Diabetes Misrepresented in New York City’s Public Service Announcement


Will a “shock and scare” tactic get New Yorkers to kick their sugar habit?  The city’s “Don’t Drink Yourself Sick” public service announcement (PSA) is the latest installment in their “Pouring on the Pounds” health education campaign.It targets sugar-laden beverages as the cause of obesity, diabetes and heart attacks. The Health Department wants people to give up sugary drinks, but people won’t – and I’ll tell you why.

The PSA focuses on all the wrong things:

  • Scare tactics – which don’t promote behavior change
  • Hopelessness – which disempowers people
  • Myths, which keep people ignorant and powerless
  • Negative information and imagery instead of positive
  • No representation of the benefit of changing behavior

While I don’t dispute the wisdom of cutting down on excess sugar and empty calories, I’m willing to bet for the reasons listed above – the ad’s gruesome photo of toes putrid with advanced diabetic neuropathy, (nerve damage from high blood sugars) which represents failure reason #1, that New Yorkers will not be dropping their sodas and lattes anytime soon.

In a press release New York City Health Commissioner, Dr. Thomas Farley, said, “This new campaign shows how easy it is to drink a staggering amount of sugar in one day without realizing it. We hope that this campaign will encourage people to make the simple switch to healthier alternatives such as water, seltzer or low-fat milk. If this campaign shifts habits even slightly, it could have real health benefits.”

That’s true, it could, and in fairness 3 of the ad’s 30 seconds shows, in one static frame, healthy alternatives: water, seltzer, unsweetened tea, fat-free milk and black coffee. However it concerns me that as Catherine Donaldson-Evans reports in her article, “Health Officials Unveil Explicit Anti-Sugar Diabetes Ad,” that the Health Department says the graphic ad intentionally tries to frighten people into curbing their consumption of over-sweetened drinks and adopting better eating habits. Those 3 seconds hardly provide what’s needed to “adopt better eating habits.”

It also concerns me that among residents of New York City’s poorest neighborhoods, where the consumption of sugary drinks is greatest, many do not have the health literacy to be able to separate the bullet train dire visuals from the truth.

“Scaring people straight” doesn’t work
Scaring people into changing behavior seldom works, and less seldom lasts. Tara Andrews, Deputy Director of the Washington-based Coalition for Juvenile Justice (CJJ), a national nonprofit group that advises federal and state policy-makers says, ‘Scared Straight’ programs feel intuitively good but the research has shown them to be at best ineffective and at worst counter-effective. Scared Straight programs have long been discredited.”

Dr. Richard Boyatzis, lecturer and Professor of organizational behavior, psychology, and cognitive science at Case Western Reserve University, says a ‘positive emotional attractor’ is what prompts us to promote change in our lives. For example, a picture of a positive future, a picture of your best self and being focused on your strengths, hope and optimism. These make us more open and able to contemplate and create ways to bridge the gap between where we are and where we want to go.

Dr. Russell Ackoff, philosopher, behavioral scientist and management guru told us people are more successful making and sustaining behavior changes when they are moving toward what they want not trying to avoid what they don’t want.

Further all our insights from the last 20 years in neuroscience show that fear activates the fear based center in the brain (amygdala) causing stress, impairing decision-making and generating the “fight” or “flight” response. Since there’s no immediate threat to fight (no saber-toothed tiger coming at us or hiding at the corner deli) most viewers will flee – right into the next Starbucks.

The truth about obesity and diabetes
Registered Dietitian, Certified Nutritionist and Diabetes Educator Susan Weiner, and Clinical Psychologist and Certified Diabetes Educator Beverly S. Adler were alarmed by the ad’s misrepresentation of diabetes and the insinuation that ingesting a lot of sugar causes diabetes.

“Eating or drinking more calories than you burn off, regardless of where the calories come from, will cause weight gain,” says Adler, “but excess weight doesn’t necessarily cause diabetes and eating sugar does not cause diabetes.”

“Type 2 diabetes and pre-diabetes include several risk factors,” says Weiner, “in addition to being overweight.” For instance a strong family history of type 2 diabetes and certain ethnicity, such as being African American, Hispanic or American Indian, among other factors. Also, many people who are not overweight develop type 2 diabetes.”

Dr. Robin Goland, co-director of the Naomi Berrie Diabetes Center at Columbia University Medical Center in New York, says roughly 20% of the people with type 2 diabetes are thin, and that 75% of obese people never get diabetes. I also discovered the same when researching the myth, “I have to be overweight to get diabetes” for my book, 50 Diabetes Myths That Can Ruin Your Life and the 50 Diabetes Truths That Can Save It.

While the PSA doesn’t directly say eating or drinking sugar causes diabetes it implies it through the graphics and misstates, “And all that sugar can bring on serious health problems including obesity which causes type 2 diabetes…” But now you know obesity doesn’t necessarily cause diabetes and you can get diabetes and not be obese.

How to change and sustain new behavior
“This ad,” Adler says, “makes people feel that dire consequences are inevitable if they have diabetes and that their future is hopeless. It manipulates viewers with its image of one of the worst complications of diabetes – advanced neuropathy of the foot – making you think diabetes will lead to foot amputation. If viewers weren’t depressed before they see the ad they will be afterward, and depression interferes with managing diabetes.

Adler also says, “What we need is a much more positive message. Instead of implying that devastating consequences are guaranteed with diabetes, we need to take a more reasoned and realistic approach. We need to encourage people with diabetes to manage it well, letting them know that if they do they can reduce the risk of developing complications.”

Steps to Improve Healthy Eating I believe the PSA – which ran through February 22nd – was a missed opportunity. An effort that had its heart in the right place but chose the easy way out – to use fear – rather than provide workable solutions and teach people what to do, how to do it and see the benefit. In the process limited city funds and resources were misspent.

Psychologist Adler adds, “People with a positive attitude who are hopeful about the benefits healthy changes can bring are more apt to take care of themselves. They feel less stressed, make healthier lifestyle choices and begin taking control of their life.”

Just a few weeks ago the U.S. government’s revised nutrition guidelines came out calling for Americans to “Eat less” and offer several recommendations what to eat with measurable guidelines. The recommendation to drink water instead of sugary drinks like soda is among them. So is: control total caloric intake, increase physical activity, fill more of our plate with fruits and vegetables, cut down on processed foods filled with sodium, fat and sugar, increase our intake of nutrient dense foods and build strategies for developing healthy eating patterns.

Dietitian Weiner suggests these tips for healthier eating: 1) Go back to cooking basics – do more cooking at home and learn how to cook if you have an interest 2) Make time to sit down to family meals 3) Measure and get to know proper portion sizes 4) Eat more vegetables and drink more water. You’ll feel fuller and eat less calorie dense foods. You’ll also begin to distinguish whether you’re hungry or just thirsty 5) See a registered dietitian if you’re at risk for developing diabetes and need to change your eating habits. If you go on a diet that doesn’t fit your lifestyle and medical needs you will eventually go off it.

Let’s stop scaring people. Instead, let’s give people the information they need to do better and inspire them to see a healthier future for themselves.
I tried reaching Dr. Farley to ask why the city took this fear-focused, myth-perpetrating tactic. My request to ask a few questions was met with a press release from the Health Department’s Press Secretary Zoe Tobin who said the ad “is hard-hitting and realistic.”

You decide.

Originally published on Huffington Post.

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12 years ago

Thanks for the interesting blog.  It is interesting that even in California, having all of the calories listed next to food is not helping in choices.  Forcing people into choices is obviously not working.

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