Reflecting on VITALITY
- Lessons learned from the development, implementation and evaluation of VITALITY -
The VITALITY program was launched in 1991 by Health Canada as a positive approach to promoting healthy weights. Several reports and evaluations have been produced related to VITALITY. "Reflecting on VITALITY" provides a summary of the VITALITY experience based on the review of historical project files along with input from some of the Health Canada employees who have been involved in the program with an intent to share lessons learned for future endeavors.
The VITALITY Approach
VITALITY was developed as an initiative to encourage Canadians to adopt a positive and healthy approach to body weight.
VITALITY incorporated three key components:
- healthy eating;
- enjoyable physical activity/active living, and
- a positive self and body image.
VITALITY also promoted supportive environments to enable individuals to adopt these three components.
While a healthy approach to body weight is an underlying objective of VITALITY, weight is seldom an explicit part of VITALITY messages and resource materials. The focus, instead, is on health-enhancing behaviors and attitudes rather than on weight. The overall goal of VITALITY is to foster physical, mental and social well-being.
The origin of VITALITY
In the 1980s, there was considerable epidemiological research on body weight in Canada . There was a growing concern about the health effects of overweight as well as a concern about the effects of unhealthy behaviours to achieve an unrealistically thin body shape. This research culminated in the release of three documents by Health and Welfare Canada (former Health Canada in the late 1980s to serve as a basis for population-wide efforts to address body weight problems. These documents are:
- The Canadian Guidelines for Healthy Weights that described measurement standards based on health data and from which the concept of 'healthy weight' emerged;
- The Report of the Task Force on the Treatment of Obesity that outlined recommendations for the appropriate treatment of weight problems, and
- Promoting Healthy Weights: A Discussion Paper that identified challenges in the promotion of healthy weights. The challenges included the need to:
- promote societal and personal acceptance of a range of healthy weights and variations in body size;
- encourage Canadians to develop and maintain appropriate eating and physical activity patterns;
- improve and develop services to promote healthy weights and treat weight problems;
- create environments that support positive attitudinal and behavioural changes, and
- increase knowledge about healthy weights and factors affecting weight.
VITALITY was a programmatic response to the concerns and concepts presented in these documents.
A chronology of the development and implementation of VITALITY
In 1989, A Blueprint for Action: The Integrated Approach was released. This document provided a framework for the development of a population-wide initiative to promote healthy weights among Canadian adults. This framework was planned to provide an integrated approach to the promotion of healthy weights and incorporate healthy eating, enjoyable physical activity, positive body image and environmental supports for change.
VITALITY was created based on the concepts presented in "A Blueprint for Action" and was launched in January 1991. The target audience for the initiative was adults age 25 to 44 years with 9 to 13 years of education.
Between 1991 and 1996, Health Canada undertook activities and developed resources to implement and support the VITALITY initiative. Of the funds allocated to VITALITY, 74 percent were spent on social marketing and 26 percent on community action and professional education. The following summarizes VITALITY activities between 1991 and 1996. Several of these activities were carried out in partnership with other organizations.
In 1991, individuals from the media and health sectors were introduced to the VITALITY initiative, television and radio ads were produced and VITALITY calendars were distributed.
In 1992, a VITALITY information package for Leaders was developed with information for health and fitness educators and handouts for the public. The VITALITY message was incorporated into Canada's Food Guide to Healthy Eating and a two-page VITALITY fact sheet was included in the accompanying document Background for Educators and Communicators. The VITALITY message was incorporated into the Physical Activity Readiness Questionnaire (PAR-Q) published by the Canadian Society for Exercise Physiology. Health Canada partnered with the maker of Fleishmann's margarine to create a 16-page assessment VITALITY booklet, which was distributed in grocery stores and mailed to over 18,000 health professionals.
In 1993, in partnership with food companies, VITALITY was promoted in 750 grocery stores and over 100 dietitians participated in grocery store events. A 7-day interactive VITALITY Planner was developed and distributed which served as the basis for the 1994 monthly planner. VITALITY tips were prepared and provided to the media and Public Service Announcements in
the form of posters were developed for transit shelters and movie theatres. Special TV segments were produced and shown over a 26-week period.
In 1994, a comprehensive VITALITY Leaders' Package was developed and distributed. In addition to resources for leaders and the public, the package also included a series of six referenced articles on self and body image. VITALITY segments were shown twice a week for 39 weeks on the French language TV program Salut Bonjour (featuring Olympic gold winner Sylvie Bernier) and camera-ready VITALITY newspaper articles were developed. In addition, the VITALITYWorkplace Health System was launched which included a comprehensive guide to implementing programs in the workplace that promote the three VITALITYmessages: healthy eating, active living and positive self and body image.
In 1995/6 the Canadian Dietetic Association, in partnership with Health Canada , featured VITALITY in a Nutrition Month Campaign. A partnership with the Canadian Society for Exercise Physiology resulted in a VITALITY monograph for fitness appraisers. An 8-page VITALITY insert was included in selected Canadian magazines and inserts were printed separately for additional distribution by health organizations. A VITALITY workshop kit with supplements on women and weight was also developed in 1996.
Although new resources have not been produced since 1996, an updated VITALITY Guide for Leaders is available. Canada's Food Guide to Healthy Eating plus the Background for Educators and Communicators both of which include VITALITY information are also available.
It should be noted that in addition to the Health Canada activities described above, VITALITY and VITALITY concepts have been incorporated into other initiatives across Canada , although this has not been systematically documented. For example, recent information from Nova Scotia and Newfoundland and Labrador illustrate the incorporation of VITALITY concepts into province-wide policies and plans to promote healthy weights. VITALITY concepts have been integrated into school health curriculum at the provincial level, for example in Ontario . VITALITY concepts have also been used as a basis for programs that provide an alternative to dieting, such as the Canadian-based program HUGS International.
Evaluation of VITALITY
It has been difficult to measure the impact of VITALITY due to the breadth of the program goal and component parts. An evaluation of VITALITY must also take into consideration the fact that the program was launched in an era of large fiscal restraints . Nevertheless, between 1992 and 1996 several evaluations were conducted to gauge its reach and impact. Whether VITALITY is a message, a program, or an approach was a fundamental question raised by many of these evaluations.
Weaknesses
Evaluations indicated there was confusion among Canadian professionals and the public as to exactly what VITALITY was and how it related to the promotion of healthy weights, to Canada's Food Guide to Healthy Eating and, in particular, to physical activity and the Active Living initiative. The role of ParticipACTION in the public awareness aspects of VITALITY may have led Canadians to link VITALITY more strongly with physical activity/active living than with other VITALITY components . It also became clear that nutrition in Canada was anchored in the health system while physical activity was rooted in the recreation sector. The VITALITY concept was good but met with system
barriers and there were no concerted efforts to bridge the two and bring them together .
Evaluations indicated that the initiative appeared to lack an overall strategy as well as coordination and continuity of program activities. Another drawback mentioned repeatedly was the focus on messages to individuals and a lack of emphasis on activities to encourage environmental support for change. Reports highlighted an over-emphasis on the healthy eating and active living component, which outweighed attention to the positive self and body image aspect. Some recommendations mentioned a need to make explicit the healthy weights objective of VITALITY as a way to link the three components of the initiative.
Strengths
Strengths included the uniqueness of VITALITY, the support by many health professionals for the VITALITY concepts and the incorporation of these into community programs. Support for VITALITY as an integrated, positive and prevention-oriented approach was strong, although the need for it to be recognized as a 'program' or 'brand name' was questioned. Public opinion research conducted in the early 1990s showed an acceptance by Canadians for government programs such as VITALITY that convey health messages.
Since its inception, VITALITY has been promoted through networks across Canada and integrated into existing and new programs to promote healthy weights and good health in general. It is difficult, therefore, to assess the overall leverage of the initiative. However, evaluations conducted to date indicate that VITALITY has not gained the recognition and reach that was planned. This lack of success may be due in large part to lack of sustained funding.
VITALITY for the 21st century?
VITALITY provides a unique and integrated approach fo addressing issues related to body weight and body weight problems - although this has been an implicit not explicit objective of the initiative. With the rising prevalence of overweight in Canada as well as the on-going social pressure on women to be unrealistically thin, renewed efforts will be needed that incorporate concepts such as those included in VITALITY. Whether the weight message should be made explicit in new endeavors is one consideration. Whether new efforts should be launched under the VITALITY banner is another. Nevertheless, much has been learned from the VITALITY experience. There is general agreement that a comprehensive and integrated approach to the promotion of healthy body weights is needed and that a systematic and sustained effort will be required.
We would be interested in your thoughts and experiences with VITALITY generally as well as the concept of an integrated approach to healthy body weight. Please direct your comments to the Office of Nutrition Policy and Promotion: Healthy_Eating@hc-sc.gc.ca
April 2004
Cat. H44-68/2004E-HTML
ISBN 0-662-36921-1
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