How Scared Should We Make Kids of Type 2 Diabetes?

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How scared should we make kids of Type 2 diabetes?

That’s a legitimate question since new ads designed to frighten children into saying no to sugary drinks have proven effective.

“We were surprised at the findings,” says Dr. Amy Bleakley, a senior research scientist at the Annenberg Public Policy Center of the University of Pennsylvania, who along with her team conducted a study into what kinds of ads affected behavior to reduce consumption of sodas and other sugary drinks. “We thought using humor would be more effective among children.”

The study tested 805 kids, ages 13-17, about their intentions to drink sugary drinks, such as sodas and sport drinks, after seeing fear-based public service announcements (PSAs) urging kids to not drink those sugary drinks. The ads using fear were compared to other PSAs that used humor and sympathetic concern to try and change behaviors in people. The ads were made possible through a 2012 initiative by the U.S. Centers for Disease Control and Prevention to cut tobacco use and consumption of sugary drinks, two leading contributors to preventable death in the United States.

Bleakley said that the fear-based ads produced “a significantly higher intention” among teens to cut back on sugary drinks, than did the other ads.

One reason for this might be because the ads were very graphic. In one PSA that ran in New York City in 2012 a man is shown downing a soda, a sweetened tea, a coffee drink, two more sodas and the tally is that he has stuffed 93 packets of sugar into his body throughout the day. The result of which, the ads says, is obesity and diabetes. The scene that goes with the voiceover saying that too many pounds can cause Type 2 diabetes then shows blackened and amputated toes.

It’s the toes that cause the fear, and that’s what makes the ads effective, according to the research by Bleakley. But, even though it works, is fear really the best way to urge people, especially young people, to consume fewer sugar-rich calories?

There is a legitimate need to curb destructive behaviors, especially among children, that can contribute to preventable diseases. An effective method for reducing smoking, for instance, is using PSAs, and other advertising, designed to scare children, and adults, into quitting by showing the results of smoking. And, according to research, when you add disgust to the fear, the ads become even more effective.

When I worked for an advertising agency in the 1990s there was one very effective ad campaign in Arizona designed to reduce teen cigarette use. It was called the “Smelly Puking Habit” campaign. The ads had scary images, but they also focused on describing smoking as a vile, disgusting habit that caused a person to become gross, and unattractive, two things that teens fear probably more than eventual disability and death.

That said, cigarettes are not the same as sugary drinks, and smoking ain’t diabetes, especially to teens. Cigarettes and alcohol are age-restricted products while sugary drinks are unregulated and heavily advertised. This, and other differences, bring up some downsides to using fear to prevent diabetes in the same ways that fear was used to discourage smoking.

One issue with using fear to associate the consumption of sugary beverages with disease is that the behavior becomes stigmatized, and a portion of the population then blames the victim for their behavior. This will tend to happen even if a person already has the condition.

“Fear-based ads must be incredibly cautious about walking the fine line between warning about health dangers and blaming those already affected by those dangers,” writes Dr. Ishmeal Bradley, MD, in Clinical Correlations, the online medical journal for New York University. “For example, safe-sex ads that encourage people to use condoms to prevent the spread of HIV could potentially stigmatize people living with HIV. These ads could imply that those persons infected with HIV were not cautious enough or careful enough to avoid infection. If only they had followed the advice of the public health community, they would have remained HIV-free.”

Additionally, the long-term effectiveness of using fear-based advertising to change behaviors is still very much in question. One reason for this is that people will simply avoid watching, or looking at an ad featuring blackened and amputated toes because it scares them, and people avoid things that are frightening. Also, according to journalist Lisa Magloff in an article about fear-based advertising in the Houston Chronicle, “Fear appraisal ads tend work better with objectives that are easy to achieve.” Motivating people and teens to change their dietary habits is simply not a simple, one-step task that a 30-second PSA can significantly impact long-term.

What might be more effective is using empathy and support to help people change their destructive behaviors. Doing so is more complicated than simply scaring the hell out of a viewer and saying, “Mission accomplished!” Doing so necessitates a complex approach requiring more subtle, supportive, and caring messaging that needs to be supported and voiced by an entire society.

The kind of society that can successfully undertake that sort of effort is a society that doesn’t submit to fear.

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