum of Responsible
Food Marketing Communication, 2008).
Conclusion
To conclude, (childhood) obesity is an important issue with regard to all four dimensions of
sustainability. Healthier lifestyles that are achieved through both healthy diets and physical
activity have considerable impact on improving social sustainability (e.g., by breaking the
vicious circle of low socio-economic status and obesity), cultural sustainability (e.g., by
rediscovering traditional recipes that usually contain very little pre-processed food), economic
sustainability (e.g., by reducing health care system costs), and ecological sustainability (e.g.,
by producing healthy food in an organic way).
Hence, there are several opportunities to overcome the obesity epidemic, although it will
certainly not be easy unless all relevant stakeholders work together towards a common goal.
In any case it should be remembered that one very important driver – according to empirical
evidence from behavioural economics and the psychology of consumer behaviour - is
“Making the healthy choice the simple choice” in order to promote healthy nutrition,
especially when it comes to children.
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