Challenging Dogma - Spring 2008

...Using social sciences to improve the practice of public health

Friday, April 18, 2008

Limitations of Jump Up and Go! Campaign: Are Kids really Jumping to Lose Pounds? - Karen Potter

Jump Up & Go!, sponsored by Blue Cross Blue Shield of Massachusetts, emphasizes educating children on its “5-2-1 message”. This message includes, eating 5 servings of fruits and vegetables each day, keeping television, computer, and video game time down to less than 2 hours per day, and getting at least 1 hour of physical activity each day. The program promotes these behaviors by educating parents, clinicians, teachers, and children about healthy eating and physical activity. The program provides tools and activities for the classroom. Blue Cross Blue Shield initiated the program in 1998, and nearly 10 years later, obesity among children is still on the rise (1).

Jump Up & Go! fails to address some key social and behavioral factors that are linked to obesity. The program could be improved by incorporating an understanding of their social networks, an understanding their environment, and an understanding of how to empower children with self-efficacy.

Obesity is a serious health concern for children and adolescents. Overweight people are at much greater risk of developing type 2 diabetes, obstructive sleep apnea, orthopedic complications, renal disease, and metabolic syndrome (2). The prevalence of obesity is increasing for all ages as demonstrated by two National Health and Nutrition Examination Surveys (1976–1980 and 2003–2004). For children aged 2–5 years, prevalence increased from 5.0% to 13.9%, for those aged 6–11 years, prevalence increased from 6.5% to 18.8%, and for those aged 12–19 years, prevalence increased from 5.0% to 17.4% (3). Considering the increase in prevalence, negative health consequences, and the rise in obesity among children, public health groups need to focus and think more creatively about how to develop interventions that succeed.

Fails to consider social networks (4): Who are their friends and family?
Although the Jump Up and Go! campaign includes the active participation of many stakeholders and works within the school system, it fails to consider children’s current social networks and their friends and family. Having their parents, friends, and other family involved in the intervention and educating them as well is critical. The program is based on collaboration between parents, clinicians, teachers, peer leaders, community resources, and the children. There are tools available to each group to help support the intervention. The program is bringing the right people together to get involved, but it fails to consider who these people are and the children’s underlying social network. What if their friends or family members are obese? How likely are they going to be able to help motivate the children? Research demonstrates that having obese friends or family member greatly influences whether you become obese (5). Who are their peer groups and friends? This same research shows that children whose friends are also obese are more likely to be obese (5). Having obese social contacts might change a person's tolerance for being obese or might influence his or her adoption of specific behaviors. “Network phenomena appear to be relevant to the biologic and behavioral trait of obesity, and obesity appears to spread through social ties (5).”

Obesity is accepted, or rather the social-norm in some cases. Children behave like those around them. If the campaign was able to tap into this understanding, the positive habits, such as eating healthy and exercising could spread and encourage a decrease in obesity through social networks.  

Social Learning Theory focuses on the interaction between individuals and their immediate environment (6). Especially among children, Social Learning Theory could help better understand and work toward addressing the underlying factors of obesity. Having a clear sense of those people that the children directly interact with, both parents and fellow classmates, among others, is important. The campaign needs to go beyond the education approach, assuming that intention will lead to behavior change. By incorporating Social Learning Theory concepts, the program could focus on changing the behaviors of the individual children, but also those in their environment. It is important to give both groups the tools to achieve a social goal (i.e. weight loss or control in this case) that is desirable as well as positively reinforces this behavior change (6).

Fails to consider environment: What is available in school and what do they go home to?
Although this campaign includes family members, the main focus of the effort is in the schools. The intervention also encourages parents to come in and be a part of this learning in school. But the intervention fails to consider what is available in the school to support this education, such as healthy food options and time to exercise. Second, the Jump Up & Go! campaign fails to address availability of healthy food at home and other influential environmental factors such as access to safe places to exercise, parents’ work schedules, and access to healthy food.

The environment in school may be a problem, even though it is where the education is received. Despite receiving the support and education in the school system, what if in the cafeteria only offers unhealthy food? Or how much time are schools really spending on physical activity? Across the nation, physical education has declined. Physical education is squeezed out of the school day, which is a trend that parallels the national increase in childhood obesity (7).

Furthermore, the intervention does not address changing the behaviors or environment that the children go home to after school. What if their parents both work and it is easier to stick kids in front of the television? Many children have few options after school to do anything but sit in front of the television (8). Then, on television, children are exposed to advertisements about junk food. Junk food marketers spent an estimated $15 billion in 2002 on marketing aimed at children (9). Many children do not have access to physically safe places or healthy food options after school. Their family may not have the money to pay for fruits and vegetables or cannot access them easily (10). It really takes a more holistic approach to address the problem and to think beyond the school environment. For example, Somerville, Massachusetts experienced some early successes with a community-wide effort that includes working with restaurants, ensuring cross walks are available, and making school lunches healthier (11).

From the learning in school, children may have intentions to eat healthier and become more physically active, but if access is a problem in their schools and/or their home environment, the true success of the campaign is likely to be affected, as there are several barriers to implementation of the ideas communicated in the campaign.

Fails to understand self-efficacy: Do they believe they can do it?
The Jump Up and Go! campaign fails to look at the underlying reasons why children’s intent does not lead to behavior change, or specifically what reasons they believe they cannot execute the behavior to achieve the desired results. It does not address children’s individual self-efficacy. Self-efficacy is a person’s confidence that he or she can perform a behavior (6). In this campaign, the idea that the person believes he or she can execute the behavior is not considered and second, that the outcome expectation, or loss of weight, is not attained when they engage in the behavior but rather takes time to see the results. In short, motivating children to lose weight is hard.

The Jump Up and Go! campaign asks children to do a lot, including eat 5 servings of fruits and vegetables a day, and get two or few hours of screen time and one or more hours of physical activity each day (1). These changes, while good, do not take into account that it is a lot to ask someone to change all at once. In addition, telling a child to make these changes is not sufficient to make them see the benefits, which in most cases are far off, including prevention of health problems and diseases later in life.

In the first instance, in order to understand if the person can execute the behavior, the intervention should also address underlying causes of why they believe they can or cannot complete the behavior. Self-esteem issues are one of the underlying factors. For example, the lack of motivation, self-consciousness, and concerns about not being good enough are linked to reduced physical activity (12).

Tangible outcomes from obesity prevention take time. The outcome expectation is not attained when they engage in the behavior. Motivating children to lose weight is very hard. Kids want fun today, not tomorrow (13). Obesity and making progress against it does not happen overnight, so it is hard to see the results. Therefore, prevention campaigns need to think creatively about self-efficacy. How can programs, like the Jump Up and Go! campaign, ensure that children see tangible results or see the changes in behavior helping other kids or their friends? What is their reward for losing weight? Again, in order to promote self-efficacy, it is important to also consider Modeling Theory or Social Learning Theory (6). These theories suggests that if kids saw other kids losing weight or keeping the pounds off, or eating healthy or exercising more, they would be more likely to do the same, especially if they were already role models or leaders.

The time to prevent childhood obesity is now. Children who are obese are more likely to become obese adults. Starting with children is a good place to start so they develop healthy lifestyle habits from an early age. There is a 70 percent chance that overweight adolescents will become overweight or obese adults (14).

The Jump Up and Go! campaign focuses on children and is a step in the right direction but certainly could be improved upon if it were to further consider and address social and behavioral science principles including focusing on social networks, social environments, and self-efficacy which incorporate Social Networking Theory, Social Learning Theory, and Social Cognitive Theory. Currently the campaign attempts to educate the youth on healthy behaviors at a young age, which is positive, but mainly doing so in terms of a Rational-Empirical Model, assuming children, if provided the necessary information, will make a rational decision (6).
The campaign, in addition to focusing on education and involving key stakeholders, must take further steps to understand how and why children change behavior. It should consider who their friends and family are and move to teach by example. Children often model what they see. Education is valuable, but without changes to their environment and access, both in and outside the school will continue to be barriers to change. In addition, the program needs to address the idea that they can do it and change their attitude about self-efficacy.


1. Blue Cross Massachusetts. Jump Up & Go!., Accessed on 5 March 2008.
2. Amschler, D. The Alarming Increase of Type 2 Diabetes in Children. Journal of School Health, 2002.
3. CDC, Overweight Prevalence,, Accessed on 13 March 2008.
4. Lamendola, Bob, et al. Study Links Obesity to Attitude of Friends and Family Toward Weight, Knight Ridder Business News, 26, June 2007.
5. Christakis, Nicholas A. and Fowler, James, The Spread of Obesity in Large Social Network over 32 Years, The New England Journal of Medicine, 26 July 2007.
6. Edberg, Mark, Essentials of Health Behavior: Social and Behavioral Theory in Public Health, Jones and Bartlett Publishers, 2007.
7. Vicki Kemper, Schools are Skipping P.E., Los Angeles Times, 30 September 2003,, Accessed on 7 March 2008.
8. Glazer, Carol, Obesity is Not Just about Food, Boston Globe, 5 December 2005.
9. Mercola, Joseph, Four Ways Junk Food Marketing Targets Your Kids,, Accessed on 2 April 2008.
10. Sallis, JF, The Role of Built Environments in Physical Activity, Eating, and Obesity in Childhood. The Future of Children 2006, 2006.
11. Parker-Poe, Tara, Snack Attack: As Child Obesity Surges, One Town Finds Way to Slim; Somerville, Mass., Goes Beyond Schools to Push Exercise, Good Eating, Wall Street Journal, 10 May 2007.
12. GAO Congressional Briefing, Childhood Obesity: Factors Affecting Physical Activity,, Accessed on 21 March 2008.
13. Bloom, Marc, On Your Own: Running; Motivating Kids to Exercise Can Be Child's Play, New York Times, 8 February 1988.
14. United States Department of Health & Human Services, The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity,, Accessed on 21 March 2008.

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