#BetterHealth: A qualitative analysis of reactions to the UK government's better health campaign - Bournemouth University Research Online
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985576
brief-report2021
HPQ0010.1177/1359105320985576Journal of Health PsychologyTalbot and Branley-Bell
Brief Report
Journal of Health Psychology
#BetterHealth: A qualitative
1–7
© The Author(s) 2021
analysis of reactions to the UK Article reuse guidelines:
government’s better health sagepub.com/journals-permissions
https://doi.org/10.1177/1359105320985576
DOI: 10.1177/1359105320985576
campaign journals.sagepub.com/home/hpq
Catherine V Talbot1,2
and Dawn Branley-Bell1
Abstract
This study examined reactions to the UK government’s Better Health campaign through a thematic analysis
of tweets. Four themes were generated: Embracing Better Health; There is no Better Health without mental
health; Inconsistent messaging; Only a surface-level solution. Findings suggest the campaign is problematic,
given its lack of consideration for mental health and wider societal factors that contribute to obesity. The
campaign could exacerbate mental health difficulties for individuals with eating disorders due to its focus on
weight and perceived fat-shaming approach. Recommendations are made to develop future campaigns that
avoid negative public responses, minimise harms, and maximise intended benefits.
Keywords
communication, obesity, public health, weight
Introduction compared with individuals with healthy BMIs
(Docherty et al., 2020; Hussain et al., 2020).
The ‘Better Health’ campaign was launched by Consistent with this, the general population
the UK government on 27th July 2020 (Public have reported facing difficulties staying healthy
Health England, 2020). This national campaign during the pandemic, with Duffy (2020) finding
encouraged individuals to make healthier life- that almost half of respondents reported putting
style choices, by losing weight, getting active on weight and 29% reported increased alcohol
and quitting smoking. A range of tools were consumption.
available to help people manage their health, Responses to the Better Health campaign
including mobile applications (e.g. NHS have been mixed, with Sport England (2020) and
Smokefree; Couch to 5K), online support
groups, virtual fitness videos, a body mass
index (BMI) calculator, and offers with organi- 1
Northumbria University, UK
sations who provide weight loss plans (e.g. 2
Bournemouth University, UK
Slimming World). The campaign launched dur-
ing the COVID-19 pandemic and was driven by Corresponding author:
Catherine V Talbot, Department of Psychology, Faculty of
data showing that obese people are significantly Science and Technology, Bournemouth University, Fern
more likely to become seriously ill and be Barrow, England BH12 5BB, UK.
admitted to intensive care with coronavirus Email: Ctalbot@bournemouth.ac.uk2 Journal of Health Psychology 00(0)
the British Heart Foundation (2020) welcoming As we were primarily interested in the con-
measures that aim to tackle obesity, such as the tent of individual tweets, retweets were
9pm watershed on fast food adverts. In contrast, excluded from the sample. Only tweets written
the campaign has also received some negative in English were included in the sample. We also
press coverage (Mead, 2020; Wilson, 2020) and excluded tweets from health organisations
reactions from eating disorder organisations (e.g. advertising the campaign (e.g. Public Health
BEAT, 2020) who argue that the campaign may England, the National Health Service and
be damaging for some people. This is substanti- National Health Trusts) as these do not repre-
ated by research showing that people with eating sent public reaction. Company advertisements
disorders have been negatively impacted by ‘a were also excluded from the sample. The final
public preoccupation with food, weight gain and sample included in the qualitative analysis
exercise’ during the COVID-19 pandemic comprised 181 tweets (approximately 13.5% of
(Branley-Bell & Talbot, 2020, p. 10). Insight into individual tweets collected by Ncapture).
public reactions can identify whether the cam-
paign is perceived as socially excluding or dam-
Analysis
aging to some populations. It is important to
know how the campaign is being received by the Tweets were imported into NVivo12 and ana-
public more widely. These insights can help to lysed thematically, following the six steps out-
guide the design of future campaigns to maxim- lined by Braun and Clarke (2006): data
ise positive behaviour change, and minimise the familiarisation; generating initial codes; search-
potential for unintended negative impacts. ing for themes; reviewing themes; defining and
Social media provides a valuable source of naming themes; producing the report. The first
information about public attitudes, opinions and author began by familiarising herself with
even behaviours (Snelson, 2016). Twitter is one tweets and coded the entire dataset, identifying
of the widely used social media platforms and is initial themes. These themes were then shared
often regarded as a platform used to publicly with the second author who provided critical
voice opinions (Branley & Covey, 2017; feedback. Changes were made to themes where
Highfield, 2016). Consistent with this, research- appropriate and the analysis was refined until
ers have used tweets to evaluate health campaigns both authors agreed upon the finalised themes.
(e.g. Schlichthorst et al., 2018), yet to our knowl-
edge, this method has not been used to evaluate
Ethics
the Better Health campaign. Our study addresses
this gap and uses public tweets to examine reac- Ethical approval was obtained from the
tions to the Better Health campaign. Northumbria University ethics board [26267].
The British Psychological Society code of
Ethics and Conduct (2014) states that unless
Methods consent has been sought, observation of public
behaviour must take place in spaces where
Data collection and sampling individuals would expect to be observed by
Ncapture was used to collect tweets posted strangers. Tweets can therefore be viewed as
between 27th July 2020 and 7th August 2020 public behaviour. However, to promote the
containing at least one of the following search anonymity of users it is good practice to para-
terms: ‘#BetterHealth’; ‘Better Health cam- phrase quotations of tweets to reduce the likeli-
paign’. Tweets were collected across this 10-day hood of users being identified using search
time period to capture immediate reactions to engines. Therefore, all quotes in this paper
the campaign and also to ensure the sample was have been paraphrased in a manner that retains
not unweildy. Ncapture identified 4606 tweets the original meaning, with both authors agree-
in total, including 3266 retweets. ing on the phrasing of each tweet.Talbot and Branley-Bell 3
Data availability This suggests that the campaign was a positive
influence for some users, motivating them to
Data are not available for this study given that adopt healthier lifestyles.
account holders could be identifiable if it were
made accessible.
There is no better health without
mental health
Results
Unfortunately, other users tweeted that there
Our thematic analysis generated four themes: was a lack of consideration for mental health by
Embracing Better Health; There is no Better the campaign, with one person advocating:
Health without mental health; Inconsistent mes- ‘there is no #BetterHealth without mental
saging; Only a surface-level solution. Despite health’. This is particularly problematic, given
the campaign focusing on different factors asso- that the campaign was established during the
ciated with health, tweets tended to focus on COVID-19 pandemic – a time when mental
weight loss and this is reflected in our themes. health problems were more pronounced (Pierce
et al., 2020):
Embracing better health
It isn’t #BetterHealth though? It’s #WorseMental
Researchers have found that social media can Health. Mental health is important and I wish the
provide individuals with access to supportive government would not ignore it.
communities that can help with weight loss
(May et al., 2016). This was also evident in our Above and beyond the campaign simply over-
sample, with users documenting their weight looking mental health, many felt that it could
loss journeys and sharing personal experiences actually be detrimental for mental health, par-
on Twitter. For example, users often described ticularly for those with eating disorders. Users
the positive physical and mental changes that commented that the campaign was triggering of
accompanied weight loss: disordered eating behaviours because of its fat-
shaming approach, and focus on lower weight
After my heart attack, I could have stayed as I and calorie intake as equating to health:
was, but I didn’t. I changed my diet and walked
daily, it wasn’t difficult, I didn’t do anything #BetterHealth does not (and should not) equal
special but as a result, I lost five stone in a year, being thin. Calorie counting to control your diet
which helps my heart, relieves some pressure, is known to be a big trigger if you suffer from
small changes #BetterHealth disordered eating. Restricting food intake is not
always the healthier choice.
Some users felt that the campaign engendered a
sense of community among the population, Many users tweeted about representations of
with one person tweeting: obesity in the campaign, with some stating that
the campaign was ‘fatphobic’, ‘disempowering’
Yesterday, I started a vegan diet. I feel like I’ve and reinforcing of stereotypes:
joined a slimming club with the whole country. I
like it. #BetterHealth The NHS #BetterHealth advert is such a one-
dimensional portrayal of overweight people – it
Whilst others tweeted that they felt motivated depicts them as just fatties who fail when it comes
by the campaign: to exercise!
I’m very encouraged by #Betterhealth. The NHS Fat-shaming media messages can be damaging
‘Better Health’ campaign encouraging weight to people with eating disorders (Spettigue et al.,
loss is a good idea, it’s commendable. 2004). For example, these type of messages can4 Journal of Health Psychology 00(0)
enhance implicit anti-fat attitudes, which have #BetterHealth campaign = because you are fat,
been associated with reduced wellbeing (Ravary you are causing coronavirus deaths to rise. Lose
et al., 2019; Webb et al., 2016). Consistent with weight!! Eat out to Help out scheme = here’s
this, users commented that the pandemic posed 50% off your bill, take your family to KFC or
heightened risks for people living with, or sus- McDonald’s!
ceptible to, eating disorders. For example, one
person highlighted that the general population Users also pointed out unfortunate TV advert
may not notice calories on menus, but this could scheduling, where Better Health commercials
have detrimental impacts on individuals with were immediately followed by fast food or
eating disorders: takeout adverts:
I would love to know how many people, who do Watching the TV, I saw the #BetterHealth
not have disordered thinking about food, will campaign for the first time. The advert was im-
actually read calories on menus. Most people will mediately followed by an advert for McDonald’s.
just be like ‘whatever’ but those of us with eating
disorders will be left feeling like we can’t eat These inconsistent messages were clearly con-
anything. fusing for users and could potentially impact
the effectiveness of the campaign. Instead, a
It was evident from the tweets that many users cohesive, whole systems approach may be more
had lived experience of eating disorders, with effective in promoting Better Health.
some stating that the campaign would make
their daily experiences more difficult:
Only a surface-level solution
I am lost for words about the #BetterHealth
Obesity is a complex condition and researchers
campaign. I’m terrified for those of us who have
have identified genetic, lifestyle, educational
worked so damn hard to develop a happier
relationship with food. This campaign will only and environmental risk factors (Fruh, 2017).
make this everyday battle a lot harder. Some users felt that the campaign fails to
account for the complexity of obesity by not
This suggests that the campaign may pose considering these wider societal factors:
heightened challenges for people with eating
disorders – a population that has already faced Already, after less than a week, I’m tired of seeing
the Better Health adverts. Instead of addressing
significant difficulties during the COVID-19
the reasons why some people find it hard to eat
pandemic (Branley-Bell & Talbot, 2020). well, it’s just a surface level solution.
Inconsistent messaging Some drew attention to health inequalities that
contribute to obesity, for example highlighting
In their tweets, some users perceived the UK gov- the cost involved in eating healthy:
ernment to be delivering inconsistent messaging.
For example, one month after the campaign was #BetterHealth Make fruit and veg cheaper for
established (August 2020), the government everyone as I find it so expensive to eat healthy!
launched the ‘Eat Out to Help Out’ scheme which In comparison, crisps and chocolate are cheap,
encouraged the public to dine at restaurants by cheap, cheap!
providing discounts; helping to support the econ-
omy during the pandemic. This was perceived by Instead of promoting calorie-counting, many
many as contradictory and hypocritical, particu- users advocated for better education around
larly as some perceived the restaurants as focus- health behaviours and cooking skills, and
ing on fast-food or unhealthy options: increased access to exercise facilities:Talbot and Branley-Bell 5
We need to recognise the psychological reasons individuals experiencing eating disorders have
behind conditions, give people the skills to already been shown to be reluctant to seek help
prepare healthy food, and access to exercise. during the pandemic due to worrying that they
Prescribing cycling and cutting calories misses might be a ‘burden’ to the NHS (Branley-Bell &
the point! #BetterHealth is not enough.
Talbot, 2020).
Despite aiming to achieve positive changes,
These findings highlight that some users felt the the campaign is likely to have been detrimental
campaign did not account for the complexity of to some of the population. Clearly, there is a
obesity and excluded certain groups of people, need for future campaigns to avoid negative
such as those who cannot afford to engage in public responses, minimise harms and maxim-
Better Health behaviours. ise the intended benefits. To achieve this, we
suggest the following points of action guided by
Discussion the findings from our research:
Our findings suggest that public reactions to the a. Campaigns must move away from
Better Health campaign were mixed, reflecting ‘surface-level solutions’ and focus on
offline debates about its appropriateness (e.g. a more appropriate, complete picture
BEAT, 2020). The campaign was received posi- of health and wellbeing. It is vital that
tively by some individuals who tweeted about campaigns recognise that mental and
the positive impact it was having on their lives, physical health are intertwined and it
increasing exercise and motivation. is not appropriate to just target physi-
Interestingly, users tweeted that the Better cal health without consideration of
Health campaign engendered a sense of com- related mental issues. Failing to en-
munity among the general population. Given a compass mental health components
recent focus on social prescribing (Drinkwater can lead some populations to feel
et al., 2019), our findings suggest that commu- overlooked.
nities may be a valuable resource for promoting b. Campaigns must consider other wider
healthy lifestyles. This supports public health societal issues that may provide a bar-
campaigns as a potential driver of positive rier to the behaviour being promoted
behaviour change, and although weaknesses (e.g. education, financial situation,
were also identified in the Better Health cam- etc.). A successful campaign will rec-
paign – there are lessons to be learned. These ognise and address these issues wher-
insights can help guide the design of future ever possible – this can prevent users
campaigns to maximise the benefits and protect reacting negatively to the campaign
against unintended harms. due to feeling that important issues
Despite the campaign being beneficial for are being ignored (e.g. cost of healthy
some individuals, our findings show that the diets).
Better Health campaign was perceived by some to c. Campaigns and other public messages
be inappropriate, shaming, dismissive of mental must pay careful consideration to the
health, hypocritical and potentially damaging. language used, avoiding the use of
This echoes reactions from professional bodies, shaming and/or triggering terminol-
mental health charities and organisations (e.g. ogy. Emphasis should also be placed
BEAT, 2020) who have critiqued the campaign for upon overall improved health and not
its use of shaming language. For example, when on physical attributes such as weight
the campaign was first launched it was described or body shape. Many negative reac-
using wording such as ‘war on obesity’ and ‘pro- tions to the Better Health campaign
tect the NHS, save lives’ (Mead, 2020). The latter resulted from perceptions of inappro-
statement is particularly concerning given that priate language use.6 Journal of Health Psychology 00(0)
d. Campaigns must involve the public a resource from which to learn and develop
and targetted audiences during design more effective campaigns in the future.
and development. In the instance of In conclusion, public reactions to the Better
the Better Health campaign, it would Health campaign were mixed, with some indi-
have been beneficial to identify and viduals appearing to embrace the campaign and
involve audiences which may be par- others being more critical due to its perceived
ticularly affected by messages around inconsistency with other guidance, lack of con-
weight (e.g. individuals with lived ex- sideration for mental health and ‘surface-level’
perience of eating disorders). This can solution to the complex issue of obesity. Our
help to avoid widespread public back- findings show that public health campaigns do
lash and potential harm to vulnerable have value in promoting positive behaviour
populations. Individuals with lived change. However, the Better Health campaign
experience can help to advise on ap- in it’s current form could potentially exacerbate
propriate terminology, highlight wid- mental health difficulties; particularly for those
er societal factors and/or behavioural with eating disorders due to it’s focus on weight
drivers which may have been initially and perceived ‘fat-shaming’ approach. We have
overlooked, and help to provide initial detailed clear points of action to help maximise
insight into how the campaign may be the positive impacts of future public health
perceived prior to widespread public campaigns, and minimise unintended harms. In
release. particular, we recommend that the voices of
e. Care must be taken to promote a con- vulnerable groups are centred in the develop-
sistent message across campaigns ment of future campaigns and a ‘whole systems
and sectors. A ‘whole systems ap- approach’ is taken to promote better health.
proach’ is needed and opportunities
for public messages to be perceived Declaration of conflicting interests
as contradictive or hypocritical must The author(s) declared no potential conflicts of inter-
be avoided. For example, although est with respect to the research, authorship, and/or
some restaurants on the ‘Eat Out to publication of this article.
Help Out’ scheme may have offered
healthy food choices, the existence of Funding
this campaign and the ‘Better Health’ The author(s) received no financial support for the
campaign were perceived by many to research, authorship, and/or publication of this
be contradictory. article.
Our research has some limitations. Firstly, only ORCID iD
Twitter users were included in this study. While
Catherine V Talbot https://orcid.org/0000-0001-
Twitter is a valuable resource for accessing 9353-8990
public opinions (Branley & Covey, 2017;
Highfield, 2016), researchers could also use References
alternative methods (e.g. surveys, interviews
and focus groups) to access more diverse per- BEAT (2020) Public health not public shaming.
Available at: https://www.beateatingdisorders.org.
spectives and ensure that data is captured from
uk/get-involved/campaign/current/public-health-
users who do not use, or have access to, this not-public-shaming (accessed 5 January 2021).
platform or technology. Users may also be more Branley-Bell D and Talbot CV (2020) Exploring the
likely to tweet when they have a negative opin- impact of the COVID-19 pandemic and UK
ion, which may have resulted in our sample lockdown on individuals with experience of eat-
being more negatively weighted. However, that ing disorders. Journal of Eating Disorders 8(1):
is not to discount the value of these opinions as 44. DOI: 10.1186/s40337-020-00319-y.Talbot and Branley-Bell 7
Branley DB and Covey J (2017) Pro-ana versus Available at: https://www.itv.com/news/2020-
pro-recovery: A content analytic compari- 07-27/obesity-campaign-branded-stigmatis-
son of social media usenurs’ communication ing-by-eating-disorder-specialists (accessed 5
about eating disorders on Twitter and Tumblr. January 2021).
Frontiers in Psychology 8: 1356. DOI: 10.3389/ Pierce M, Hope H, Ford T, et al. (2020) Mental health
fpsyg.2017.01356. before and during the COVID-19 pandemic: A
Braun V and Clarke V (2006) Using thematic anal- longitudinal probability sample survey of the
ysis in psychology. Qualitative Research in UK population. The Lancet Psychiatry 7(1):
Psychology 3(2): 77–101. 883–892.
British Heart Foundation (2020) Government announces Public Health England (2020) Major new campaign
‘landmark steps’ towards addressing UK obesity. encourages millions to lose weight and cut
Available at: https://www.bhf.org.uk/what-we- COVID-19 risk. UK Government. Available
do/news-from-the-bhf/news-archive/2020/july/ at: https://www.gov.uk/government/news/
government-announces-obesity-strategy-bhf- major-new-campaign-encourages-millions-to-
response (accessed 5 January 2021). lose-weight-and-cut-covid-19-risk (accessed 5
British Psychological Society (2014) Code of Human January 2021).
Research Ethics. Available at: https://www. Ravary A, Baldwin MW and Barts JA (2019) Shaping
bps.org.uk/sites/www.bps.org.uk/files/Policy/ the body politic: Mass media fat-shaming
Policy%20-%20Files/BPS%20Code%20of%20 affects implicit anti-fat attitudes. Personality
Human%20Research%20Ethics.pdf (accessed and Social Psycholgy Bulletin 45(11): 1580–
5 January 2021). 1589.
Docherty AB, Harrison EM, Green CA, et al. (2020) Schlichthorst M, King K, Turnure J, et al. (2018)
Features of 20 133 UK patients in hospital with Influencing the conversation about masculinity
covid-19 using the ISARIC WHO Clinical and suicide: Evaluation of the man up multi-
Characterisation Protocol: Prospective obser- media campaign using Twitter data. Journal of
vational cohort study. BMJ 369: m1985. DOI Medical Internet Research 5(1): e14.
10.1136/bmj.m1985. Snelson CL (2016) Qualitative and mixed meth-
Drinkwater C, Wildman J and Moffatt S (2019) ods social media research: A review of the
Social prescribing. BMJ 364: I1285. DOI: literature. International Journal of Qualitative
10.1136/bmj.l1285. Methods 15(1): 1–15.
Duffy B (2020) Getting used to life under lockdown? Spettigue W and Henderson KA (2004) Eating dis-
Coronavirus in the UK. Kings College London and orders and the role of the media. The Canadian
Ipsos. Available at: https://www.ipsos.com/sites/ Child and Adolescent Psychiatry Review 13(1):
default/files/ct/news/documents/2020-05/kings_ 16–19.
charts_28.5.20.pdf (accessed 5 January 2021). Sport England (2020) Support for new Better Health
Fruh SM (2017) Obesity: Risk factors, complications, campaign. Available at: https://www.sporteng-
and strategies for sustainable long-term weight land.org/news/support-new-better-health-cam-
management. Journal of American Association paign (accessed 5 January 2021).
of Nurse Practitioners 29(S1): S3–S14. Webb JB, Fiery MF and Jafari N (2016) “You
Highfield T (2016). Social Media and Everyday better not leave me shaming!” Conditional
Politics. Cambridge: Polity Press. indirect effect analyses of anti-fat attitudes,
Hussain A, Mahawar K, Xia Z, et al. (2020) Obesity and body shame, and fat talk as a function of self-
mortality of COVID-19. Meta-analysis. Obesity compassion in college women. Body Image
Research & Clinical Practice 14(4): 295–300. 18: 5–13.
May CN, Waring ME, Rodrigues S, et al. (2016) Wilson A (2020) Why Boris Johnson’s obesity cam-
Weight loss support seeking on Twitter: The paign could cause further suffering for those
impact of weight on follow back rates and inter- with eating disorders. Independent. Available
actions. Translational Behavioral Medicine 7(1): at: https://www.independent.co.uk/voices/boris-
84–91. johnson-better-health-obesity-campaign-corona-
Mead K (2020) Obesity campaign branded ‘stig- virus-menus-calories-b447407.html (accessed 5
matising’ by eating disorder specialists. ITV, January 2021).You can also read
