Promoting physical activity and healthy eating: convergence in framing the role of industry

Are young adults' discussions of public health nutrition policies associated with common food industry discourses? A qualitative pilot study

OBJECTIVE

Unhealthy diets are a key risk factor for chronic disease, with young adults (18-30 years old) in high-income countries like Australia and the UK particularly at risk. Improved public health nutrition policies can help address unhealthy diets in the population, but many of the more regulatory policies are opposed by food industry groups. This research explores how young adults in Australia and the UK discuss a range of topical public health nutrition policies and analyses whether and how their views may be associated with food industry discourses.

METHODS

Eight focus groups were held in Sydney, Australia, and Glasgow, UK, with a total of thirty young adults participating. A deliberative-style method was used in the focus groups to generate discussion about six public health nutrition policies, such as taxation of sugar-sweetened beverages and restrictions on advertising of less-healthy foods. Discourse analysis was used to examine participants' discussions.

RESULTS

Twenty discourse codes were developed iteratively from the focus group data. These were thematically linked with nine food industry discourses found in the peer-reviewed literature, including industry self-regulation, personal responsibility, corporate social responsibility and challenging nutrition science.

CONCLUSIONS

These results demonstrate there is an association between common food industry discourses and some young adults' views about public health nutrition policies. Implications for public health: Identifying, engaging with and responding to common industry discourses is a priority in order to build greater public support and acceptability of policies that will improve diet and prevent chronic disease.

Framing global discourses on non-communicable diseases: a scoping review

Background

The choices that policymakers make are shaped by how their problems are framed. At last, non-communicable diseases (NCDs) have risen high on the global policy agenda, but there are many disputed issues. First, what are they? Their name refers not to what they are but what they are not. Second, where do their boundaries lie? What diseases are included? Third, should we view their causes as mainly biomedical, behavioural, or social, or a combination? Our failure to resolve these issues has been invoked as a reason for our limited progress in developing and implementing effective remedies. In this scoping review, we ask “What is known from the existing literature about how NCDs are framed in the global policy discourses?” We answer it by reviewing the frames employed in policy and academic discourses.

Methods

We searched nine electronic databases for articles published since inception to 31 May 2019. We also reviewed websites of eight international organisations to identify global NCDs policies. We extracted data and synthesised findings to identify key thematic frames.

Results

We included 36 articles and nine policy documents on global NCDs policies. We identified five discursive domains that have been used and where there are differing perspectives. These are: “Expanding the NCDs frame to include mental health and air pollution”; “NCDs and their determinants”; “A rights-based approach to NCDs”; “Approaches to achieving policy coherence in NCDs globally”; and “NCDs as part of Sustainable Socio-economic Development”. We further identified 12 frames within the five discursive domains.

Conclusions

This scoping review identifies issues that remain unresolved and points to a need for alignment of perspectives among global health policy actors, as well as synergies with those working on mental health, maternal health, and child health. The current COVID-19 pandemic warrants greater consideration of its impact on global NCDs policies. Future global strategies for NCDs need to consider explicitly how NCDs are framed in a changing global health discourse and ensure adequate alignment with implementation and global health issues. There is a need for global strategies to recognise the pertinent role of actors in shaping policy discourses.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-020-05958-0.

Weighing in: the taste-engineering frame in obesity expert discourse

OBJECTIVES

We sought expert opinion on the problems with 2 dominant obesity-prevention discourse frames-personal responsibility and the environment-and examined alternative frames for understanding and addressing obesity.

METHODS

We conducted 60-minute, semistructured interviews with 15 US-based obesity experts. We manually coded and entered interview transcripts into software, generating themes and subthematic areas that captured the debate's essence.

RESULTS

Although the environmental frame is the dominant model used in communications with the public and policymakers, several experts found that communicating key messages within this frame was difficult because of the enormity of the obesity problem. A subframe of the environmental frame--the taste-engineering frame--identifies food industry strategies to influence the overconsumption of certain foods and beverages. This emerging frame deconstructs the environmental frame so that causal attributes and responsible agents are more easily identifiable and proposed policies and public health interventions more salient.

CONCLUSIONS

Expert interviews are an invaluable resource for understanding how experts use frames in discussing their work and in conversations with the public and policymakers. Future empirical studies testing the effectiveness of the taste-engineering frame on public opinion and support for structural-level health policies are needed.

The predictive validity and effects of using the transtheoretical model to increase the physical activity of healthcare workers in a public hospital in South Africa

There have been studies conducted on the effectiveness of the transtheoretical model (TTM) in improving the level of physical activity at worksites worldwide, but no such studies have been conducted in South Africa. The aim of this study was to determine the predictive validity and effects of using the Transtheoretical Model to increase the physical activity of healthcare workers in a public hospital in South Africa. A quasi-experimental design in the form of a single-group, pretest–posttest model was used to examine the possible relationship between an exposure to interventions, attitude, knowledge, and an increased level of physical activity. Two hundred hospital staff members (medical and nonmedical staff) were randomly selected for participation in the study. The following variables were measured: TTM stages of physical activity, knowledge and attitudes, fitness level, body mass index, and level of exposure to the intervention. The interventions designed were based on the concept of progressing stages of physical activity in TTM stage sequences: (1) pamphlets about physical activity and health, (2) posters, fun runs, and sports day, and (3) a second set of posters, a daily radio program, and aerobic classes. Post-intervention, participants had significantly increased their stages of physical activity, attitudes, and knowledge compared with their pre-tests. Mean scores of TTM (3.70) and knowledge (3.65) were significantly (p < 0.05) greater at post-test. Overall accuracies of TTM at pre-test correctly predicted TTM at post-test by an average of 66.9%. The use of TTM to identify the stage of physical activity of healthcare workers has enabled the researcher to design intervention programs specific to the stage of exercise behavior of hospital staff. The predictors (TTM1), exposure levels, knowledge, attitudes, and processes of change have significant contributions to the outcome (TTM2).

Lessons for public health campaigns from analysing commercial food marketing success factors: a case study

Background

Commercial food marketing has considerably shaped consumer food choice behaviour. Meanwhile, public health campaigns for healthier eating have had limited impact to date. Social marketing suggests that successful commercial food marketing campaigns can provide useful lessons for public sector activities. The aim of the present study was to empirically identify food marketing success factors that, using the social marketing approach, could help improve public health campaigns to promote healthy eating.

Methods

In this case-study analysis, 27 recent and successful commercial food and beverage marketing cases were purposively sampled from different European countries. The cases involved different consumer target groups, product categories, company sizes and marketing techniques. The analysis focused on cases of relatively healthy food types, and nutrition and health-related aspects in the communication related to the food. Visual as well as written material was gathered, complemented by semi-structured interviews with 12 food market trend experts and 19 representatives of food companies and advertising agencies. Success factors were identified by a group of experts who reached consensus through discussion structured by a card sorting method.

Results

Six clusters of success factors emerged from the analysis and were labelled as "data and knowledge", "emotions", "endorsement", "media", "community" and "why and how". Each cluster subsumes two or three success factors and is illustrated by examples. In total, 16 factors were identified. It is argued that the factors "nutritional evidence", "trend awareness", "vertical endorsement", "simple naturalness" and "common values" are of particular importance in the communication of health with regard to food.

Conclusions

The present study identified critical factors for the success of commercial food marketing campaigns related to the issue of nutrition and health, which are possibly transferable to the public health sector. Whether or not a particular factor contributes to future success depends on the specific context of use, the combination of factors and the environment. Consideration of the specific applicability of the success factors identified in this study during the design of marketing activities could benefit public sector food and health-related campaigns.

The 2008 Physical Activity Guidelines for Americans: Implications for Clinical and Public Health Practice

The US government released its first formal recommendations on physical activity, the Physical Activity Guidelines for Americans, in 2008. By issuing the guidelines, the government has established increased physical activity as a major societal health target for the 21st century. The guidelines include recommendations of the types and amounts of physical activity that people should perform to gain important health benefits. Physicians and other health care providers can help people attain and maintain regular physical activity by providing advice on how to be active, appropriate types of activities, and ways to reduce the risk of injuries. Although training for providers on how to counsel patients about physical activity is limited, training of future providers offers an opportunity to improve this area of medical education. Public health practitioners have shifted their efforts to promote physical activity toward an environmental focus, usually incorporating organizational and community-level interventions. As federal health policy moves toward a greater emphasis on prevention of chronic diseases, it is expected that new resources will become available to support physical activity promotion in health care and public health settings. Familiarity with the guidelines should aid professionals in medicine and public health in responding effectively to these new expectations and opportunities.

Physical activity: Cinderella or Rodney Dangerfield?

Physical inactivity is one of the leading causes of death, disability, and health care costs, but resources and other investments in promoting physical activity are neither proportional to nor ideally suited to address the problem, especially in the United States. Capacity for physical activity promotion is lacking, when compared to the response to other major health risk and protective behaviors. The authors of the commentaries in this special issue were asked to identify key issues from a variety of perspectives and to recommend actions that can be taken now to increase physical activity across the population so that all segments of society benefit, especially those at high risk of chronic diseases. The goal is to stimulate research institutions, public health agencies at all levels, and policy makers to raise physical activity as a priority commensurate with other pressing public health concerns.