Our campaign to halt the rise of obesity in Western Australia (WA), LiveLighter, was established in 2012 and has helped increase knowledge of the link between overweight and obesity and cancer, and also reduce the consumption of sugary drinks and junk food. But there is still work to be done.
The rates of overweight and obesity in WA and Australia have been steadily increasing over recent decades. Nearly one-third (31 per cent) of Australian adults are considered obese. Additionally, many adults are not aware when they are above a healthy weight: among adults who are overweight, nearly half (47 per cent) consider themselves to be a healthy weight, while 13 per cent of obese adults believe their weight to be within a healthy range.
Health impact and burden of disease
Being overweight or obese is the second largest contributor to the burden of disease in Australia, behind tobacco use. Being above a healthy weight is associated with numerous chronic diseases, including type 2 diabetes, cardiovascular diseases, and 13 types of cancer. In Australia, overweight and obesity are responsible for 7.8 per cent of the total burden from cancer. Between 2003 and 2015, the disability-adjusted life years (DALYs) attributable to overweight and obesity increased by 27 per cent. It is anticipated that increasing overweight and obesity, if not addressed, will cost Australia in excess of $87.7 billion over the 10-year period from 2015/16 to 2024/25.
LiveLighter is a public education campaign launched in WA in 2012. The campaign 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 campaign is part of a healthy lifestyle and education program commissioned and funded by the WA Department of Health. The WA Department of Health works in partnership with Cancer Council WA on the LiveLighter campaign to develop and deliver these 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 the need for changes in the environment, including regulation, to support healthy eating and physical activity.
LiveLighter targets WA adults aged 25-64 years old, with key secondary audiences including parents, people of Aboriginal and Torres Strait Islander descent, people living in regional or remote areas, and people experiencing socioeconomic disadvantage.
Over the past eight years, LiveLighter has run seven phases of state-wide television-led advertising. Each wave of advertising is supported by a range of secondary media channels, including radio, out-of-home, and digital advertising.
Figure 1. An overview of the LiveLighter campaign waves and evaluation phases (view full size (pdf, 81kb))
For mass media campaigns to be successful in achieving behaviour change, they need sufficient and sustained funding. Comprehensive evaluation has allowed LiveLighter to demonstrate the significant and positive results of the campaign, and in turn, secure ongoing funding.
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, the first wave of a new creative execution is evaluated with a cohort study, and other waves are evaluated using cross-sectional post-campaign surveys (see Figure 1).
Sugary drink and junk food consumption
According to almost all evaluation measures used, the most successful LiveLighter campaign messages are 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. Encouraging people to drink fewer SSBs has been a key objective of the campaign since the first phase of "Sugary Drinks" in 2013/14. After these advertisements ran, the proportion of people who drank SSBs at least once in the past week significantly decreased from a baseline of 60 per cent to 46 per cent in 2016 and 41 per cent in 2019. The same pattern was found for frequent SSB consumers (four or more times in the past week) from baseline to 2019 (28 per cent to 14 per cent).
LiveLighter ‘Sugary Drinks are a Rotten Choice' campaign bus stop ad
There has also been a significant change in SSB consumption in WA among secondary school students, despite them not being part of the primary target audience for LiveLighter. A steeper decline was observed in the consumption of SSBs by secondary students in WA compared with other states. This result, coinciding with the beginning of LiveLighter, could indicate that the campaign has encouraged changes at a household and family level that has flow-on effects for adolescent SSB consumption.
LiveLighter ‘How much sugar is in your drink?' infographic
Knowledge of the link between overweight and obesity and chronic disease
Understanding the risks associated with particular health issues or behaviours can be a strong motivating factor for behaviour change. Although there is high public awareness of the association between overweight and obesity and heart disease, type 2 diabetes, and fatty liver disease, fewer people are aware of the link between overweight and obesity and cancer. Since the introduction of LiveLighter, this awareness has been significantly higher than baseline at each evaluated phase of the campaign (from 41 per cent at baseline to 55 per cent in 2019).
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. However, there is concern from some groups that these campaigns could increase weight stigma. A recent study assessing unintended consequences of 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 dissatisfaction1. The LiveLighter campaign will continue to monitor public attitudes to the campaign and to people living in larger bodies.
As well as encouraging individual behaviour change, public health education campaigns can influence people's perception of policy initiatives. Public support is high for government to fund public health campaigns, such as LiveLighter (95 per cent in 2020)2. In 2020, most Western Australians were in favour of the government taking actions to support healthy lifestyles, such as:
- Restrictions on junk food sponsorship and advertising at children's sporting events (85 per cent)3.
- Restricting sale and promotion of sugary drinks and junk food at venues where children play sport (76 per cent)4.
- Taxing soft drinks to reduce the cost of healthy foods (92 per cent)5.
- Restricting junk food promotions and advertisements on public transport and at bus stops (75 per cent)6.
The junk food and sugary drink industries (ultra-processed food industries) present a substantial challenge for healthy lifestyle campaigns. In WA alone they have a combined advertising spend upwards of $30 million per year.7,8
Advertising for energy-dense, nutrient-poor products dominates traditional and digital media formats, with healthier foods relatively under-represented. Children and young adults are frequently exposed to junk food marketing. Recent research has shown that over three-quarters of the food advertisements that high school students see on their commute to school are for unhealthy foods and drinks. Such continued exposure to unhealthy food advertising may increase junk food intake among teenagers. Within WA, there are few restrictions on where Quick Service Restaurants can open new stores, with local governments having extremely limited scope for objection, even if community opposition is high.
Amidst the background of inadequate restrictions on aggressive advertising by the ultra-processed food industries, it remains a challenge for health campaigns to achieve sufficient cut-through to elicit behaviour change. LiveLighter faces a number of challenges in campaign delivery, including opposition from the ultra-processed food industries and various regulatory and policy barriers and inequities that are not placed upon competing industries.
Public health 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.9
WA is the only Australian state, and one of the first places in the world, to design and implement a dedicated and ongoing obesity prevention campaign. The dearth of other new or established campaigns targeting obesity means there have been few learnings to draw from or existing campaign materials to license. Thanks to the support of the WA Department of Health LiveLighter is able to pave the way for future campaigns in other jurisdictions that aim to address overweight and obesity.
In late 2019, formative research was conducted to inform the creation of a new LiveLighter campaign which launched in 2021. Results from focus group discussions involving people with a BMI of 26 and over largely reinforced the behavioural model that the original campaign was based on, while revealing some subtle changes in attitudes towards weight management.
- Jongenelis MI., Morley B, Dixon H. Perceptions of healthy weight and lifestyle campaigns. Report prepared for Cancer Council Western Australia; 2019.
- Nuss T, Chen M, Dixon H, Wakefield M, Morley B. Evaluation of the Western Australian LiveLighter® Campaign: Aug-Sep 2020. Centre for Behavioural research in Cancer, Cancer Council Victoria; 2021.
- Gascoyne C, Chen M Dixon H, Morley B. Research Memorandum; 2020.
- Nuss T, Chen M, Dixon H, Wakefield M, Morley B. Evaluation of the Western Australian LiveLighter® Campaign: Aug-Sep 2020. Centre for Behavioural Research in Cancer, Cancer Council Victoria; 2021.
- Nuss T, Gascoyne C, Dixon H, Wakefield M, Morley B. Evaluation of the Western Australian LiveLighter® Campaign: Feb-Mar 2020. Centre for Behavioural Research in Cancer, Cancer Council Victoria; 2020.
- Nuss T, Chen C, Dixon H, Wakefield M, Morley B. Evaluation of the Western Australian LiveLighter® Campaign: Aug-Sep 2020. Centre for Behavioural Research in Cancer, Cancer Council Victoria; 2021.
- Initiative. Competitive data - Non-alcoholic beverages. Landsberry & James, Fusion AQX; 2019.
- Initiative. Competitive data - Takeaway. Landsberry & James, Fusion AQX; 2019.
- 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. Melbourne, Australia: Centre for Behavioural Research in Cancer, Cancer Council Victoria; 2018.
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