The issue
The rates of overweight and obesity in Western Australia (WA) and the rest of Australia have been steadily increasing over recent decades (1). Most Australian adults have a BMI of 25 or above (66 per cent in 2022, up from 56 per cent in 1995), and one third (32 per cent) of Australian adults are considered obese (1). Additionally, many adults are not aware when they have overweight or obesity: nearly half (48 per cent) of adults with overweight, and 11 per cent of adults with obesity consider themselves to be ‘about the right weight’ (2).
Health impact and burden of disease
Risks associated with having a BMI of 25 and above combined with dietary risks now make up the largest contribution to the burden of disease, overtaking tobacco use (3). Having a BMI of 25 and above is associated with numerous chronic diseases, including type 2 diabetes, cardiovascular diseases, and thirteen types of cancer (4). In Australia, overweight and obesity are responsible for 8.4 per cent of the total disease burden (3). It is anticipated that increasing overweight and obesity, if not addressed, will cost Australia $87.7 billion by 2032(5).
The prevalence of overweight and obesity varies by location, with adults in metropolitan Public Health Network areas (PHNs) less likely to be overweight or obese compared with adults in regional PHNs (61 per cent vs 69 per cent) (4). While Aboriginal and Torres Strait Islander people have approximately the same rate of overweight and obesity as non-Indigenous Australians, they have much higher rates of chronic disease related to having overweight or obesity, such as diabetes and cardiovascular disease (6).
The campaign
In 2012 the WA Department of Health funded a dedicated Healthy Lifestyle Promotion and Education Program, LiveLighter® is the mass media campaign component of this program. The program aims to halt the rise of obesity in WA and to increase the number of WA adults adhering to dietary and physical activity guidelines. The LiveLighter® program is led by a mass media campaign, supported by material such as meal plans, healthy recipes, blog posts and other tools provided through the LiveLighter® website and social media.
Cancer Council WA works in partnership with the WA Department of Health on the program to develop and deliver the following community-level outcomes:
- Increase understanding of the risks associated with unhealthy choices.
- Increase awareness of the link between overweight and chronic disease.
- Support the trial, adoption and maintenance of healthy eating, physical activity and healthy weight.
- Encourage public debate about obesity and the need for changes in the environment, including regulation, to support healthy eating and physical activity.
Past campaigns
Over the past 12 years, the LiveLighter® campaign has run nine phases of state-wide television-led advertising, beginning with ‘Toxic Fat’ in 2012 to the most recent campaign phases in 2022-23, ‘Menu App’ and ‘Reverse’. To complement the television commercials, each wave of advertising is supported by a range of secondary media channels, including radio, out-of-home, and digital advertising. LiveLighter® targets WA adults aged 25-64 years old, with key secondary audiences including parents, Aboriginal and Torres Strait Islander people, people living in regional or remote areas, and people experiencing socioeconomic disadvantage.
Figure 1: An overview of the LiveLighter® campaign waves and evaluation phases
The impact
For mass media campaigns to be successful in achieving behaviour change, campaign funding needs to be sustained over a significant period of time (7). The comprehensive evaluation framework for the campaign has allowed LiveLighter® to secure ongoing funding, with post-campaign evaluations illustrating the significant and positive results of effective mass media advertising. The Centre for Behavioural Research in Cancer (CBRC) has coordinated the evaluation of the campaign since its inception. The first evaluation conducted was a cohort study comparing WA to the control state of Victoria. Since then, most campaigns have been evaluated using cross-sectional post-campaign surveys, except where a new creative has been launched, in which case a pre-post cohort study has been used (see Figure 1).
Sugary drink and junk food consumption
According to almost all evaluation measures used, the most successful campaign messages continue to be those that encourage people to reduce their intake of sugar-sweetened-beverages (SSBs). Over a third of Australian adults consume SSBs weekly, with almost 10 per cent consuming them daily (8). Encouraging people to drink fewer SSBs has been a key objective of the campaign, with the proportion of people who drank SSBs at least once in the past week decreasing significantly from baseline (60 per cent at baseline to 51 per cent in 2023).
As well as reducing sugary drink consumption, the LiveLighter® campaign also encourages people to consume less junk food. The ‘Junk Food’ campaign wave launched in 2016 and was followed by a decrease from baseline in the proportion of people who consumed takeaway food at least once in the past week (62 per cent at baseline to 54 per cent in 2016).
Knowledge of the link between overweight / obesity and chronic disease
Understanding the risks associated with particular health behaviours can be a strong motivating factor for behaviour change (7; 9). A key objective of the LiveLighter® campaign is to increase the awareness among WA adults of the link between having overweight and the increased risk of developing multiple chronic diseases. Although there are consistently high levels of awareness among the general public of the association between overweight/obesity and heart disease, type 2 diabetes, and fatty liver disease, fewer people are aware of the link between overweight/obesity and cancer. Since the introduction of LiveLighter®, this awareness has remained significantly higher than baseline at each evaluated phase of the campaign (41 per cent at baseline to 58 per cent in 2023).
Weight stigma
Research with Australian adults found that obesity prevention campaigns graphically emphasising the negative health consequences of excess weight (such as LiveLighter®) achieve higher message acceptance, argument strength, personalised perceived effectiveness and emotional impact than less hard-hitting campaigns (10). However, there is concern that these campaigns could increase weight stigma (11). It is therefore important to monitor and assess any potential unintended consequences of the LiveLighter® campaign.
Post-campaign evaluation and independent research have demonstrated that there is no evidence of increased weight stigma resulting from the LiveLighter® campaign, and measured attitudes towards people who are above a healthy weight have improved since the beginning of the LiveLighter® campaign. The proportion of people who agreed that ‘compared to those with a lower body weight, people with a higher body weight are more likely to; lack will power, have less energy, and have fewer friends’ is significantly lower than at baseline. A study dedicated to exploring potential unintended responses to the LiveLighter® campaign found no clear evidence of adverse impacts on assessed cognitive, emotional, behavioural, or psychological outcomes, such as internalised weight bias, anti-fat attitudes, self-esteem, and body dissatisfaction (Jongenelis 2019).
Policy
As well as encouraging behaviour change, public health mass media campaigns can influence the public’s and decision maker’s perception of policy initiatives. Support for various obesity prevention policy initiatives are assessed after each campaign wave. Public support is high for government-run public health mass media campaigns, such as LiveLighter® (90 per cent in 2023).
Following Phase 9 of the LiveLighter® campaign in 2023, the majority of WA adults were in favour of the government taking actions to support healthy lifestyles, such as
- Limiting the sale and marketing of junk food and sugary drinks in government buildings (70 per cent)
- Restricting junk food sponsorship of all sporting leagues, clubs, teams, athletes, and events by study phase (63 per cent)
- Requiring local governments to consider the health of their communities when deciding whether a new unhealthy food outlet should be approved (70 per cent)
- Regulating supermarkets so that the promotions, discounts and placements of food and drinks reflect those that support health (75 per cent)
- Taxing soft drinks to fund nutrition and health programs (68 per cent)
- Restricting unhealthy marketing at outdoor sites where children are present (78 per cent).
The challenges
The junk food and sugary drink industries (ultra-processed food industries) present a substantial challenge for healthy lifestyle programs and campaigns. Advertising for energy-dense, nutrient-poor products dominates traditional and digital media formats, with healthier foods relatively under-represented. These industries are prolific and in WA alone are likely to have spends in the tens of millions.
Public education campaigns like LiveLighter®, which use mass media marketing are also facing an increasingly fragmented media landscape, in which decisions around what media channels to use are not as straightforward as they once were. As the public turns towards digital media and away from free-to-air television, it is now more expensive than ever to broadcast public education campaigns with sufficient reach to achieve population-wide behaviour change (Durkin & Wakefield, 2018).
The increasingly fragmented media landscape gives the junk food industry an advantage, as they have greater financial ability to broadcast their messages widely. Public education campaigns such as LiveLighter® face an enormous challenge in competing against this industry, and therefore it is more crucial than ever to be strategic with media channels and produce ads that are highly engaging
The future
WA is the only Australian state, and one of the first places in the world, to design and implement a dedicated and ongoing healthy lifestyle promotion and education program. Overweight and obesity continues to be a significant health issue in Australia and worldwide. Healthy lifestyle campaigns underpinned by strong evidence, such as LiveLighter®, are a key piece of the puzzle to promote a healthy diet, and physical activity, alongside effective health policy, to support people to achieve and maintain a healthy weight. It is hoped that LiveLighter® can pave the way for future campaigns internationally that aim to address healthy eating, physical activity and overweight and obesity.
For more information about LiveLighter®, please get in touch with us at live.lighter@cancerwa.asn.au.
References
Durkin S, Wakefield M. CBRC Research Paper Series No. 49: Media use and trends and implications for potential reach of public education and motivation campaigns: application to tobacco control. Centre for Behavioural Research in Cancer, Cancer Council Victoria: Melbourne, Australia, December 2018.
Jongenelis, M. I., Morley, B., and Dixon, H. (2019). Perceptions of healthy weight and lifestyle campaigns. Confidential report prepared for Cancer Council Western Australia.