Health Education Research, Vol. 16, No. 3, 343-355,
June 2001
© 2001 Oxford University Press
Mass education for obesity prevention: the penetration of the BBC's `Fighting Fat, Fighting Fit' campaign
Imperial Cancer Research Fund, Health Behaviour Unit, Department of Epidemiology and Public Health, University College London, 2–16 Torrington Place, London WC1E 6BT and
1 BBC Education, 201 Wood Lane, London W12 7TS, UK
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Abstract |
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The study aimed to evaluate the BBC's `Fighting Fat, Fighting Fit' campaign's success in achieving public awareness of the need for obesity prevention, and putting over its message of healthy eating and increased physical activity. Demographic factors associated with awareness of the campaign were assessed. Data were collected from a national representative British sample as part of the ONS Omnibus survey in March 1999. Questions included weight and height, recognition of the campaign name, recall of the content of the campaign, and participation in the campaign registration scheme. More than half of the respondents had heard of the campaign and 30% recalled the healthy lifestyle messages, although fewer than 1% registered to participate in the scheme. Awareness of the campaign was high in all socio-economic groups, but memory for the healthy lifestyle message was significantly poorer in those with lower levels of education and from ethnic minority groups. Disappointingly, awareness was also no higher in overweight than normal weight respondents. The results strongly support the effectiveness of the campaign in publicizing the issue of increasing prevalence of obesity and the need for lifestyle change, but suggest that different approaches might be needed to maximize participation from groups most in need of lifestyle change.
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Introduction |
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Obesity is currently the second most avoidable cause of ill health in the UK after smoking, increasing the risk of many chronic and potentially fatal diseases (WHO, 1998
). The proportion of people who can be classified as `overweight' or `obese' is rapidly increasing worldwide. In the UK, the prevalence of obesity has doubled over the last decade, and over 50% of the adult population is now classified as overweight and more than 17% as obese (Prescott-Clarke and Primatesta, 1996). The current consensus is that an environment which promotes sedentary lifestyles and consumption of energy-dense foods is the primary cause of the increase in weight (Jebb, 1999). As a result, both eating and activity patterns need to be addressed if the rising prevalence in obesity is to be controlled. In an effort to reverse this trend, the BBC launched the `Fighting Fat, Fighting Fit' (FFFF) campaign in January 1999. It was designed to inform people about the need for active obesity prevention, and to educate and encourage people to eat more healthily and become more physically active. The emphasis was on achieving small and permanent changes to lifestyle rather than dieting and short-term weight loss.
There is little doubt that mass-media health campaigns can enhance knowledge and awareness of health-related issues. However, evidence that they can stimulate behaviour change is less convincing (van Wechem et al., 1997; Cavill, 1998). Projects such as the Stanford Heart Disease Prevention Program (SHDPP) and the North Karelia Project both demonstrated community-wide reductions in cardiovascular disease (Tuomilehto et al., 1986; Fortmann et al., 1993), following significant reductions in population plasma cholesterol levels, blood pressure and smoking rates. More recently, activity promotion campaigns such as the `Fit for Life' programme in Finland have demonstrated significant increases in activity (Vuori et al., 1998). However, all of these campaigns included significant elements in addition to mass-media programming, such as face-to-face counselling. Campaigns which have relied on mass-media programming alone have proved less effective. For example, a mass-media campaign to encourage people living in Scotland to exercise more, appeared to have no effect on the exercise levels of the general population, although there were increases in reported exercise levels among people calling the campaign telephone information line (Wimbush et al., 1998).
In their analysis of effective mass communication strategies for health campaigns, Flay and Burton argue that the failure of some mass-media health campaigns may be because they fail to contact their target audience (Flay and Burton, 1990). Although large numbers of people are reached through the media, high-risk groups may be less exposed than low-risk groups to health promotion messages and may be more likely to forget the messages to which they are exposed (Ben-Sira, 1982; Bakdash, 1983; Bakdash et al., 1984). Many authors acknowledge that exposure to, awareness of and comprehension of the message of any campaign are critical precursors to attitudinal and behavioural change (Hovland et al., 1953; Flay and Burton, 1990). Surprisingly, relatively few evaluations of mass media programmes have measured awareness of the campaign messages.
The present study therefore aimed to assess awareness of the FFFF campaign and recall of the campaign message, as part of a wider assessment of the impact of the FFFF campaign on obesity management and prevention in Britain.
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Design
Campaign programming
The FFFF campaign was the largest health education campaign ever undertaken by the BBC, spanning 7 weeks of numerous peak and day-time programming across BBC One and Two, BBC Radio 2, and local BBC radio programmes, and was supported by a BBC FFFF Website, Ceefax pages, a book, a video, the Radio Times and telephone lines for further information. As part of the campaign, people were invited to telephone or write for a registration pack at a charge of £2. The pack included a self-help guide for lifestyle change, and three registration cards to return over a 5-month period to chart progress in weight loss, activity levels and eating habits.
Target audience
The campaign was explicitly targeted towards groups with a higher prevalence of obesity. However, whilst those in socio-economic groups 3M and 4 (skilled, semi-skilled and unskilled manual) tend to have higher levels of obesity, this did not directly correspond with the BBC's `media reach' (i.e. those who typically watch BBC television programmes). The cross-over between those most likely to be obese, and the BBC's typical audience was considered to be those in social classes 3NM and 3M aged 21–45 (skilled non-manual and manual groups).
Campaign message
BBC Education commissioned a steering group to advise on the content of the campaign message, made up of fitness and nutrition experts, behavioural psychologists, and health education experts. The final product was a campaign message saying that obesity is on the increase, and that weight problems are best tackled with small but permanent changes in diet and exercise, rather than short-term dieting. A limited amount of concept testing was carried out with the target group by the BBC to establish the acceptability of the message and the content and acceptability of the campaign trails. The campaign message was supplemented with a booklet which was part of the campaign registration scheme. The booklet offered practical advice about how lifestyle changes in eating and activity might be achieved, and is described in more detail below.
Registration scheme and booklet
The registration scheme was highlighted during and after the programmes throughout the 7 weeks of the campaign and offered 6 months of membership. The 22-page long booklet included a self-help guide for lifestyle change and three registration cards to return over a 5-month period to chart progress in weight loss, activity levels and eating habits. It contained information about the health benefits of making lifestyle changes, charts for assessing current activity levels, and a selection of potential exercise and eating goals to choose from, alongside practical advice about how to achieve them (e.g. by grilling or steaming food rather than frying it). It also contained information about the balance of foods that should be eaten in order to achieve a healthy diet, and money-off vouchers for both the FFFF book and exercise video up to a total value of £3. In addition, those sending back the second registration card received a voucher for a free exercise session in one of over 1050 participating fitness centres in the UK. As an extra incentive, participants who showed the greatest improvement in eating and activity habits over the 6-month period had a chance to win prizes such as a year's supply of fruit and vegetables or a home visit by a health and fitness expert.
Book
The FFFF 192-page long book (BBC Worldwide, £4.99) contained basic information about healthy eating and was divided into two sections. The first section was designed to help the reader understand why eating habits and activity levels are so important for general health and to identify where and how improvements could be made. The second contained three different plans for healthier living, a questionnaire to identify which plan was appropriate for a particular reader to follow and a selection of recipes. The `Slimming Plan' was designed for those who wanted to lose weight. The `Maintenance Plan' was designed to help those at a target weight to stay there and the `Healthy Eating Plan' for those who wanted to adopt healthier ways of eating, without needing to lose weight. The book emphasized that healthy eating should be supplemented with exercise to produce a healthy lifestyle.
Video
The video (BBC Worldwide, £10.99) introduced 10 people with varying body shapes, lifestyle and weight, who wanted to lose weight, be fitter and healthier. The emphasis was on lifestyle change and doing activities that could be fitted into the everyday routine. The bulk of the video comprised a 50-min workout and an alternative 20-min workout for those with less free time. It was recommended that the workout be done three times a week. All 10 people depicted on the video either lost weight or inches and reported lifestyle changes.
Programmes
The programming was broad, covering a number of topics and targeting different audiences in order to have wide-spread appeal. The principal television programmes broadcast as part of the campaign were Weight of the Nation, Fat Free, Fat Files (Horizon trilogy) and Body Spies. Weight of the Nation was an hour long, prime-time special that launched the campaign. It was hosted by a well-known presenter, with celebrity guests and health experts. A TV chef produced some recipes designed to be healthy, tasty and suit even those with a very limited budget; a nutritionist advised viewers on what to eat to feel satisfied rather than deprived; a sports scientist and fitness expert discussed suitable activities for all sorts of people of varying abilities, needs and circumstances; a GP and health writer offered general health advice; and a fit, size 20 aerobics instructor, demonstrated some simple exercise routines that could be done by anyone of any size, even in a small room. In addition, contributors who had been filmed over several months in their efforts to be healthier visited the studio to discuss their progress. A group of students on a limited budget, five colleagues from a male social club and a working mother were featured. Repeated again was the message that diets do not work and long-term changes are essential. Fat Free was a six-part documentary series broadcast in the evenings, which followed five people with different reasons for losing weight and using different weight loss methods, over a 6-month period. Their lives and progress were captured on camera, and ranged from a 37-year-old father of one who, in order to lose over half his body weight, arranged to have his stomach stapled, to a single mother who had worked in the fast food trade all her life. By the end of the series, the mother had lost 4 stone and managed to fit into her old wedding dress. The father, disturbingly, died from a blood clot in his lungs following his operation. The key message of the FFFF campaign about making small, long-term lifestyle changes took a low profile in this series; instead the focus was on dieting and weight loss, and hence was somewhat at odds with the main message of the campaign, although it highlighted the extremes to which people will go to lose weight and the potentially serious consequences of taking such action. Fat Files was a trilogy broadcast later in the evenings in a science slot, which looked at the science of obesity. The programme discussed the role genes play in diet and body size, and how they might explain why some people find it harder to diet than others. It also looked at the use of surgery and drugs to combat fat, and possible causes of eating disorders. Body Spies was broadcast on weekday afternoons, and was aimed at those who smoke, drink or eat too much, do not know how to relax and do little exercise. So-called `lifestyle challenges' were set by experts such as nutritionists, acupuncturists and health promotion consultants on a range of different issues, and with a range of different types of people. The Body Spies team travelled round the country and met two sets of people every week who had agreed to change their lifestyle, and be spied upon by their family and friends (as well as the viewing public). The pairs of volunteers, ranging from married couples, friends, work colleagues, family members, etc., were filmed for 1 month. Each couple was given a uniquely tailored 4-week plan.
In parallel with the television programmes, BBC Radio launched their part of the FFFF campaign, which ran for 3 days, with the help of celebrities and well-known radio presenters. These programmes included interviews with celebrities about their eating and activity habits, followed by advice from a TV chef on healthy eating alternatives. The Health Minister was interviewed about the disturbing trends of increasing rates of obesity among not just the adult population, but also among young people. The importance of follow-up and continued support from the campaign was discussed, so that people did not return to their old habits. Listeners' queries about how to be healthier were answered in a phone-in which emphasized the need to avoid drastic changes in diet and encouraged making realistic, achievable and sensible alterations and substitutions. In addition, there were a number of other local radio slots and interviews.
Campaign trails
A generic campaign trail was broadcast on TV and radio in late December 1998. Weight of the Nation had programme-specific trails in early January 1999, as did Fat Free. The target audience for the trails differed from that for the campaign as a whole, being targeted towards men aged 45+ in social class groups 3NM, 3M, 4 and 5, and women aged 35+ in social class groups 3NM and 3M, with the primary, secondary and tertiary target audiences being women aged 35+ in social class groups 3NM and 3M, men aged 45+ in social class groups 3NM and 3M, and men aged 45+ in social class groups 3M, 4 and 5, respectively. The TVRs (TV audience rating points) were used to measure the media weight of these programme trails and are given in Table I. One TVR point equals 1% of the target audience having seen the trail; however, the figures in Table I represent the cumulative percent of people viewing the campaign trails. Originally the campaign was designed to have a total of 240 TVRs, but due to the trails being fitted round an unpredictable Christmas schedule the campaign was over-served in terms of TVRs by approximately double (516). Hence the FFFF campaign was heavily advertised and 62% of all adults saw the campaign launch trail at least once. Furthermore, Fat Free received a high proportion of advertising, having approximately double the TVRs of either the campaign launch trail or the trail for Weight of the Nation.
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BBC Radio 2 Action Line
The BBC Radio 2 Action Line had experts available to advise listeners on their eating and activity habits, as well as to provide details of how individuals could join the FFFF campaign.
Print media
The FFFF campaign was mentioned briefly in more than 60 magazines, nine national newspapers and 120 regional newspapers. Articles regarding the FFFF campaign appeared in the national press about 28 times in total, before and during the 7 weeks of the campaign.
Logic of the campaign
The campaign aimed to stimulate behaviour change and consistent with this aim was based on behaviour change theories such as Social Learning Theory (Bandura, 1977, 1986) and the Health Belief Model (Becker, 1974). It also used elements outlined by Flay and Burton in their review of effective mass communication strategies for health campaigns (Flay and Burton, 1990). Hence programmes such as Weight of the Nation and Body Spies modelled the desired behaviour, showed it to be effective in achieving the desired results and presented it as pertinent to real-life situations. Both the programmes and the booklet provided specific guidance for self-management of behaviour change and for coping with lapses. In addition, both the programmes and the booklet aimed to mobilize social support for behaviour change, by encouraging people to join together in making lifestyle changes, to solicit support for their individual lifestyle changes, and by offering incentives to use local fitness centres and thereby encourage the use of pre-existing infrastructures.
Procedure
ONS survey
The data presented here were collected as part of the monthly Omnibus Survey of the Office for National Statistics in March 1999. A stratified probability sample of adults was selected by random sampling of addresses on the Postcode Address File of private households in Great Britain. Within each household, one person over the age of 16 was randomly selected to be interviewed by trained interviewers, using a computer-assisted interview schedule
From a target sample of 2690 eligible addresses, 583 of the selected individuals refused to be interviewed and 213 were unable to be contacted after three attempts, so 1894 (70%) interviews were achieved. This response rate is typical of high quality home-interview studies aiming to attain a representative sample of the population. No information is available on non-responders.
Measures
- Campaign penetration. Awareness of the campaign was assessed with five questions. All interviewees were asked: `Have you heard of the BBC campaign called Fighting Fat, Fighting Fit?'. If they had heard of it, they were asked: `Could you say what the campaign was about?' (all responses were coded into weight loss, obesity, dieting, healthy eating, being more active, eating disorders, other, or don't know, by the interviewer). Those who had heard of the campaign were also asked: `Could you tell me where you heard about it?' with a prompt card listing TV, radio, other people, Radio Times, other magazines/newspapers, Internet, don't know/can't remember. All participants were then asked: `There have been several television programmes which featured the campaign. Which, if any, of these did you see?' and shown a card listing Weight of the Nation, Fat Free, Fat Files, Body Spies, none of these, don't know/can't remember. Finally, those who had heard of the campaign were asked: `And which of the items on this card apply to you?' and shown a card listing; I sent off for the FFFF registration pack, I filled in a registration form and sent it back, I called the FFFF Radio 2 Action Line, none of these.
- Demographic and anthropometric characteristics. A great many demographic variables are recorded as part of the ONS omnibus surveys, of which age, gender, ethnicity, marital status, years of education, occupational social class based on the Registrar General's classification of the individual's current or last occupation and region of the country were used in the present analyses. Age, gender and marital status were used as basic descriptors of the population studied. The two socio-economic measures (years of education and occupational social class), region and ethnicity were selected because of the particular interest in the present paper of documenting the campaign's success in the groups with the greater risk of obesity, i.e. lower socio-economic status, those from Northern regions in the UK, and some ethnic groups. Weight and height were self-reported in whichever metric the individual preferred. Body mass index (BMI) was calculated from weight in kilogrammes and height in metres. Overweight status was defined as a BMI of 25–29.9 and obesity as a BMI of 30 and over.
Statistical methods
Results were analysed first using simple descriptions of the levels of awareness of, and memory for, the material. Logistic Regression (SPSS, version 10.1) was used to evaluate the predictive effect of the different demographic and anthropometric groups first in univariate, and then in multivariate analyses. The weighting factor (to control for the probability of selection related to the number of people in the household) was left on for these analyses as recommended in the Omnibus technical report.
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Results |
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Demographic and anthropometric characteristics of the interview sample are shown in Table II
. Women had a lower mean BMI than men and more of them had a BMI in the normal weight range. More men were overweight, but more women were obese.
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Table III
shows the level of awareness of the campaign in the whole group and in relation to a range of socio-demographic and anthropometric variables. Over half the sample said that they had heard of the campaign (57%). Fewer (29%) recalled watching one of the TV programmes and about the same number remembered that the campaign involved either healthy eating or being more active. Active involvement (sending for the registration pack) or participation (sending back the registration form) was extremely rare in any group. Logistic regression was used to establish the predictive effects of each of the demographic variables on each of the dependent variables. Significant univariate effects are marked with letters and indicate that higher levels of awareness, a greater likelihood of watching the programmes and better memory for the messages were found among younger, white, female respondents and those with more years of education. There were no significant regional differences nor any differences associated with body weight. There were no group differences in involvement with the programme, but the numbers were very small.
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The campaign was effective in reaching its target audience. A significantly larger proportion of those in the BBC's target audience (non-manual and skilled manual aged 21–45) had heard of the campaign compared with those not in the target audience (67 versus 54%) (
2 = 17.3; d.f. = 1; P < 0.001).
Logistic regression (see Table IV) was used to establish the independent predictive effects of each of the demographic variables (model 1) and then to see if having watched any of the TV programmes increased recall of the messages. Results are shown as odds ratios (ratios of the odds of recalling the message in each group compared with the reference group) and confidence intervals of the odds ratio. Where confidence intervals do not include 1, the odds of recalling the message is significantly different from the reference group. Awareness of the lifestyle message was again higher in respondents who were younger, white, female and had more years of education. There were no differences associated with weight group. An additional 8% of respondents mentioned weight loss, obesity or dieting without recalling the element of lifestyle change.
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A second multivariate logistic regression (Table IV
, model 2) was carried out, including whether or not respondents said that they had watched any of the programmes (the so-called exposure variable), to see whether exposure to the televised material improved recollection of the content. These results (model 2) showed that exposure had a significant independent association with recollection of the lifestyle change message. People who remembered having seen one of the programmes were significantly more likely to recall the lifestyle change message and this effect was independent of the demographic predictors, suggesting that the TV programmes were effectively transmitting the message. Of course, it is another matter to determine whether better understanding of the message resulted in people either agreeing with it, or even more, acting on it.
The majority of those who had heard of the campaign, said that they were introduced to it through television (87%), with radio the second most reported medium (14%). Overall 29% remembered watching at least one of the FFFF television programmes, with women and younger people being more likely to have seen one. The most popular programme was Fat Free—a six-part series following five people who used different methods to lose weight. Figures from the Broadcasters' Audience Research Board (BARB) measuring TV audience size also shows that Fat Free was the most popular programme, followed by Body Spies and then Weight of the Nation (see Table V).
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Discussion |
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This study used a well-established, high-quality, national representative survey to establish awareness of, recollections of and active involvement in the FFFF campaign. The BBC had estimated that 5 million people would view some of the FFFF programmes and hoped to make 25% of the adult population aware of the campaign. Results from the present survey of 1894 adults suggested that the FFFF campaign achieved a penetration approximately double that expected, with over half of the respondents having heard of the campaign and 29% (equating to around 13 million adults) recollecting seeing at least one of the TV programmes. This awareness figure is confirmed in the BBC's `programme reach' survey using random-digit dialling which found that 62% of the people sampled said that they had heard of the campaign.
Almost a third recalled the campaign as being about healthy eating or increased physical activity, indicating that the campaign had been reasonably effective in transmitting the intended message of lifestyle change. As noted earlier, understanding a campaign message is clearly an important first step towards persuading people to make behavioural changes. However, correctly recalling the campaign message is quite different from agreeing with it or acting upon it. The current study did not assess the extent to which the FFFF campaign changed or confirmed people's attitudes about healthy lifestyles.
One advantage of television as a medium of health communication is that it may be more accessible than other media to less educated groups and could therefore minimize the usual socio-economic bias in health education (Macaskill et al., 1992). At the planning stage, the campaign was intended to appeal to men and women in the manual/unskilled non-manual groups, who tend to have higher levels of obesity. These were indeed the groups who saw more of the TV programmes. However, when it came to recalling the main message of the campaign, there was, as in most health education campaigns, a bias towards those with higher levels of education. Previous research on mass-media health campaigns has shown that campaign awareness, message recall and participation is usually greater among those in more educated, middle classes than in the lower socio-economic groups (Rissel, 1991; Moatti et al., 1992; Fonnebo and Sogaard, 1995; Freels et al., 1999). Whilst in the current study this result may be partly because the media reach of the BBC does not extend so much to lower socio-economic groups, the findings are consistent with the view that, unless programmes are specifically targeted at lower socio-economic groups, they will fail to reach those most in need of lifestyle change.
Generalization of these results is limited by the fact that the response rate for the survey was around 70%, although this is typical for the Omnibus surveys in the UK and similar surveys elsewhere. Comparisons with census data suggest that there is a slight under-representation of young people (aged 16–24 years) and those of lower socio-economic status, which reflects the general trend within survey data that these groups are less available or willing to participate in government surveys (Bost et al., 1997; Bajekal et al., 1999). Insofar as these groups were less likely to recall the programmes, this may mean that the overall campaign awareness statistics are slight over-estimates.
A second shortcoming was the use of self-reported weights and heights, which tend to result in under-estimations of weight, especially among women, and over-estimations of height, especially in men, which in both cases would tend to underestimate BMI. Comparisons with data from the most recent Health Survey for England (Department of Health, 1998), which uses measured weights and heights, suggests that this bias was shown in the present data. The average BMI in the present study was 24.7 in women and 25.3 in men, compared with 26.0 for women and 26.3 for men in the Health Survey for England. However, as the primary focus of the present study was broad socio-economic status differences in awareness and there was in any case little difference in reported awareness of the campaign in relation to weight group, the shortcomings of reported weights and heights are not likely to materially affect the conclusions.
The study has the advantage of using interviews rather than a questionnaire, so it is likely that there was a more accurate ascertainment of the answers. All respondents were asked about awareness of the campaign and whether they had watched any of the TV programmes. They were also asked about the message of the campaign without offering response options, so that recall, rather than recognition was assessed. The sample was also large and fairly representative of the UK population, so within the limits of the method, it would appear reasonable to conclude that campaign awareness was high and that around half of those who said that they had heard of the campaign knew what the message was. Of course, acting on this message is an altogether different matter.
Few mass-media campaigns have formally evaluated the degree to which they have reached their target population (Flay, 1987). Two, 1-day, television campaigns in Norway claimed a population penetration of over 90% (Fonnebo and Sogaard, 1990, 1995), although most other health promotion campaigns have reported considerably lower levels of awareness, broadly equivalent to the levels reported in the present study. For example, Fat Watch, a campaign to reduce fat intake in the Netherlands which included mass-media and supermarket-based advertising reported a population penetration of 60% in the target group of household shoppers for food (van der Feen de Lille et al., 1998), and a national mass-media campaign to increase walking in Scotland based on a television advertisement achieved a 70% awareness level following a 4-week campaign (Wimbush et al., 1998). In contrast to the present study, awareness of the latter campaign was higher in non-manual socio-economic groups, but calls to the campaign telephone line for further information were lower among these groups despite their higher levels of awareness. Furthermore, in both the latter study and the present one, the gap between campaign awareness and active participation was considerable. In the present study only 1% of those questioned sent off for the registration pack, while the Scottish study achieved a response rate of only 5%, suggesting that a large percentage of those who hear about health education campaigns do not feel moved to obtain more information. Furthermore, of the 17 respondents (fewer than 1%) who said that they had sent off for the registration pack, only three reported having returned their first registration card. Extrapolating from these small numbers to the British population as a whole, would suggest that around 400 000 registration packs would have been sent out and over 90 000 registration cards returned. In fact, the total number of pack requests received by the BBC was 265 804 with 34 281 registration cards returned. In view of the very small numbers who took part in the registration scheme, no statistical analyses were possible, but the pattern of responses seemed to run parallel to awareness of the campaign, as might be expected.
The people who appeared to gain least from the campaign were those from ethnic minority groups. The sample size was very small (although consistent with the proportion of ethnic minorities in the British population), so any conclusions must be tentative. The ethnic minority sample were as likely as the white majority to say that they had seen one of the TV programmes, but were significantly less likely to recall the message of lifestyle change. This issue certainly needs to be addressed in preparing future campaigns. The other groups left relatively untouched by the campaign were those who were overweight or obese. Despite them having strong reasons to find the material personally relevant, they were no more likely to have watched the TV programmes or correctly recalled the campaign message than normal weight respondents. Whether this is because the publicity failed to engage their attention or their lack of interest reflected a general tendency to attach a lower priority to material related to diet and weight, there must be concern that the campaign did not succeed in capturing the attention of the most needy group.
With these two caveats, the FFFF campaign appeared to be highly effective in publicizing the issue of lifestyle change, if not actually motivating mass action. The majority of the British population had heard of the campaign, many watched the TV programmes and most correctly recalled the lifestyle change message. On the present evidence, fewer than 1% actively participated, indicating a huge gulf between awareness and behaviour, but even if 1% of those who heard the campaign message made some changes in their lifestyle, then the campaign will have made an important contribution to the nation's health.
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Acknowledgments |
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Thanks to staff at BBC Education for providing information about the FFFF campaign. Thanks also to the British Heart Foundation and Weight Concern who provided financial support for this work.
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References |
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Received on March 18, 2000; accepted on September 24, 2000
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