by Michael Booth, editor and chief, Health Elevations
When it comes to the monumental task of changing Americans’ unhealthy diets, researcher Lori Dorfman likes to say, “Information is necessary but not sufficient.”
Few things make the point better than Dorfman’s favorite New Yorker cartoon. A doctor stands before a grieving, newly widowed woman in the intensive care unit’s waiting room. “I was able,” the doctor says unhelpfully, “to get in one last lecture about diet and exercise.”
Speaking to a full house at the 2014 Colorado Health Symposium at Keystone, Dorfman described the relentless fast-food messages consumers are bombarded with in her own Berkeley, Calif., and every other city in the country.
Doctors in Colorado towns bisected by highways and pockmarked by billboards have said the same thing: Right after leaving a doctor’s office lecture about high-fat, high-sugar foods, the patient will drive a road crammed with signs for Dairy Queen and Burger King and Dunkin’ Donuts and Pizza Hut.
“People in those environments don’t have the power of control … ” Lori Dorfmam
“Education can’t compete,” argued Dorfman, who takes the proximity issue a step further: She shows a picture of a double-decker billboard – on top is an anti-obesity message from the California public health department; directly below it is a smiling woman holding bags from McDonald’s.
“The assumption is that we have an information gap, and if we just fill that gap, people will be healthier,” she added. Maybe the big idea shouldn’t be personal change, Dorfman said, but policy change.
The switch in point of view comes by recognizing that the problem is not an information gap, but a power gap, said Dorfman, a Ph.D. in public health who teaches communication at University of California, Berkeley’s School of Public Health. The burgeoning sugar-control movement at local and state levels across the country is in part a realization that advertising overwhelms consumer willpower. The modern citizen may need a civil intervention on his or her behalf to get breathing room to make better choices.
Thus the attempts at putting a “sugar tax” on sodas, flavored drinks and other snack foods; and New York City’s attempt to limit the size of such sodas in the Big Gulp era.
This new angle recognizes, Dorfman explained, that “people in those environments don’t have the power of control over that environment, and public policy can help them create and find that power.”
Until now, the message dominant for so long has been the one about personal responsibility and individual, inward-focused action, she said. “You are what you eat,” is the oldest example. People have gained too much weight because of bad choices, and if only they exercised more willpower – and exercised, period – then the problem would be solved.
It’s not that the old message is false, Dorfman noted. It’s just inadequate when competing daily against the mass marketing of appealing junk food.
“Both of these can be true at once, and both of them are true at once,” she said. But we as a society are out of balance in how we tell stories about these things, she added. In addition to getting better information about eating and exercise choices, Dorfman said, it’s time for “consumers” to become “citizens” and to hear how public policy on nutrition and the built environment could bring more rapid change.
“It’s not either-or, but only one kind of story is getting told right now,” she said.
Michael Booth is managing editor of Health Elevations, a quarterly journal for The Colorado Health Foundation, devoted to identifying and promoting best practices in health and health care in Colorado. Booth is a former health care writer for The Denver Post and has covered health, medicine, health policy and politics throughout his twenty five-year journalism career.