Photo courtesy of CRUK

Healthy Debate

Campaigns to change public behavior often meet resistance. The UK effort to link cancer and obesity highlights the good and bad in provoking a little outrage. Brunswick’s Ben Hirschler reports

For the strategist behind a controversial campaign highlighting the link between obesity and cancer, Malcolm Clark had a surprising first job—as assistant to the managing director of a chocolate company.

It is an irony that says a lot about the complexities surrounding the sensitive subject of body weight and health. How do you inform people about the dangers of being overweight without coming across as a “nanny knows best” killjoy out to shame those putting on the pounds?

It’s not easy. Nonetheless, Mr. Clark and colleagues at Cancer Research UK (CRUK) took up the challenge two years ago with a hard-hitting campaign that delivered an emphatic message calling out excess weight as the second biggest preventable cause of cancer after smoking.

It was designed to drive home the point that government and corporations must do more, through policy changes, to reduce consumption of foods high in sugar and fat. And Mr. Clark reckons his time in business gave him valuable insights into the industry’s thinking.

The CRUK campaign certainly made a splash. The decision to position obesity next to smoking grabbed public attention and the media went to town delving into the links between obesity and 13 different cancers. That was exactly what the cancer charity had wanted, since its research showed that raising awareness of an issue and getting it talked about could create an environment where policymakers are forced to act.

In the UK, more than one out of every 20 cancer cases are caused by excess weight. This video from CRUK explains how obesity can lead to cancer.

But the campaign also triggered some strong criticism. Specifically, the blunt strapline in nationwide outdoor posters stating that “Obesity causes cancer” led to accusations that CRUK was “fat shaming” overweight people.

That was never the intention. In fact, CRUK was at pains to point out when lobbying politicians and businesses that obesity was not just an individual issue, since there are multiple environmental drivers at work. These include increasing portion sizes, an explosion of fast-food restaurants, advertisements for unhealthy food on TV and more sedentary lifestyles. All these factors can make it harder to be healthy, especially in areas of economic and social deprivation.

But by framing weight as the problem, rather than focusing on all the environmental factors, critics argued that CRUK was effectively telling people that cancer was their fault. Mr. Clark remains proud of the campaign, which won CRUK the Marketing Society’s Brave Brand of the year in 2019, but admits there are lessons to be learned.

“There were some unintended consequences and no one should feel they are to blame for cancer,” he said. “Obesity is a complex issue and there are many contributing factors. However, our starting point is simple: We are a cancer charity and we want to prevent cancer by reducing the risk factors involved.”

 

By framing weight as the problem, rather than focusing on all the environmental factors, critics argued that CRUK was effectively telling people that cancer was their fault.

One thing is clear: The campaign of outdoor posters, radio, print and digital advertising really did work to raise understanding. Awareness of the association between obesity and cancer surged from 17 percent before the first national campaign in 2018 to 43 percent after it. (By comparison, four out of five people knew of the link between cancer and smoking going into the campaign, while half recognized a connection to alcohol and a quarter to sunburn.)

Additional posters placed around Westminster helped CRUK raise awareness of the issue among members of Parliament to a consistently higher level than within the general population.

The initial evaluation found that 84 percent of people agreed the campaign had an important message, while a relatively small 8 percent found it offensive.

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A year later, the evidence-based campaign was back with even more attention-grabbing billboards—this time depicting giant cigarette packets in which the brand names had been replaced with the word “obesity.” The strapline was subtly moderated to read “Obesity is a cause of cancer too.”

CRUK also simultaneously published figures showing that four common cancers—bowel, kidney, ovarian and liver—were more likely in Britain to have been caused by being overweight or obese than smoking tobacco.

But the criticism moved up a gear as well, with a petition and an open letter to the head of CRUK from dozens of academics and nutritionists. They complained that the cancer charity was undermining years of public health efforts to address the harmful effects of weight stigma.

In a sign of strong feelings, some of the CRUK posters were defaced with graffiti saying things like “weight stigma causes shame, not health” and “anti-fat bias.”

“As an organization, we felt we had something important to say and were prepared to defend ourselves, which might have antagonized some of our critics,” Mr. Clark admitted. “We should focus on the many positives of the campaign, but we also have to accept that there were people who were genuinely upset. We got criticism and, if I’m honest, some of it was valid—especially where they did not see our wider policy-focused communications.”

So where do the campaigners for healthier diet and lifestyle go from here?

The facts remain the same. While there are other factors behind cancer over which people have no control—such as genetics and simply getting older—obesity is a preventable and growing problem. Some 23,000 new cases of cancer in Britain every year are already linked to excess body weight and, if current trends continue, almost four in 10 British adults could be obese by 2035, causing a cumulative 670,000 cases of cancer in the process.

Exactly how excess weight can cause cancer is not completely clear, although scientists believe it is linked to the fact that fat in the body can send out signals telling cells to divide more often, thereby increasing the chance of errors and risking the development of tumors.

What is in no doubt is that the highest health burden all too often falls on the most deprived in society, since unhealthy food is often cheaper and more visible, meaning families on low incomes can struggle to access healthy options.

The ultimate goal of the CRUK project is to promote meaningful policy changes in areas such as curbing junk food advertising in order to create an environment in which everyone can lead healthier lives. But Mr. Clark thinks that this more subtle message on policy did not come through as strongly as the simple headline linking excess weight and cancer.

“The real question is how can you talk about obesity and excess weight sensitively? Are there ways of doing it in a mass awareness campaign without causing offence to some people, even if that offence is unintentional? It is a question-mark.”

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Ben Hirschler is a Brunswick Senior Advisor based in London. He spent three decades at Reuters, where he was the agency’s senior pharmaceuticals correspondent.

Illustration: Franziska Barczyk

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