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SAN ANTONIO -- While both health education-focused messaging and a counter-marketing messaging approach reduced adults' intent to consume sugary drinks, the former invoked more perceived weight stigma among older adults, a randomized experiment showed.

On a 1-5 scale with lower scores indicating less intention to consume sugary drinks, health education messages (2.53) and counter-marketing messages (2.35) were more effective at meeting their goal than control messages about highway safety (2.80, P<0.001), reported Anna H. Grummon, PhD, MSPH, of Stanford University School of Medicine in California, at the ObesityWeek annual meeting.

The counter-marketing messages, however, elicited significantly less perceived weight stigma on a 1-5 scale (1.93) than the health education messages (2.36, P<0.001).

"Both health education and counter-marketing messages reduced intentions to consume sugary drinks, suggesting they both hold promise for changing behavior," Grummon said. "For older adults, health education reduced intentions more than counter-marketing but also elicited more perceived weight stigma," creating a "trade-off between effectiveness and wanting to avoid this unintended consequence."

"For young adults, we don't see that same trade-off," she noted. "Counter-marketing is just as effective as health education without eliciting as much weight stigma, suggesting perhaps this is an especially promising approach for this age group."

Sugary drinks increase risks of heart disease, type 2 diabetes, and obesity, and although consumption has declined in recent years, it remains prevalent. "On any given day, 60% of children and half of adults consume sugary drinks," Grummon told attendees. "Consumption is even higher among adolescents and young adults."

Public health campaigns typically use a traditional health education approach that describes the health effects of products or behaviors.

"This approach makes sense because a lot of us care about our health, so reminding us about the health harms of sugary drinks can and does change our behavior," Grummon said. However, past health campaigns about sugary drinks have often portrayed weight in a way that can be stigmatizing. An alternative approach is counter-marketing, such as the against smoking.

"Counter-marketing talks about health harms, but its real focus is on exposing deceptive, misleading, or harmful marketing activities used by corporations," Grummon explained. "The goal is to undermine the power of these activities by exposing them and get us to dislike the companies that use them and so want to avoid their products."

The success of the Truth Initiative and other counter-marketing campaigns has driven interest in using similar approaches for sugary drinks for two reasons.

"First, counter-marketing aligns healthy eating with values that we hold very strongly, like autonomy and social justice, and so this might motivate us to change our behavior because we care about advancing these values," Grummon said. "This might be especially important for young adults who tend to be more motivated by proximal outcomes like conserving their autonomy, compared to more distal outcomes like avoiding heart disease or type 2 diabetes."

A second potential advantage relates to weight stigma. "Weight stigma causes a whole host of negative physical and mental health consequences and also, unfortunately, tends to undermine healthy eating," Grummon noted, adding that since counter-marketing focuses on corporate behavior instead of weight, it's possible it might reduce some of the unintended consequences of stigma.

Bill Dietz, MD, PhD, of the Milken Institute School of Public Health at George Washington University in Washington, D.C., agreed that counter-marketing is a compelling approach for messaging about sugary drinks and other unhealthy food products.

"I think we've been beaten up on health too long," Dietz told 番茄社区app. "We know in adolescents and young adults that health is not a compelling reason to change behavior, so I think we need to look for more powerful incentives to change behavior."

For this study, the researchers recruited 2,169 adults to participate in an online randomized experiment in August 2023. About half the sample (49%) were young adults between the ages of 18 and 29; 71% were white, 12% were Black, and 11% were Latino. About a third (34%) had some college or less, and 36% had a household income below $50,000.

The participants were randomly assigned to one of three conditions. The control group viewed four neutral messages encouraging safe driving, modeled after the National Highway Traffic Safety Administration campaigns. Another group viewed four health education messages that discouraged sugary drinks for health reasons, and the last group viewed four counter-marketing messages that discouraged sugary drink consumption by exposing corporate behavior.

The health education messages highlighted the amount of sugar in the drinks and included messages like, "Don't pour on the pounds." Counter-marketing message examples included "Don't let the beverage industry make a profit by making you sick" and "Soda, sports drinks, and fruit drinks are loaded with sugar" because companies are "trying to get you hooked."

Participants viewed each message for at least 10 seconds and then answered questions about their intentions to consume sugary drinks and whether the messages promoted negative attitudes about people who have overweight or obesity.

Grummon noted that there is room for improvement in developing effective messaging since these messages were created specifically for the study and had not been extensively pilot-tested or vetted.

"We think that further investment in the counter-marketing messages could help them catch up or even surpass the health education messages in terms of their effectiveness, and could help us refine them in a way that would further lower their unintended consequences," she said.

Dietz agreed that effective campaigns will need evidence of a stronger impact before they could be adopted and implemented.

"The problem is that, as [Grummon] points out, these are modest effects and we need much more powerful ones if we're going to do counter-marketing," Dietz said. "That means looking at what is compelling for adolescents." Before actually developing a counter-marketing initiative, he added, "you need to understand what's going to compel behavior."

At the top of that list, he said, is climate change. Counter-messaging about sugary drink manufacturers' impact on climate change, such as farming for sugar-producing crops like sugarcane and corn, may be an effective approach that also does not increase weight bias.

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