Tuesday, May 13, 2014

Better Fed?: A Critique of Jamie Oliver’s Feed Me Better Campaign- Alexandra Corbet

            As in many developed countries, the 1990s and early 2000s saw rates of obesity in the United Kingdom increase sharply. As of 2012, approximately 25% of adults were classified as obese compared to 15% in 1993 (1). As waistlines in the UK grew, so did concerns surrounding the consequences of obesity. Particularly alarming have been the rates of childhood obesity and associated short and long-term health effects. The number of children aged 2-15 classified as overweight or obese has declined slightly since peaking in 2005, but is still unacceptably high with approximately 28% of children classified as overweight or obese in 2012 (1). The immediate and prospective consequences of childhood obesity are numerous and well documented: type 2 diabetes (2); asthma (3); sleep apnea (4); cardiovascular disease (5); musculoskeletal problems (6,7); mental health disorders (8,9) and decreased life span (10). Similarly documented are the effects of diet on obesity with the consumption of energy-dense, micronutrient-poor foods confirmed as a key risk factor (11). 
            It was upon this backdrop that celebrity chef Jamie Oliver began the Feed Me Better campaign in 2005 through his charity The Jamie Oliver Foundation. The campaign arose out of Jamie Oliver’s School Dinners, a four-part series televised on Channel 4 in which Oliver sought to expose the abysmal quality of school lunches in the UK (12). School Dinners documents Oliver as he attempts to overhaul the kitchen of Kidbrooke School in Greenwich Borough and introduce students, staff, and parents to lunches of improved nutritional quality. The program was viewed by over 5 million people and garnered attention from multiple mainstream media outlets and politicians (12). Building on the success of School Dinners, the Feed Me Better campaign was established with five core aims:

1. Guarantee that children receive a proper, nutritionally balanced meal on their plates.
2. Introduce nutritional standards and ban junk food from school meals.
3. Invest in dinner ladies: give them better kitchens, more hours and loads of support and training to get them cooking again.
4. Teach kids about food and get cookery back on the curriculum.
5. Commit long-term funding to improve school food. (13)

            Feed Me Better resulted in a number of significant successes, many of which stemmed directly from the media attention School Dinners amassed. In 2005, then-Prime Minister Tony Blair pledged £280 million to improve school meals and established a School Food Trust; nutrient-based standards for school lunches were revised in 2005 and became legally binding in 2008 (14); and in 2009, studies on student behavior and concentration suggested that nutrient-dense lunches improved student performance (15). The Jamie Oliver Foundation declared Feed Me Better a success in 2006 and the charity has since shifted its focus with current campaigns centered on food education.
            Despite the unarguable political and media backing of Feed Me Better, Oliver faced substantial resistance from students, staff, and parents when trying to implement changes in schools. Much of this resistance can be attributed to the failure of Feed Me Better to effectively employ the principles of social and behavioral theory. These principles serve as the basis of successful public health interventions and can significantly impact the level of success an intervention will have.  The following will critique Feed Me Better based on features of Framing Theory, Reactance Theory, and the Theory of Reasoned Action with supporting evidence drawn from the literature. Each critique will be accompanied by a series of recommendations to demonstrate how the aforementioned theories could have been better applied to Feed Me Better. As Feed Me Better is no longer active, such retrospective recommendations are of little use to the campaign itself. However, with numerous organizations working to address the issues of childhood obesity within the United Kingdom, reflecting upon the weaknesses of Feed Me Better can hopefully create stronger programs in the future and healthier kids.
Convincing Kids: Where is the Frame?
            The success of the Feed Me Better campaign can be measured in several ways. From a political and policy perspective, Feed Me Better was a triumph. For the students of Kidbrooke School however, the campaign was not well liked. It was with this important audience that the framing of Feed Me Better failed. Framing is a communication technique that makes salient certain aspects of an issue in order to promote a particular interpretation in the intended audience (16). Frames draw on the  “the broadly shared beliefs, values, and perspectives familiar to the members of a societal culture” to define the problem, diagnose the cause, make moral judgments, and propose a solution (16, 17). Frames typically consist of five elements beginning with a 1) core value that is supported by 2) a central message, 3) metaphors, 4) catch phrases, and 5) visual imagery. The effectiveness of a frame will be determined by the strength of the core value in and coordination of the supporting elements. In the realm of public health, framing of issues in specific ways can and does influence popular opinion, policy decisions, and individual behavior (18). For example, Jacobson et al. found that when smoking was framed as an issue of personal freedom by the tobacco industry, antismoking legislature stalled despite the well-documented evidence of smoking’s deleterious effects on human health (19).
            The framing of the Feed Me Better campaign to the students of Kidbrooke School was based on a weak core value and lacked the supporting elements of an effective frame. In School Dinners, Oliver discusses at length the detrimental effect poor quality school lunches are having on British youth with particular emphasis on health outcomes. The narrator informs audiences that school dinners are in a state of ‘crisis’ with “a diet of fatty processed foods threatening our nation’s health” (12). Oliver himself then contributes a colloquial version of the aims of the Feed Me Better campaign: to produce a “better, cooler, cleverer, healthier nation.” While several values can be deduced from these quotes, the value that remains central is that of health. While many within the public health and policy world champion health as a core value, evidence suggests that it does not hold the same importance in the wider population (18, 19). More specifically, the value of health did not register with the students at Kidbrooke School. This failure is not entirely surprising given evidence on children’s understanding of health. In their study of children’s concepts of health and illness, Myant & Williams found that between the ages of 4-12, children were unable to accurately explain the causality of asthma and other non-infectious diseases (20). As the health consequences of a poor diet are non-communicable and chronic in nature, the likelihood that students subject to the Feed Me Better campaign were able to make this connection is small. To furthermore expect students to place value in health or the absence of chronic disease is unreasonable. 
            In addition to its reliance on a weak core value, the framing of the Feed Me Better campaign did not effectively employ the accompanying elements of framing. When pitched to politicians and television audiences, the campaign was framed using metaphors of war that invoked imagery of noble battles being fought on behalf of British youth. The value of health was present, but perhaps more importantly were the values of nation and family. This frame resonated with adult audiences but not with students. There is little evidence from campaign materials to suggest that Feed Me Better was even framed or presented to students at all (13). At no point in School Dinners were students introduced to the campaign or its aims, let alone in a way that would resonate their understandings of the world. Without an adequate and effective frame, Feed Me Better was unable to make the aims of the campaign “noticeable, meaningful, or memorable” to the audience that was most directly effected (16).
            To improve the reception of the Feed Me Better campaign and its strategies among students, it should have been framed in a way that resonated with children. The frame needs be based on a core concept that is actually valued by youth and supported by metaphors, phrases, and imagery that are immediately recognizable and relevant to their interests. Notorious for the strategic targeting of youth in its marketing, fast food companies have made millions of dollars in profit through this strategy (21). Fast food advertising typically portrays products as fun, cool, and exciting- all values that are easily recognized and desired by children (21). Adopting this value and recasting the Feed Me Better campaign with ‘fun’ as the core value would promote acceptance by its key audience. The metaphor of a playing a game or sport could be used to make healthy food choices more familiar and relevant to children. This metaphor would immediately conjure imagery of popular games and sports, which could be capitalized on by the campaign. Feed Me Better might specifically incorporate sports imagery and sayings such as “You win!”, “He shoots, He scores!”, and “Goal!” to reinforce the idea that healthy food is associated with desirable outcomes. This frame would cast the healthy food of Feed Me Better not as an issue of health but of one that contributes to a child’s ability to have fun.
Psychological Reactance: “We Don’t Like Your Disgusting Food”
            Reactance theory states that when a person experiences a real or perceived threat to a given freedom, the individual will take action to restore that freedom  (22). This reaction is termed psychological reactance. ‘Freedom’ can refer to both an act and an attitude but it must be something that is realistically possible. The magnitude of reactance is determined by several factors:
            1) the importance of the free behaviors that are eliminated or threatened;           
            2) the proportion of free behaviors eliminated or threatened; and 
            3) when there is only a threat of elimination of free behaviors, the magnitude of that threat (22). 
            At Kidbrooke School, Jamie Oliver changed the lunch menu with minimal warning or explanation (12). Initially, healthy new menu items were served alongside the highly processed and nutrient-void foods that had come to typify British school lunches. When given the choice, students did not choose Oliver’s healthy dishes. Upon realizing this, Oliver immediately banned all junk food at Kidbrooke School. Without the option to choose smiley fries and sausage rolls, students’ freedom to eat junk food was eliminated and they were instead forced to eat new and unfamiliar dishes. To restore the freedoms that had be taken, students took a number of different actions: they refused to eat school lunches and instead ventured off-campus to obtain junk food elsewhere; they organized petitions and ‘protests’ to voice their displeasure over the menu changes; and they arranged with their parents to have fast food delivered through the school fence at lunch (12). For students, Feed Me Better was not perceived as providing healthy new lunch options but instead as removing the ability to eat fast food. Instead of accepting and embracing the new lunch menu, students’ objectives were to obtain junk food and reestablish the freedom that Feed Me Better had taken away. 
            The magnitude of reactance can also be influenced by the qualities of the ‘messenger’, that is the person who is perceived to be threatening a given freedom. In his study on deflecting reactance, Paul Silvia manipulated simple characteristics to make the messenger seem more or less similar to the subject (23). When the messenger had the same birthday or name as the subject (increased similarity), the subject exhibited less reactance than when the birthday and name were different. As the primary messenger of the Feed Me Better campaign, Jamie Oliver had little in common with the students, parents, and staff at Kidbrooke School. He occupies a different social class, has different educational and professional experiences, and importantly, has very different understandings and values surrounding food (12). These differences are abundantly clear in his interactions with the students, staff and parents. He scoffs when a student cannot identify a zucchini, is regularly condescending to the kitchen staff, and makes multiple comments to suggest that what he is doing in schools is full of “love and care” in contrast to what the staff were doing prior to his arrival (12). By verbally acknowledging and reinforcing the differences between himself and those at Kidbrooke School, Oliver likely increased their reactance to Feed Me Better.
            Countering the reactance faced by Oliver and the Feed Me Better campaign could have been achieved through multiple strategies. Students displayed reactance because their freedom to chose a meal and specifically, to choose a meal of junk food was taken away. Altering the approach of the campaign to maintain that freedom of choice and ideally, enhance it would have minimized the reactance that developed (22). Much of the food served by Oliver was unfamiliar to students. Involving their active participation in the creation of menus could have given them the sense that choice was being given to them as opposed to taken away. Each grade could be assigned a day of the week for which they would be responsible for choosing a meal that would be served. This would still allow the Feed Me Better campaign control over the majority of lunch options but incorporate the choices of students.
            Another option would be to serve meals that involve increased levels of ‘eater participation’ or healthier version of familiar dishes. Such meals might include tacos where students could choose between the type of tortilla and protein, and include a toppings bar where students would completely determine an aspect of their lunch. This strategy would again emphasize the choice students have at lunchtime and not the restrictions. Favorite foods listed by students in School Dinners included chicken fingers, French fries, and beans, all of which are simple to make from scratch. The American branch of the Jamie Oliver Foundation has posted recipes for healthy updates of each of these dishes that could be consulted by kitchen staff (24). Providing students with meals that are similar in look and taste to those that they desire could reduce psychological reactance.
Food Choices and Social Norms
            While individual-level models are not useful in all situations, elements of the Theory of Planned Behavior/ the Theory of Reasoned Action (TPB/TRA) can explain specific challenges faced by the Feed Me Better campaign.  The TRA is based on the idea that decision-making is rational and cognitive (25). While this element of the theory has been criticized, it also states that a behavior occurs only after an individual takes into account their own attitudes about the behavior and surrounding the social norms (25, 26). Social norms refer to how a behavior is judged by a group and motivation to conform to these norms will significantly affect an individual’s desire and ability to perform the behavior (26).
            The likelihood that a student would respond positively to a new food provided by Oliver and the Feed Me Better campaign was very much influenced by the actions of their peers. In several scenes of School Dinners, the refusal of even one child to taste a new vegetable (asparagus) is followed by the refusal of nearly every student in the class. Oliver surveys the children on their opposition and asks whether removing the several particularly resistance students would influence their answers (12). Many of the students respond affirmatively. When the particularly resistant students are taken out of the classroom, the remaining children try the asparagus and the majority of them outwardly enjoy it.
            The influence of social groups and social norms on behavior was not adequately taken into account by the Feed Me Better campaign. The above situation illustrates that while a student may have positive attitudes towards trying a new vegetable, their perception of how that behavior would be judged by the group was significant enough to prevent the behavior. When the child perceived the behavior to be more positively regarded by their peers, the behavior was completed. Materials produced by campaign outlining implementation strategies assume that through education, students will accept healthy food (13). This follows the assumption of rational and cognitive decision-making but does not account for the significant influence of social norms on a behavior. There are no strategies laid out to promote the acceptance of Feed Me Better amongst student groups nor are there methods to address social barriers to its successful implementation. The barriers that are addressed are largely structural: funding, institutional support, adequate training, and supplies- all of which are real and significant. However, even if all such barriers were removed, without addressing the social norms that surround food choices, students are still unlikely to welcome or adopt a program like Feed Me Better.
            Instead of altering the existing TRA framework, incorporating elements that increase a sense of ownership and control could work to shift existing social norms surrounding new foods and healthy food choices. Working in small groups, Feed Me Better could incorporate an interactive component to their campaign. Immediate recommendations include small-scale gardens where students could grow their own vegetables and workshops to teach basic cooking skills. Both programs have been implemented in several other settings and have been met with much success (27, 28). Children that participated in the Stephanie Alexander Kitchen Garden (SAKG) program in Australian schools were significantly more likely to try new foods and had higher levels of confidence in cooking and gardening (27).  Importantly, students highly enjoyed the classes and many reported that they liked cooking ‘a lot’ (27). The evidence from SAKG suggests that social norms surrounding healthy food and food choices shifted following this program. A comparable approach by Feed Me Better could work in similar ways.
            The Feed Me Better campaign spearheaded by Jamie Oliver was a noble and assertive effort to improve the standards of school lunches across the United Kingdom. It addressed the significant public health concern of childhood obesity and its associated health consequences. While Feed Me Better gained widespread political and popular support, it was met with resistance by many of the students it sought to help. Analyzing the campaign on the basis of several social and behavioral principles demonstrates that Feed Me Better had a number of weaknesses: it did not effectively use framing to communicate a core message; it generated psychological reactance among students; and it neglected to factor in the effects of social norms on behavior. While the program has come to a close, future projects of the Jamie Oliver Foundation and others that seek to improve childhood nutrition should reflect upon the strengths and weaknesses of Feed Me Better. Effective public health interventions must be framed in ways that are relevant to their target audience, they must work to reduce psychological reactance, and they can improve social acceptance of the behavior through activities that increase sense of ownership and control. As demonstrated though this critique, the effective utilization of social and behavioral theory is often key in determining whether a program succeeds or fails. Strategies based in these theories can be applied in many creative ways and play a integral role in improving the health of our children, communities, and nations.  

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