DECEMBER 2003

What, if any, is the relationship between marketing and obesity?

Shelley Rosen: There is no connection. McDonald's has an advisory council of doctors and it is fascinating when you hear the real experts talk about it. The obesity problem is about energy balance. It's not just what you're consuming, it's how you're expending it. So, it's an equation.

When it comes to children, there are two great concerns. One is, here in the United States, there are only two states -- Illinois and Texas -- that still have physical education in gym class. Second, because of Mr. Stranger Danger and safety issues, children cannot walk or bike to school anymore. They are driven to school. They don't have gym class, they come home to a latchkey situation, and often times are leading a sedentary life.

When you ask if obesity is a marketing and communications issue, the answer is no. It is an opportunity for marketers to help share and explain energy balance and what people can do about it, but you've got to look at both sides of the equation.

Robert Lawrence: I don't think there's been any smoking gun evidence of a connection. But Marian Nestle at NYU, who runs the nutrition program there, likes to point out that each year about $11 billion have been spent on persuading us to eat M&M's, Big Macs and drink Budweiser. The total marketing spending, when she reported on this for McDonald's, for example, was about $600 million dollars a year. For M&M's alone, it was about $70 million dollars a year.

The U.S. Department of Agriculture has a miniscule budget to inform people about the healthy food pyramid. The marketing of high-fat foods, particularly by the fast food industry, is contributing to the trend for more and more consumption of their products. I would assume they wouldn't put $11 billion dollars into it if they didn't think they were getting some positive return.

Colleen Fahey: Marketing, in general, helps people get, find or select what they want. So, marketing can help people find ways to fitness or to indulgence. It's a facilitator, and it equally can lead people to obesity or fitness, depending on how it's used.

Amy Myrdal: There's a huge relationship because any good marketer's goal is to sell more. And when we're talking about food, if you're selling more, and you've got more and more products in the marketplace, that means the average consumer is exposed to more and more calories each day.

We've seen an increase in obesity at the same time that we've seen an increase in the number of products available in the marketplace. We've seen this effect on both adults and children, but in children in particular. Looking at a national data set from the late '80s to the mid '90s, we've noticed that kids' calorie consumption has increased by anywhere between 80 and 200 calories a day.

Shari Aaron: There's a direct relationship between marketing and obesity, certainly over the course of the last five to 10 years. We've done a really great job as marketers to create products that are convenient, tasty, fun and provide a great source of comfort. While there have been many products created to support a healthier lifestyle or a healthier outlook on life, there are many signals that we give to the public that are anti-health oriented.

Many consumers are at fault for being "asleep at the wheel" when it comes to taking good care of themselves, but marketers are at fault, too, for the barrage of products that promote bad health. Marketers also are at fault for not holding consumers up to higher standards which could help them lead better lives. We are seeing that a good number of today's consumers are willing to hold companies more accountable for their actions -- so, regardless of who is at fault, companies need to pay attention to growing concerns and growing health problems.

Should marketers promote health and fitness among Americans, and if so, how?

Aaron: I think they promote health and fitness already. The carrots are out there; the running shoes are out there; the parks are out there; and the opportunities for sporting and health clubs are out there. Should we promote more health clubs? I don't think that's necessarily the answer. It's more about understanding where a consumer is on the health spectrum.

"When you ask if obesity is a marketing and communications issue, the answer is no." -- Shelley Rosen, McDonald's

Certainly providing support -- whatever that means to somebody on an individual level. There is 21 percent of the population that I call our "health activists." Those are people who identify themselves as caring about their health and promoting some sort of physical activity for themselves. But there's a good 45 percent of the population who are really more "health reluctant." Those are people who do not put their focus on physical activity and do not put a focus on choosing foods or opportunities to promote their health.

The message that you would give to a "health reluctant" would be very different than a "health activist," who actually have a whole different mindset than the "health reluctants." The "health activists" are also very optimistic-minded, they're very take-charge and they are overly stressed because they do a lot of things in their lives. So, a "health activist" would need a different type of message and different types of programs to help support them in the direction they're already headed.

Fahey: One fascinating marketer right now is the U.S. Centers for Disease Control, which has an incredible campaign about health and fitness called Verb. Its mission is to increase and maintain physical activity among tweens.

The program launched in midyear 2002, so it's still in its infancy. It ties in partners from the media and it goes through influencers -- teachers, boys' clubs, coaches, park districts, manufacturers and media -- to reach children with a message about healthy physical activity.

The partners include sports leagues, manufacturers like Wilson Sporting Goods, retailers as well as the Sporting Goods Manufacturers Association. We have also partnered with the media, including Sports Illustrated for Kids and Nickelodeon with its "Just Play" promotions. There's a website called Verbnow.com, which is aimed at children.
The ultimate goal is to combat childhood obesity, but the strategy is through healthy, active lifestyles.

Lawrence: We've seen how effective public service announcements are when they are required -- for example, one minute of public-service airtime for every six minutes of tobacco advertising. It was actually the tobacco industry that went back to the FCC and suggested no tobacco advertising on TV be done at all because they were being outgunned in that one-minute against their six minutes by very effective educational messages.

Quick service or fast food restaurants are trying to include healthier items. Probably the best example is Subway and what they've done with their low-fat and all-vegetable sandwiches. I remember a conversation with a senior person at Wendy's, who said that their salad bar was about 3 percent of sales and 4-1/2 percent of cost. They would love to offer healthier food choices to their customers but they were in the business to sell food and people were not taking advantage of what was being offered.

For example, the veggie burger that McDonald's began in test market areas, including several outlets in New York City, a portion of their very large advertising revenue going to inform the consumer about the benefits of reducing saturated fat would probably go a long way toward improving overall choice. And if indeed their profit margin on selling a veggie burger may even be greater than their profit margin on selling a beef hamburger, it would be in their interest. It's a little puzzling that we haven't seen more of that.

Myrdal: We should all take an interest in protecting the health of our consumers, because if we don't, we'll lose them sooner. The lifetime value of the consumer will drop because people will be dying earlier. That's a very stark comment to make, but it's the truth.

Marketers should be thinking about packaging foods and beverages in smaller portions, especially for children. They should be looking at options that are realistic for the calorie needs of a younger audience. In terms of promoting health, marketers could do more by using research. There are some companies, such as General Mills with its Cheerios brand, that are putting some strong research behind their marketing messaging.

But I don't think anybody is doing a really great job right now. Food marketers should be talking about fitness, but not outside the context of also talking about calories. It's a little deceiving to say to folks to eat whatever you want as long as you exercise because it's a lot easier to not eat 500 calories than it is to exercise off 500 calories.

Rosen: Brand leaders -- such as Microsoft, Coca-Cola, Nestle, McDonald's -- owe it to society to promote health and fitness because our brands are so powerful. We have an opportunity to send the right message, to demystify the mysteries of health and fitness.

"Consumers are at fault, but marketers are at fault too." -- Shari Aaron, Yankelovich

We have to simplify it, make it easy to understand, easy to get, and easy for people to realize that they could eat one less cracker a day and save 200 calories. They could take the stairs. Instead of driving around the grocery store parking lot ten times waiting till that spot in the front is open, they can park a little farther away and get their fitness in. It's really not that hard, but we have to demystify it.

What is your organization doing to address this growing public issue, if anything?

Lawrence: We at the Center for a Livable Future at Johns Hopkins, in collaboration with the Meatless Monday Campaign, are attempting to draw attention to the fact that the Surgeon General's recommendations and Healthy People 2010, are that Americans should reduce their intake of saturated fat by 15 percent by the year 2010. And it turns out that one day a week conveniently equals about 15 percent.

We need to get people to think about their dietary intake and start the week off with choices that are low in saturated fat -- in other words, non-meat products -- that this will be a good way for people to begin thinking about moderation.

It doesn't demand that people become vegetarians. It just points out that our current consumption per capita of meat in the United States is approximately twice what we really need from a protein point of view and many times greater than that from a saturated fat point of view.

Myrdal: Dole has been committed to nutrition education for children since the early 1990s, as part of the national 5-A-Day For Better Health program. Since 1991, we've been providing free nutrition education materials to elementary schools. We get teachers interested in using these materials by giving national awards and recognizing teachers who are helping us in this effort, for example.

We're also doing more and more work with school foodservice professionals to help improve the school foodservice environment and to recognize school foodservice professionals who are going the extra mile. Cafeterias are the only source of revenue for most districts and there's a lot of pressure for school foodservice directors to generate revenue. If they can do that, in addition to keeping the best health and nutrition interest of the students in mind, we feel they should be commended.

We've recently established the Dole Nutrition Institute, which is a non-profit foundation funded by our privately held company that is looking at research into what is in fruits and vegetables that causes them to be so healthful and beneficial. And we're going to be launching employee wellness programs in a few weeks so that our own employees are better educated, motivated, and working in environments that support more healthful choices.

Fahey: We handle the Verb accounts. So Saatchi Kid Connection, Publicis Dialogue and Frankel -- all partners in the Publicis network of agencies -- are working together on this. It's a collaborative effort because children's lives are very active and their media consumption and the ways to touch them and reach them are broader than broad. So together, we bring our expertise to reaching them in a collaborative fashion.

Aaron: We are studying consumers and health even more in-depth today -- we understand their differences, and are help marketers make stronger connections to their targets on a more individual level. We have a MindBase segmentation, which goes down to a household level. This helps marketers understand where their consumers are on the "health spectrum." With this more detailed understanding of the mindset, values and expectations of consumers, we can help clients determine who their best customers are, what the best products should be and can also help brainstorm and create ideas and programs to help them move their target along in a healthier direction.

We also are very active in pushing marketers to develop stronger health initiatives. We believe that this country is just on the cusp of addressing these obesity concerns. So, we're using our marketing smarts, our 30 years of connecting with consumers, and our 30 years of working with clients, to push them in the new products realm and not just products. We believe that you've got to address consumers' mindsets about themselves, their attitudes about where they are today when it comes to nutrition, food and health -- it's the attitudes that are precursors to behavior. We have gone from 25 messages in the media a week to over 1100+ a week -- we have only just begun to get consumer's attention -- this issue will be of growing importance as Boomers age and Xer and Echo Boomer Parents turn more of their attention to these issues.

"Food marketers should be talking about fitness, but not outside the context of calories." -- Amy Myrdal, Dole

Rosen: McDonald's Corporation has always been committed to the wellness of children and families everywhere we do business. That's not just because of our Ronald McDonald's charities, but we have been marketing, if you will, and sharing information on nutrition and wellness since the early 1970's.

We now know that this is the social issue of the 21st century. What we want to do is align our efforts to help do our part. Seventy-six percent of all meals are still consumed in the home and there are 870,000 restaurants in the United States of America. McDonald's has 13,000. McDonald's, as a brand leader, is going to do its part. But the reality is that many, many decisions on what people eat and how they live their lives are occurring in the home.

Within the context of that, we are going to organize our efforts in three key areas. We are going to increase menu choices. We already have a lot of choice, but we are going to increase menu choices in the fresh category and talk about the quality of food and what it really means.

We're also going to organize efforts around physical fitness and finding simple ways for kids and families to get out and move. Take your kids for a walk before dinner, get some fitness in your life. We will use our proprietary sports sponsorships as well as local heroes to make this story come alive because we need to make it fun. Finally, we are focusing on educating moms, kids and families -- specifically on nutrition, energy balance and menu choices -- to lead a healthier lifestyle, both in our restaurants and outside in the community, as well.

Which brands are doing the best job of marketing health and fitness among Americans, and why?

Myrdal: I just saw a McDonald's ad this morning for their Happy Meals for adults, including the pedometers, the premium salads, and the water bottles. I have to commend them. I think they've gotten a lot of hits for the premium salads because of the high-fat content of their dressings. I think if they cut back the portion size of the dressing, they could do a better job there.

Wendy's has been kind of a leader in this when they started with the salad bars, back in the '80s, and giving people the option to choose things like baked potatoes over French fries. They haven't gotten a lot of credit for it, but they've certainly had menu options that have been healthful. Chick-Fil-A has done a really good job, and they've been one of the leaders in providing nutrition information at point-of-purchase in terms of having brochures readily available.

Fahey: Gogurt found a way to make yogurt more portable, more fun, that you can squeeze it out of a tube instead of eating it with a spoon. It's perfect. It could be even more fun, but it's a great step in the right direction.

Another one like that is milk. When they took milk out of a big white carton that was too big to pick up and put it into brightly colored milk jugs -- that was fantastic. Once again, that could be made even more fun, but it's a great step in the right direction.

You also have cheese becoming cheese heads and string cheese and so forth. I'd like to see someone do something like that with grapes and carrots -- I don't think it would be that hard.

Rosen: There are so many wonderful brands that are marking the performance side of fitness -- the Gatorades of the world, the Nikes. They're really talking about the power and the ultimate fitness goals. That's outstanding. I would like to see more marketers democratize it and make it for the "everyman" to participate, and to me that's what's missing. And that's why we're so excited about it.

Lawrence: Subway has clearly done a very good job with promoting their low-fat items and celebrating the few people who have in fact used regular Subway fare to go on a reduced diet. Boca Burgers is doing a good job with its soy protein, hamburger alternative.

The organic food production movement has gotten a big boost from Whole Foods. I'm not aware of their national campaign, but certainly in the mid-Atlantic area, they've done a really good job of promoting across the board, food products that have been raised without a lot of pesticide, herbicide, other synthetic inputs.

"Food marketers should be talking about fitness, but not outside the context of calories." -- Amy Myrdal, Dole

Aaron: As a mother of two boys, as a shopper, and as somebody with a "health activist" mindset, I would challenge them all that they could be doing a better job. I don't feel that there's one path or one company that's really got it right yet.

I can see a lot of companies taking positive steps in that direction and applaud them for that. Coke has given pedometers to middle school students so they can begin to measure the number of steps they take in a day. I noticed when I was at the counter at Subway that they had a little message posted where they were talking more about kids and fitness.

Anybody in the sports category who is selling sports equipment -- the Warriors and the lacrosse folks of the world who are selling my kids lacrosse equipment and engaging them to get out there and be active -- should also be commended.

Does your organization view this issue as more of a problem or an opportunity?

Lawrence: We actually view it as both a problem and an opportunity from a health perspective. Clearly, the opportunity is to improve the quality of the American diet, to continue to move people toward a healthier diet, to regain some of the momentum that we had 25 years ago, when the first real connection was made between elevated cholesterol, the intake of animal fats, and the epidemic of coronary artery disease that we were experiencing at that time.

There's been very good progress. We've had decreased incidence of cardiovascular disease. However, it continues to kill about 500,000 Americans each year from sudden death related to rhythm disturbances and other acute consequences of coronary artery disease, and then another 500,000 Americans each year experience a myocardial infarction and survive it. It continues to be the leading cause of death for all Americans.

The problem is a health problem. The opportunity is to connect improving the diet with protecting the environment. Because if we are successful in reducing the total amount of meat consumed then we will slow and maybe even reverse the spread of industrial animal production facilities around the country that are doing so much damage to our surface waters and introducing antibiotic-resistant organisms that can cause human disease.

Aaron: I'm ever the optimistic person so, of course, I'm going to say it's more of an opportunity. What's past is in the past, and we got to where we were for certain reasons in ourselves, both as a marketer and in our personal lives. I see a lot of great progress that both companies and consumers are making. I'd like to think that we could all work together to get us to a healthier place a year from now, two years from now, and down the road.

Rosen: We view it as an opportunity because people are ready to listen. People want to know what they can do -- they really do -- and we want to help. We want to be a gateway of information and potentially an inspiration to help people change their lives. We see everything at McDonald's as an opportunity, given our size.

We care a lot about kids. In the U.S., we're testing a product called apple dippers; we're making it fun for kids to eat fruit. It's apples in a bag for a dollar with some caramel dipping sauce that's fun for kids to eat. We're launching milk products. If we can make it fun to eat fruits and vegetables and understand the food pyramid, that is really exciting.

Fahey: There's a great opportunity, especially when you talk to moms. They want to be able to provide a higher level of healthiness in foods to their kids. One problem is that healthy foods have lagged in terms of looking for ways to be exciting and appealing to children. There has been a dichotomy between 'virtuous' food and making it fun.

"We need to get people to think about their dietary intake and start their week off with choices that are low in saturated fat." -- Robert Lawrence, Johns Hopkins

Firms who have, what you might call "virtuous food" communicate the virtue instead of assuming the virtue and finding ways to make it fun and giving it value beyond its nutritional value. We need to encourage companies that sell fruits and vegetables, and soy and wheat germ to try to think what is pure fun and entertaining.

The fun foods also have an opportunity to market health and fitness, as so many people are looking to harmonize being healthy with having food appeal. It's an opportunity to find ways to make, for example, "apple French fries." But they're not fried, there're just apples. That needs to be explored.

Myrdal: It's actually created more opportunities for us because of our heritage in 5-A-Day, and because we've recently become a privately held company with a very vocal chairman and owner who says we want to be a leader in nutrition and health. We want to be the leader in helping people find more healthful solutions and become more physically active.

So, a lot of retailers have come to us and said, you know, what ideas do you guys have, how can you work with us, how can you help us lead consumers to more healthful products? It's been fun for us to have some of these conversations with big retailers.

Retailers are all looking for that competitive edge. They can no longer compete on price, so they've got to look at what they can do in terms of community service and the nutrition and health is becoming a larger and larger community service issue and opportunity for them.

Any additional thoughts?

Myrdal: We've been doing a lot of tracking of policy issues recently and we're very hopeful that Congress is going to be supportive of legislation that improves the nutrition environment in places like public schools -- congressional support to back those industries that are offering the most healthful products.

I'll give you one specific example. The Undersecretary of Agriculture, Eric Bost, has put together a package for Congress without increasing his budget, which is about $42 billion. He has said, let's motivate the schools to offer more healthful options. Let's not dictate what they serve. Let's let them choose, on a local level, what's appropriate for their student bodies.

But if they start offering more fruits and vegetables, more bottled waters, fewer soda and high sugar drinks, more low-fat or non-fat dairy options, let's give them a higher reimbursement rate. Let's make it worth their while financially to use the most healthful options, which often times do cost a little bit more. So, it's a phenomenal public policy step in the right direction to give our nation's children a chance at choosing healthier foods. And it also gets around the reality that schools have that pressure to generate some revenue.

Aaron: We've noticed that the definition of health is changing. Echo-boomers and X-ers have a much different definition of health and what it means to take care of themselves versus boomers and seniors. Companies have to realize what this new health definition is. It's not just your blood pressure -- it's your mind-set, it's your reaction to stress, it's spirituality in your life, and social connections.

Rosen: My vision of this is one of collaboration. If we can focus on collaborating with other corporations and industries, then we can do even better to further advance the right messaging. We can tell the story about energy balance, and all the goodness that everybody is offering in their portfolios -- whether it's whole meal replacement or in a box or a coffee cup.

It's a story about balance and helping people demystify the truth of what it is that we can to do to lead a healthy life. We've been working with a doctor, Dr. Dan Baker, who has spent years studying happiness. His philosophies and studies say that happy people live 7 to 10 years longer because of their attitudes. Well-being and leading a healthy well-balanced life is just as important as what we're putting in our bodies.

Lawrence: If we were able to line up enough food producers and food sellers in a campaign that would link healthy diet with fitness and doing something about the current obesity epidemic, it could be a really wonderful opportunity for some companies that would be linking their products to healthy diets.