Using entertainment to improve lifestyles and health

Improvement of people's lifestyles is one of the most important initiatives of the UN's Sustainable Development Goals.1UN General AssemblyTransforming our world: the 2030 Agenda for Sustainable Development.http://ec.europa.eu/environment/sustainable-development/SDGs/index_en.htmDate: 2015Date accessed: August 8, 2018Google Scholar However, 80% of cardiovascular deaths occur in low-income and middle-income countries (LMICs) because resources to implement healthy lifestyle measures are limited.2WHONoncommunicable disease fact sheet.http://www.who.int/en/news-room/fact-sheets/detail/noncommunicable-diseasesDate accessed: August 30, 2018Google Scholar Mass media campaigns are usually costly and might have an adverse effect on teenagers who rebel against the message.3Wakefield M Terry-McElrath Y Emery S et al.Effect of televised, tobacco company–funded smoking prevention advertising on youth smoking-related beliefs, intentions, and behavior.Am J Public Health. 2006; 96: 2154-2160Crossref PubMed Scopus (155) Google Scholar A possible cost-effective option is to use sports and entertainment media as platforms to influence people to lead healthier lifestyles. A successful example of a mass lifestyle intervention is the Quit Smoking with Barça campaign, which influenced 70 000 European citizens to stop smoking.4EU publicationsEx post evaluation, ex-smokers campaign.https://publications.europa.eu/en/publication-detail/-/publication/4c008831-cef9-11e5-a4b5-01aa75ed71a1/language-enDate: 2015Date accessed: August 8, 2018Google Scholar The effectiveness of storytelling to raising awareness about important health issues has also been tested. For example, movies distributed in east African villages to raise awareness against female genital cutting improved attitudes about girls who remain uncut.5Vogt S Mohmmed Zaid NA El Fadil Ahmed H Fehr E Efferson C Changing cultural attitudes towards female genital cutting.Nature. 2016; 538: 506Crossref PubMed Scopus (35) Google Scholar We hypothesised that storytelling in a television series might help increase awareness of the importance of a healthy lifestyle. To test this hypothesis, we developed a sub-plot for SpangaS—a soap opera on daily Dutch television targeted at young people. We introduced an overweight and unhealthy character in the 11th season. When this character's father suffered a heart attack, he realised the dangers of an unhealthy lifestyle and changed his habits. The 200 000 daily viewers of the show were not pre-warned about the intervention. To measure the reaction to this plot and the viewers' awareness, we used a novel quantification method of social media to measure tweets, posts, or photos related to predefined keywords, including weight, diabetes, exercise, fruit, vegetables, and lifestyle. Similar data collected during the tenth season of SpangaS served as control data. The advantage of doing the experiment in Dutch was that the influence was limited to the Netherlands and Flanders, Belgium (figure). During the 11th season of SpangaS, we detected a substantial increase in social media posts related to all predefined keywords after the episode in which the character was inspired to change his lifestyle; no such change was observed during the tenth season. These findings supported the strong influence of entertainment media on lifestyle. We are developing a movie based on the 11th season of SpangaS, which will be distributed in 6000 schools across the Netherlands. These schools will be randomly assigned to view the film with and without the health-related messages. All participants will partake in a pre-intervention and post-intervention lifestyle survey. The entertainment industry and the medical community should work together to improve the health of individuals. Entertainment media could be used as a low-cost and powerful tool to promote a healthy lifestyle and help tackle the epidemic of non-communicable diseases, especially in LMICs. This online publication has been corrected. The corrected version first appeared at thelancet.com on July 15, 2019 This online publication has been corrected. The corrected version first appeared at thelancet.com on July 15, 2019 We declare no competing interests. Department of ErrorYousuf H, Narula J, Zwetsloot P-P, et al. Using entertainment to improve lifestyles and health. Lancet 2019; 394: 119–20—In this Correspondence, the country in which the movie based on the 11th season of SpangaG will be distributed in has been changed from Germany to the Netherlands. This correction has been made to the online version as of July 15, 2019. Full-Text PDF