CHAPTER 11
PUBLIC OPINIONS AND ACTION ABOUT DIET, WEIGHT, NUTRITION, AND PHYSICAL ACTIVITY

We find that, contrary to the views of health experts, most Americans are not seriously concerned with obesity, express relatively low support for obesity-targeted policies, and still view obesity as resulting from individual failure rather than environmental or genetic sources.—J. Eric Oliver and Taeku Lee, Public Opinions and the Politics of America's Obesity Epidemic (Cambridge, MA: Harvard University, 2002)

To date, the United States is losing the battle against overweight and obesity. More Americans than ever before are overweight and obese, and by their own admission, more people are gaining weight than losing it. Gallup Poll data collected in July 2003 revealed that more than one-third of Americans said they had gained "a little" weight, and 9 percent admitted they had gained "a lot." Although Americans spent in excess of $40 billion on weight-loss products and programs during 2003, just 7 percent of the survey respondents said they had lost "a lot" of weight, and 11 percent said they had lost "a little" weight. While the proportion of persons who gained weight was essentially unchanged from the previous year, fewer reported weight loss in 2003 (18 percent) than in 2002 (21 percent). (See Table 11.1.)

Weight gain occurred throughout the United States with few differences among persons of various demographic groups. Comparable percentages of men (43 percent) and women (46 percent) reported gaining weight; however, older adults (age sixty-five and older) were less likely to report gaining weight (36 percent) than were persons aged eighteen to twenty-nine (42 percent) and adults aged thirty to sixty-four (47 percent). (See Table 11.2.)

Survey respondents with a high school education or less were somewhat more likely to report weight gain (50 percent) than were those who had obtained advanced education. Similarly, persons with less than $20,000 a year in household income were slightly more likely to admit they had gained weight than persons who earned $75,000 a year or more. However, the difference—just 5 percent—was

small. (See Table 11.2.) In "More Americans Gaining Than Losing Weight" (Poll Analyses, Gallup Organization, August 21, 2003), David Moore asserted that the Gallup data reinforced the conclusion that "gaining weight occurs at roughly similar rates among most groups of Americans."

Unfortunately, persons most in need of weight loss—those who are already overweight—were more likely than those who reported normal ("about right") weight to have gained weight during the five years preceding the poll. Table 11.3 reveals that people who described their diet as "very healthy" were much less likely to report gaining weight (33 percent) than respondents who said their diet was "some-what healthy" (47 percent) or "not healthy" (50 percent).

Interestingly, self-reported health status was not directly linked to weight gain. Forty percent of respondents who rated their health as "excellent," 47 percent of those who termed their health "good," and 45 percent of

those who rated their health as "fair" or "poor" said that they gained weight. (See Table 11.3.)

DO AMERICANS ACCURATELY ASSESS THEIR WEIGHT?

Although public health officials have declared an epidemic of overweight and obesity in the United States, many Americans who are overweight apparently remain unconvinced that their body weights are excessive. Fred Kuchler and Jayachandran Variyam examined discrepancies between American adults' weight status and their perceptions by comparing self-reported height and weight data and individuals' assessments of their weight. Kuchler and Variyam published their findings in "Misperceptions in Self-Assessed Weight Status Vary along Demographic Lines," (FoodReview, vol. 25, no. 3, Winter 2002).

The investigators found that among persons who were overweight but not obese (those with body mass index greater than 25 but less than 30) more than 40 percent did not perceive themselves as overweight, instead considering

themselves "about right" or underweight. Among persons who were obese based on BMI (BMI equal to or greater than 30) 13 percent felt they were normal weight or underweight. (See Table 11.4.) The investigators found that while women were more likely to accurately assess their weight status than men were, they also were more likely to consider themselves overweight when they were not overweight (BMI less than 25).

Kuchler and Variyam classified survey respondents in terms of the accuracy of their perceptions about their weight. Persons who were overweight or obese and described themselves as overweight were termed "realists," persons of healthy weight who said their weight was about right were "practical." "Doubters" were those who were overweight or obese but characterized themselves as healthy weight or underweight, and persons of healthy weight who considered themselves overweight as well as underweight individuals who described themselves as healthy or overweight were described as "anxious." The investigators found that the accuracy of weight assessment varied along demographic and socioeconomic lines, with increasing education associated with a decrease in the percentage of "doubters" and an overall improvement in accuracy attributable to increases in "realists," and "practicals," despite a higher percentage of respondents classified as "anxious." (See Table 11.5.)

Table 11.5 also displays variation in perception along racial and ethnic lines. The majority of Asians was found to be "practical," while non-Hispanic blacks included more "doubters" and fewer "anxious."

Attitudes and knowledge about diet, nutrition, and body weight also varied among the four groups. Interestingly, the largest proportion of women who believed the "gene theory"—that an individual's weight status is predetermined, and as such, not within an individual's ability to control—were "realists." However, "realists" also predominated among men and women who disagreed with this premise. (See Figure 11.1.) "Realists" were also the largest proportions of men and women who believed that it was not important to maintain a healthy weight. Among men and women slightly more "realists" than "practicals" considered it important to maintain a healthy weight. (See Figure 11.2.)

Women who were aware of the health risks and problems associated with overweight assessed their weight more accurately (the largest proportions were "realists" and "practicals") than those who were unaware of weight-related health issues. Among men a much larger proportion of those aware of weight-related health issues were "realists," but the unaware group included more "practicals." (See Figure 11.3.) In terms of knowledge about the relationship between diet, weight, and health, the proportion of "realists" increased with increasing knowledge. (See Figure 11.4.) These findings suggest that those most likely to make use of information about the relationships between diet, weight, and health are already reasonably knowledgeable about these issues.

The investigators concluded that a variety of health education and intervention programs are needed to reach the various subgroups of persons who are overweight and obese. For example, until "doubters" are convinced that they are overweight, they are unlikely to respond to health education programs emphasizing the relationship between health risks and overweight. "Realists" may pose the greatest challenge to health educators, since many already know about the relationship between overweight and health problems but believe that change is unimportant or impossible.

Americans' Changing Shapes and Sizes

The results of a national size survey confirmed that Americans are not only getting heavier but also have changed in proportions. The "Size USA" project is an anthropometric (the study of human body measurements, and comparisons of these measurements) research study that gathered measurements of more than 10,000 people across the United States. Using a three-dimensional body scanner, researchers compiled measurements and analyzed them by gender, age groups, and four ethnicities as well as geography, annual household income, marital status, education, and employment status.

The survey was performed to assist apparel manufacturers to produce clothing that will offer a better fit to more consumers. In "Sizing Up America: Signs of Expansion from Head to Toe" (New York Times, March 1, 2004), Kate Zernike reported that the last such national survey of Americans was performed in 1941 by the United States Department of Agriculture (USDA). The USDA survey described the average American woman as a size 8, with a 35-inch bust, 27-inch waist, and 37.5-inch hip circumference. The 2003 Size USA survey found that the average white woman's bust, waist, and hip measurements in inches were 38-32-41 for women aged eighteen to twenty-five, and 41-34-43 for women aged thirty-six to forty-five. On average black women measured 43-37-46, Hispanic women 42.5-36-44, and an "other" category, composed primarily of Asian women, measured 41-35-43. Based on the Size USA survey, the average American woman wears a size 12 or 14 rather than a size 8.

American men have also increased in size. The size 40 regular, which measures 40-inches at the chest with a 34-inch waist, 40-inch hip, and a 15.5-inch collar, once considered the average, would be too small for many American men. The 2003 Size USA survey found that white men aged eighteen to twenty-five had a 41-inch chest, 35-inch waist, 41-inch hips and a 16-inch collar, and older white men, aged thirty-six to forty-five measured 44-38-42. Black men measured an average of 43-37-42, Hispanic men 44-38-42, and an "other" category, composed primarily of Asian men, measured 42-37-41.

Interestingly, measurements did not vary significantly by geography, education, or even income. The most significant variations in body shape were attributed to race, ethnicity, and age. For example, 11 percent of white women were described as having protruding stomachs compared to 3 percent of Hispanic women and 4 percent of black women. More Hispanic women (20 percent) were described as having "full waists" than white (10 percent) or black (15 percent) women. Nearly one-quarter of black men were described as having a "prominent seat" compared to 9 percent of white men and 8 percent of Hispanic men.

The study concluded that along with expanding waists, American men over age forty-five were most likely to have increased abdominal girth—"pot bellies"—and women older than thirty-six were most likely to have big hips. Nearly 20 percent of men were described as "portly" and another 19 percent had "lower front waists," meaning their waists were below their overhanging bellies.

Many Americans Deny Being Overweight

When Size USA participants were asked how they perceived their weight, more than half of the men (51 percent) and 38 percent of women described themselves as at "about the right weight." Just 10 percent of men and 21 percent of women said they were "quite a bit overweight."

A Gallup Poll conducted November 3–5, 2003, found that while 55 percent of Americans surveyed were overweight or obese as measured by BMI, just 41 percent said they considered themselves as either "somewhat" (37 percent) or "very" (4 percent) overweight. Figure 11.5 shows

that according to BMI more men (68 percent) than women (43 percent) were classified as overweight or obese. An analysis of historical trend data found that more Americans reported that they were overweight in 1990 than 2003, even though the percentage of overweight and obese Americans increased between 1990 and the end of 2003. (See Table 11.6.)

Although more than half (53 percent) of the population group known as "baby boomers"—adults aged thirty-nine to fifty-seven—consider themselves either "somewhat" or "very" overweight, even this group underestimates the problem, since the Centers for Disease Control and Prevention (CDC) estimated that 67 percent of Americans were overweight or obese in 2003. According to Gallup data, "baby boomers" and adults aged fifty-eight to seventy-four reported the highest percentages of overweight, 53 and 57 percent respectively, while 30 percent of younger adults (aged eighteen to thirty-nine) reported that they were overweight and the 30 percent of persons aged seventy-five and over said they were overweight.

In "Majority of Boomers Say They're Overweight" (Gallup Organization, June 17, 2003), Rick Blizzard observed that Gallup survey data indicated a direct relationship between self-reported personal health status and weight among adults. Forty-two percent of respondents who described their weight as "about right" also termed their physical health as "excellent" compared to just 13 percent of people who admitted that they were "very overweight." Respondents who said they were "very overweight"

were more likely to describe their health as "fair" or "poor" (44 percent) than those who defined themselves as "somewhat overweight" (24 percent), "about right" (15 percent), or "underweight"(27 percent).

In 2003 the desire to lose weight was at an all-time high—nearly twice as many adults (60 percent) said they wanted to lose weight in November 2003 compared to 31 percent in 1951. (See Table 11.7.) Still, the desire to lose weight does not necessarily translate into action. Table 11.8 shows that only 9 percent more adults were seriously attempting to lose weight at the end of 2003 than in 1951. Although most of the overweight and obese respondents to the November 2003 poll said they wanted to lose weight, less than half (36 percent of those who were overweight and 45 percent of persons who were obese) were making an effort to do so. (See Figure 11.6.)

Mothers May Not Accurately Gauge Children's Weight

Parents play a pivotal role in terms of preventing childhood obesity by shaping their children's early eating and physical activity habits. Investigators at the University of Cincinnati College of Medicine, Department of Pediatrics and Children's Hospital Medical Center, Cincinnati, Ohio, observed that frequently mothers of overweight preschoolers appeared unaware of, or unconcerned about, their children's weight. To explore mothers' perceptions about how they determine when a child is overweight, why children become overweight, and barriers that prevent effective treatment of childhood obesity, Anjali Jain and her colleagues conducted group interviews with low-income mothers of pre-school children (twenty-four to sixty months old) who were overweight

and determined to be at-risk for obesity. They reported the results of these structured interviews in "Why Don't Low-Income Mothers Worry about Their Preschoolers Being Overweight?" (Pediatrics vol. 1,007, no. 5, May 2001).

The investigators found that unlike health professionals who assess children's weight status by plotting height and weight on standard growth charts, mothers were more likely to express concern about children's overweight when their children were teased by peers or unable to participate in physical activities. The mothers did not consider their children overweight if the children were active, had a good appetite, and ate a healthy diet. Instead of describing their children as overweight, mothers described them as "thick," "strong," "big-boned," or "solid". The mothers interviewed also believed that an inherited tendency to be overweight, in terms of inherited metabolism or body type, practically guaranteed that the child would become overweight regardless of environmental factors. Given this perception, it was not surprising that the mothers believed they were unable to affect a child's biological predisposition to be overweight.

AMERICANS' ATTITUDES ABOUT OVERWEIGHT

Despite escalating media coverage of overweight and obesity, and their associated health risks, many Americans do not appear to be overly concerned about overweight and obesity—their own or others'. They demonstrate little support for policy initiatives intended to prevent and combat obesity, and persist in the belief that obesity results from individual personal failings rather than a combination of genetic and environmental factors.

Taeku Lee and J. Eric Oliver examined prevailing sentiments about weight-related issues in Public Opinionsand the Politics of America's Obesity Epidemic (Cambridge, MA: Harvard University, 2002). Lee and Oliver sought to characterize Americans' attitudes about obesity to determine how attitudes and beliefs affect support for obesity-related policy changes. They asserted that the concept of "moral failure" is at the root of public opinions that hold obesity as a personal choice and responsibility. They posited that obesity violates the valued American trait of self-reliance. Characterizing persons who are obese are as lazy, undisciplined, and lacking self-control enables the public to hold them responsible for their condition, and may be used as justification for bias and discrimination. The authors also posited that when obesity is understood as resulting from a lack of individual motivation, there will be little support for policies such as government regulations, civil protections, or taxes to prevent and decrease it.

Lee and Oliver observed that because obesity in America is a relatively recent phenomenon, public opinions about it are still forming, and most proposed policy changes such as taxes on sugary or high-fat snack foods, strengthening civil protections for persons who are obese, and increasing access to, and availability of public land for exercise are unsupported or actively opposed by a majority of Americans. In contrast, growing support exists for measures to regulate food advertising to children and provision of more nutritious school lunches. The authors attributed lack of enthusiasm for policy changes to low levels of awareness of the severity and scope of the problem as well as deeply held negative stereotypes about persons who are overweight and obese. They assert that as Americans learn that the rapid rise in obesity during the past two decades did not result from moral failure they will be more inclined to advocate policies aimed at preventing and reducing obesity.

Research conducted by the Grocery Manufacturers Association reinforced Lee and Oliver's finding that Americans are inclined to blame obese people for their condition. The 2002 survey reported that 89 percent of Americans believe that individuals are to blame for being overweight, and just 5 percent attributed obesity to environmental or genetic factors. In an online editorial, "It's Your Fault" (http://www.obesity.org, February 7, 2002), American Obesity Association executive director Morgan Downey lamented that "The moral judgement of laziness, lack of self-control, weakness even extend to denying obesity is a disease. Thus, obesity is not so different from other diseases that are modifiable by personal behavior. But our reaction to it is. Its principal feature may be that we suspend the compassion we normally feel."

The view that overweight and obesity are matters of personal responsibility is reflected by the overwhelming public sentiment that the fast-food industry is not responsible for the obesity epidemic. A Gallup Poll conducted July 7–9, 2003, found that 41 percent of Americans believe the

fast-food industry is "not responsible at all," an additional 25 percent consider the industry "not too responsible," and 27 percent said it bore "some responsibility." Just 6 percent said the industry was "very responsible" for consumers' weight problems. (See Figure 11.7.) Further, 89 percent of Americans opposed holding the fast-food industry legally responsible for weight- and diet-related health problems of persons who eat fast food regularly. (See Table 11.9.)

Increasing Awareness of Obesity Risks

A national poll conducted by Lake Snell Perry & Associates, Inc., from May 28 to June 1, 2003, for the Harvard Forums on Health, a project of the Harvard University Interfaculty Program for Health Systems Improvement, found that most Americans (79 percent) were aware that obesity is a pressing health problem in the United States today. Further, about eight in ten Americans appreciate that obesity increases the risks of heart disease (86 percent), hypertension (86 percent), and diabetes (78 percent).

Despite their understanding of obesity as a health risk comparable to cigarette smoking, Americans were divided about how best to address the problem. About half think that obesity is "a private issue that people need to deal with on their own," while the other half described it as "a public health issue that society needs to help solve." Although 81 percent of Americans believe the government should assume a role in combating obesity, just 35 percent thought it should play a major role, and 18 percent said the government should not be involved in addressing obesity. Three-quarters of the respondents felt that healthcare providers should take the lead in fighting obesity, two-thirds said schools should be involved, and about one-quarter thought employers should play a pivotal role.

Support for actions to reduce obesity was greatest for campaigns to inform and educate the public about healthy

eating, exercise, and the health risks of obesity (77 percent) and for creation of more public recreation areas where people can exercise (81 percent). More than half of the respondents (62 percent) agreed that requiring restaurants to supply nutritional information would be helpful, while less than half (41 percent) favored taxes on junk food.

Stronger support existed for measures aimed at preventing childhood obesity. More than eight in ten Americans favored healthier school lunches and health education classes, and three-quarters believed that increasing physical education in schools and educating parents about healthy eating and exercise for children were important. More than half (59 percent) supported limiting television advertising of unhealthy foods such as soft drinks, chips, and candy aimed at children, and three-quarters of Americans said they would support actions to reduce childhood obesity with their tax dollars.

Prejudice and Discrimination

While much research has documented instances of stigmatization, bias, and discrimination against persons who are overweight or obese, a Gallup Poll survey conducted July 7–9, 2003, reported that most overweight Americans do not feel that they have been discriminated against because of their weight, and the majority of Americans deny feeling prejudice against people who are overweight. Eighty-two percent of overweight survey respondents said they had never experienced weight-based discrimination, and an additional 4 percent said it occurred less often than once a year. (See Table 11.10.) As Table 11.11 shows, just 16 percent of survey respondents said that the fact that a person is overweight would cause them to respect that person less; however, 20 percent conceded that they

would be less likely to hire an overweight candidate for a job. (See Table 11.12.)

Although the survey respondents said they were not prejudiced against persons who were overweight, 43 percent agreed that setting higher health insurance rates for significantly overweight individuals was justified. (See Figure 11.8.)

Another survey, Nearly One-Half Of Americans Polled Believe Obese Workers Are Discriminated Against on the Job (San Francisco, CA: Employment Law Alliance, 2003), found that 47 percent of American workers believe obese employees suffer discrimination in the workplace. Thirty-two percent think that obese workers are less likely to be respected and taken seriously at work. Thirty-one percent say overweight and obese workers deserve special government protection against weight-based discrimination. Thirty percent feel obese workers are less likely to be hired or promoted, and 11 percent who described themselves as overweight or obese said they have been victims of weight-related discrimination.

In "Do Unhealthy Americans Get Too Much Respect?" (Gallup Poll Tuesday Briefing, September 16, 2003) Gallup Organization health-care editor Rick Blizzard posited that while it may be "politically correct" not to discriminate against persons who are overweight, as well as those who smoke or drink alcohol excessively, acceptance of behaviors which are to some degree controllable may be counterproductive. He fears that Americans' over-reliance on research and development to identify "medical solutions" for every health problem, including overweight, coupled with a tendency to blame others for health behaviors and health problems discourage people from assuming an active role in their own health by engaging in healthy behaviors.

Blizzard is concerned that absent peer pressure to reduce health risks by losing weight and exercising more, public sentiment relieves individuals of any personal responsibility for their health-related behaviors and tacitly reinforces the acceptability of overweight and obesity. He observed that Gallup data suggested that peer pressure to engage in healthy behaviors is low. Blizzard and many public health educators worry that the public's apparent indifference may undermine even the most aggressive attempts to combat the obesity epidemic in America.

Who Is to Blame for Overweight Children?

American youth are more overweight today than ever before, and, according to a May 2003 CBSNews/ New York Times poll, seven in ten Americans described childhood and adolescent obesity as a major health problem, while 29 percent considered it a minor problem. Seventy-four percent of women termed childhood overweight and obesity a major problem, compared to 62 percent of men, and more non-parents (75 percent) than parents (60 percent) considered it a major health problem.

In response to the question, "Which one of the following do you think is most to blame for children and teenagers today being overweight—children not exercising enough, children eating fast food, or parents not preparing healthy meals?" half of Americans blamed children's diets. Twenty-seven percent of survey respondents said parents were not preparing healthy meals at home, and another 21 percent blamed children's consumption of fast food. An additional 22 percent believed that children do not get enough exercise, and 17 percent held that all of these factors conspired to create the epidemic of childhood obesity. More men than women felt insufficient exercise was the main reason children were overweight, by 28 percent to 17 percent. By 31 percent to 16 percent, parents were more likely than nonparents to name lack of exercise as the primary reason American youth are overweight.

Nearly half of the parents surveyed (48 percent) said their children were consuming more fast food than they

did when they were their children, but they also claimed their children exercise as much as they did when they were young. Forty-four percent said their children engaged in as much physical activity as they had as children, and an additional 21 percent said their children exercise more than they had as children.

HAS AMERICA BECOME A FAST-FOOD NATION?

Figure 11.9 shows that while more than three-quarters of American adults know that most fast food is not exactly a healthy choice, many continue to eat it, with 30 percent reporting occasional fast-food forays—just once or twice a month, and 21 percent consuming fast food several times per week. A scant 5 percent of Americans eschew fast food altogether, and 13 percent indulge only a few times a year. (See Table 11.13.)

Young adults and men eat fast food more often than women and adults age fifty and over. (See Figure 11.10.) While fast food is popular throughout the country, adults in the East are less frequent fast-food purchasers than adults in the Midwest, South, and West. (See Figure 11.11.)

One finding from the July 2003 Gallup Poll that health educators consider discouraging is that less than one-quarter of Americans pay close attention to food labels, while more than 20 percent said they paid little (12 percent) or no attention (9 percent) to food warnings and other nutritional information. (See Table 11.14.) It may be that point-of-purchase information and content labeling are virtually ignored by more than 40 percent of consumers. Another disturbing finding was that half of the respondents who knew that fast food was not very good for them continued to eat it at least once a week. (See Table 11.15.)

Teens Eat Fast Food and Junk Food

An August 2003 Gallup Youth Survey reported by Coleen McMurray in "Are Schools Havens for Junk Food Junkies?" (Gallup Organization, September 30, 2003) found that 20 percent of teens (aged thirteen to seventeen) ate at fast-food restaurants (including take-out, drive-thru, and eat-in) several times a week (17 percent) or every day (3 percent). Just 8 percent of teens said that they ate at fast-food restaurants a few times a year or less.

In addition to fast food, teens also reported frequent consumption of junk food. Eighty-four percent of teens said they were likely to eat "some" (61 percent) or "a great deal" (23 percent) of junk food during a typical week, while just 17 percent said that they ate hardly any junk food or none at all. Most teens have ready access to junk food and soda at school, where two-thirds (68 percent) said that they have purchased soda, chips, and candy from vending machines. Not surprisingly, teens who described themselves as "somewhat" or "very" overweight reported eating more junk food than those who described their weights as normal or underweight.

Some Americans Are Confused about How to Eat Healthily

In view of all of the conflicting information about diet and nutrition, and the ongoing, fiery debate about whether a low-carbohydrate or low-fat diet is more effective for weight loss, it is no wonder that many Americans are confused about how to eat a healthy diet. A Gallup Organization poll conducted for the American Dietetic Association in 2002 found that less than half (49 percent) of respondents said they were "not at all confused" about how to maintain a healthy diet, but nearly one-quarter described themselves as very or somewhat confused. (See Table 11.16.)

In 2002, while the low-carbohydrate diet was gaining momentum, most Americans (68 percent) still believed that a low-fat diet was healthier. (See Figure 11.12.) When questioned about their diets, more respondents claimed to be avoiding fat (62 percent) than sugar (43 percent) or carbohydrates (20 percent). (See Table 11.17.)

Does Increasing Self-Awareness Help People Make Healthier Food Choices?

Iowa State University psychologists Stacey Sentyrz and Brad Bushman conducted two studies to determine whether self-focusing situations, in which people compare

their behavior to internal standards, influence them to avoid eating fatty foods. The researchers hypothesized that since self-focusing situations such as gazing into a mirror, performing in front of an audience, on camera, or seeing oneself on videotape have been shown to increase self-regulation of many behaviors, that self-focusing might also aid dieters to choose low-fat rather than high-fat foods. Sentyrz and Bushman described the studies and their results in "Mirror, Mirror on the Wall, Who's the Thinnest One of All? Effects of Self-Awareness on Consumption of Full-Fat, Reduced-Fat, and No-Fat Products" (Journal of Applied Psychology, vol. 83, no. 6, December 1998).

In the first study 320 undergraduate college students enrolled in psychology courses (160 men and 160 women) who had previously completed several questions about their diet status were randomly assigned to a room with or without a mirror. The subjects were told that the researchers were studying the quality and taste of different types of cream cheese. Subjects were given a bag of small bagels and three different kinds of cream cheese—regular, light, or fat-free. The number of grams of each type of cream cheese consumed by each subject was recorded. The researchers predicted that the presence of a mirror would reduce consumption of the regular (full-fat) cream cheese, but would not influence consumption of the light and fat-free cream cheese.

The results of the study supported the researchers' hypothesis that the presence of a mirror would reduce consumption of fatty products, but would not influence consumption of light and fat-free products. Subjects in the mirror group ate less fatty cream cheese than those in the no-mirror group. There was no difference in the amount of light or fat-free cream cheese participants ate in the mirror and no-mirror groups. The fact that the mirror influenced consumption of the fatty cream cheese suggested that the subjects had an internal standard against eating fatty foods.

The second study involved 979 shoppers at large supermarkets in central Iowa. The researchers set up a table to allow shoppers to sample three different kinds of margarine: regular, light, and fat-free. To encourage self-awareness, a mirror was present on the tabletop. The

researchers recorded the number of pieces of bread consumed with each type of margarine spread. Similar to the first study, the mirror was expected to reduce consumption of the regular (full-fat) margarine, but it was not expected to influence consumption of the light and fat-free margarine. The researchers also recorded the shopper's gender, estimated the shopper's age, and estimated whether the shopper was underweight, normal weight, or overweight in an effort to determine whether these variables might influence the effects of the presence of a mirror on consumption of fatty margarine.

The researchers found that shoppers in the mirror group ate less fatty margarine than did shoppers in the no-mirror group. There was no difference in the amount of light or fat-free margarine shoppers ate in the mirror and no-mirror groups. Weight and age did not significantly affect the results. However, consistent with the findings of previous research, women consumed less fatty margarine than did men. The researchers concluded that "self-focusing situations may lead to a decrease in consumption of fatty products. If people make food choices while in self-focusing situations, they may think twice about what they eat. Something as simple as a mirror on a refrigerator may influence people to avoid high fat foods."

ARE AMERICANS GETTING ENOUGH EXERCISE?

In "Americans Are Working Out—But How Hard?" (Gallup Poll Tuesday Briefing, December 2, 2003), Coleen McMurray reported that, according to the Gallup Organization Health and Healthcare poll conducted from November 3–5, 2003, almost half of Americans (48 percent) participate in vigorous sports or physical activities at least once in a typical week. Consistent with previous research findings, more men (55 percent) reported participating in vigorous exercise than did women (42 percent).

In "Women Less Likely to Get Vigorous Exercise" (Gallup Organization, October 21, 2003), Rick Blizzard observed that nearly half (47 percent) of women between the ages of eighteen and forty-nine and two-thirds (67 percent) of women aged fifty and older never engage in vigorous sports or physical activities, compared to 28 percent of eighteen-to forty-nine-year-old men and 54 percent of men aged fifty and older who said they never exercise vigorously.

Substantially more Americans (82 percent) engage in moderate sports or other physical activities, at least once a week, and more than half (55 percent) said that they participate in moderate activity at least three times a week. Men were slightly more likely than women to report engaging in moderate exercise at least three times a week—57 percent of men and 52 percent of women. Twelve percent of men and 19 percent of women admitted that they do not engage in any moderate exercise during a typical week.

About the same proportion of American adults—three in ten—are either highly active or sedentary. Women are much more likely than men to be sedentary—approximately one-quarter of men were sedentary compared to 34 percent of women.

Teens Exercise More Than Adults

A May 2001 Gallup Youth Survey found that 81 percent of teenagers between the ages of thirteen and seventeen said they participated in "some form of sports or exercise on a regular basis." Although the proportion of teens who exercise regularly is considerably higher than adults, the Gallup data revealed that the percent of teens who exercise regularly decreased with age, and girls are not as likely as boys to participate in sports or exercise. (See Figure 11.13.)

In "Fit or Fat? Schools May Play Hefty Role" (Gallup Poll Tuesday Briefing, October 15, 2002), Jennifer Robison observed that school physical education programs may be the only opportunities for teens to engage in regular exercise. Budget and time constraints have prompted many school districts to sharply curtail or even eliminate physical education programs, despite the fact that research conducted by the U.S. Public Health Service revealed a strong positive association between regular physical activity and students' concentration and scores on standardized reading and math tests. The Gallup Youth Survey data supported this finding—87 percent of teens with above-average academic performance said they participated in sports or other regular exercise, while just 71 percent of students with average or below-average academic achievement reported participation in sports or exercise.

Robison asserted that in view of the relationship between physical inactivity, obesity, and academic achievement, "PE classes and school-sponsored sports for both sexes are more critical than ever to kids' healthy development." She also observed that the need for regular exercise may be even more pressing for girls, minorities, and older teens.

However, there is promising news about young teens' participation in physical activity. On February 23, 2004, the CDC reported that 74 percent of American "tweens"—nine-to thirteen-year-olds—were aware of a campaign encouraging them to exercise. The public awareness and youth media campaign called "VERB: It's What You Do" exhorts teens to choose a verb such as run, jump, skateboard, or swim, and then participate in the chosen activity regularly.

The social marketing (strategies to influence the voluntary behavior of target audiences) portion of the campaign "VERB: It's What You Do" was launched in 2002. The media advertising campaign began in 2003, with paid advertising in magazines, newspapers, and on billboards and television that featured teen hip-hop artist Bow Wowand NBA star Tracy McGrady. The campaign also employs Web sites for teens and parents to motivate teens to track their physical activity and increase the amount of exercise they obtain outside of organized sports.