“Fructose is a poison,” he said repeatedly. “You gotta’ stop eating fruit.”

“I don’t understand what you mean,” I replied. “In what way is fructose a poison?”

“Well, it causes disease and … it’s a poison!”

It quickly became clear that he could not articulate what he meant by “poison” or, indeed, how fructose supposedly caused disease. Like many others, my colleague had been deceived by powerful fear-based marketing rhetoric designed to demonize carbohydrates, even naturally occurring fruit sugars, in favor of a high-fat diet. Competing with such an emotive and ideological proposition is complex and fraught with difficulty.

At its core, fear-based marketing is an emotive argument. In his classic treatise Rhetoric, the Greek philosopher Aristotle described how emotion and arousal were prerequisites to persuasion: “The orator persuades by means of his hearers, when they are roused to emotion by his speech; for the judgments we deliver are not the same when we are influenced by joy or sorrow, love or hate.” (1). Aristotle was warning against acting on instinctual emotions, suggesting they evoke beliefs where none exist (2). Over 2,000 years after Aristotle, the Welsh philosopher and polymath Bertrand Russell wrote about the conflict between intuition and intellect: “Instinct, like all human faculties, is liable to error. Those in whom reason is weak are often unwilling to admit this as regards to themselves, though all admit it in regard to others (3).

Direct Response Marketing

The average American is exposed from several hundred to several thousand adverts per day (4). Under perpetual pressure to convert potential customers into sales, advertisers resort to increasingly questionable tactics to cut through the noise. So-called “direct response marketing” is designed to evoke an emotional response from a “prospect,” and of all emotions, fear is among the most powerful.

In 2022, entrepreneur/investor Heather Morgan (later indicted and arrested on charges of federal money laundering) penned an article for Inc. entitled “4 Things You Need to Know about Selling with Fear”: “Fear can be your most powerful sales asset, but only if you know how to use it correctly,” she wrote. “This also makes it a highly effective sales strategy … Start by researching your audience’s pain points.” These strategies are commonplace, with numerous articles and websites devoted to perfecting the craft. In few places is fear-based marketing more prevalent that in health and wellness.

Fear-based marketing is so effective because it exploits the “pessimism bias”—the tendency to anticipate negative events to better avoid them. Fear-based adverts stimulate the sympathetic nervous system and the subsequent release of cortisol and adrenaline. Anxiety is the result, followed by an urgency to act to “reduce this anxiety by adopting, continuing, discontinuing, or avoiding a specified course of thought or action” (5). In other words, bad news and fear pull at our attention, tapping into our primal survival instincts, causing powerful psychobiological effects.

Many adverts skillfully manufacture or embellish a problem before providing a solution. As Morgan wrote, “Your pitch needs to end on a positive note, one that offers the other person an actionable solution to their problems.” In his book Tabloid Medicine: How the internet is being used to hijack medical science for fear and profit, Robert Goldberg proposes the anti-vaccine movement as an exemplar because it created a false link between vaccines and autism, only to capitalize on the resulting panic and fear to push alternative medicines.

Examples from the Health and Fitness World

Organic foods, pesticides, and genetically modified organisms (GMOs). There has been a dramatic surge in the sale of organic foods in the past two decades, with revenues reaching $43.4 billion (up from $3.6 billion) in the United States alone (7). According to the USDA, organic food is produced without genetic engineering or the use of GMOs. This has led to predictable anti-GMO propaganda, despite decades of research and widespread agreement on their safety (8) and environmental sustainability (9). Some organic proponents also claim that traditional farming uses pesticides that cause a range of health problems including “stinging eyes, rashes/blisters, blindness, nausea, dizziness, cancers, birth defects, reproductive harm, immunotoxicity, neurological and developmental toxicity, and even death.” In turn, organic food is often labeled “pesticide free” but this isn’t true, they simply use organic pesticides instead of synthetic ones. Importantly, regulators, such as the EPA, only test for the synthetic kind, permitting organic producers to circumvent the regulations. Natural pesticides are generally less effective than synthetic ones, requiring higher concentrations and more applications to elicit the same effect. Thus, natural and synthetic pesticides probably do not differ in terms of their relative health risks (10), which remain low in any case. 

Barefoot Running Shoes. At its core, successful athletic training is a precarious balance between applying enough physical stress to evoke a training adaptation but not so much stress to cause underperformance, injury, or illness. For a competitive athlete, injury can be devastating, resulting in loss of training time and a potential loss of sponsorship and income. As a result, products that are purported to reduce injury risk bear a huge responsibility. Barefoot running shoes have been popular for several decades. Sales pitches invariably claim that traditional running shoes, with cushioning and arch support, have weakened the muscles of the foot and lower leg, predisposing to injury. One prominent vendor of barefoot shoes coined the term Shoespiricy, maintaining that “The modern shoe industry has sold you a lie,” and that “Normal shoes f*ck your feet!” The proposed antidote, minimalist (barefoot) shoes, have little-to-no cushioning on the heel or forefoot, which obligates a change in running biomechanics (11). Nevertheless, a pair of recent review articles showed no difference in relative injury rates between barefoot shoes and regular shoes (fifteen studies) (12) and that transitioning to barefoot shoes had no effect on running economy or muscle development (twenty studies) (13).

Low-carbohydrate diets. Scientists agree that carbohydrates are a key fuel for the muscles, brain, and central nervous system and are important for muscle recovery after exercise (14). Nevertheless, there’s little place for refined sugars in the diet, and there are clear benefits to carefully moderating carbohydrate to facilitate weight loss and promote exercise adaptations (15). But moderating is distinct from eliminating, and experts maintain that exercising in a “low carbohydrate state” for more than a few days per week will compromise immune function (16). So, a balanced and considered approach is required. Unfortunately, there is a growing collective of food gurus who are devoid of such a balanced and considered perspective and who are intent on demonizing carbohydrates as the source of illness and disease. Many advocate for virtually eliminating carbohydrates from the diet, even the fructose found in fruit despite unequivocal research showing that a higher consumption of fruit and vegetables is associated with lower total and cause-specific mortality (17). Ideological views of some keto diet (low-carb, high-fat) proponents overlook the nuance of carbohydrate type and how the body deals differentially with “simple” and “complex” carbohydrates.

The Aerobic Deficiency Syndrome. Not a syndrome recognized by health professionals, “ADS” was coined by chiropractor Phil Maffetone to explain the day-to-day struggles of unfit individuals and those who exercise at high intensities and neglect their “aerobic base.” According to Maffetone, the condition can be “devastating for athletes,” potentially causing “a variety of chronic [health] conditions.” The condition, he wrote, causes an accumulation of excess body fat that can “trigger pain, various injuries, ill health and even disease.” To avoid the negative outcomes of “ADS,” Maffetone sells celebrity-endorsed training programs, books, heart rate monitors, and a range of dietary supplements he describes as a “new aerobic revolution.”

The sale of health club memberships. A 2007 study found that fear of looking unattractive was a stronger motivator for exercising at the gym compared to the aspiration of “looking good,” especially in young people (18). This typical loss aversion bias, wherein people prefer avoiding losses over acquiring equivalent gains, has since been incorporated into health club advertising. However, such marketing can backfire because “fear of judgement” prevents some people from exercising (19). There is also considerable research on the harmful impact of health and fitness advertising on body image and self-esteem, with adverts using very lean and/or sexualized female models resulting in the pursuit of “ultra-thinness” (20). Such advertisements have been criticized for skewing notions of the “normal” body, contributing to body shaming and disordered eating (21). These similar cultural pressures (in the media and social media) are thought to contribute to bigorexia in males; a type of “reverse anorexia” characterized by a preoccupation with becoming overly muscular or lean (22, 23).

Perspectives

Any given intervention should be considered valid or invalid based on merit (i.e., evidence for efficacy) and not on whether it is marketed using emotive rhetoric. In fact, fear-based framing of health messages has been explored as a way to encourage positive decisions and help consumers make better health-related choices (24). The problem is that outcomes at the individual level are impossible to predict. Companies that employ direct response marketing understand that people often make decisions based on intuition and emotion, only to retrospectively justify the decision with (flawed) logic. Not even the most seasoned critical thinkers are capable of completely muting their “chimp brains” and making purely rational, dispassionate decisions in all scenarios. However, what critical thinkers seem to do better than most is recognize when their objectivity has been compromised, and this itself is a victory. The key to any effective health and fitness decision is to take your time: time to evaluate the evidence, time to consult some legitimate experts, and time to review to what extent your biases are being exploited. Most importantly, although intuition has a pivotal role in productivity and survival, the aim of critical thinking is to hone the ability to cleave some space, and doubt, between you and your decisions. To paraphrase Bertrand Russell, intuition must be tempered by reason.

Notes

1. Rapp C. Aristotle’s Rhetoric. In: Zalta EN, editor. The Stanford Encyclopedia of Philosophy. Metaphysics Research Lab, Stanford University; 2010 [cited 2022 Mar 12 ] Available at https://plato.stanford.edu/archives/spr2010/entries/aristotle-rhetoric/.

2. Frijda NH, Mesquita B. Beliefs through emotions. Emotions and belief: How feelings influence thoughts. New York, NY, US: Cambridge University Press; 2000. p. 45–77.

3. Russell B. Mysticism and Logic. GEORGE ALLEN & UNWIN LTD; 1910.

4. Anywhere the Eye Can See, It’s Likely to See an Ad – The New York Times[date unknown]; [cited 2022 Mar 12 ] Available at https://www.nytimes.com/2007/01/15/business/media/15everywhere.html.

5. Spence HE, Moinpour R. Fear Appeals in Marketing. A Social Perspective. Journal of Marketing. 1972; 36(3):39–43.

6. Thinking vs Feeling: Psychology of Advertising | USC OnlineUSC MAPP Online. 2017; [cited 2022 Mar 14 ] Available at https://appliedpsychologydegree.usc.edu/blog/thinking-vs-feeling-the-psychology-of-advertising/.

7. OTA |[date unknown]; [cited 2022 Mar 13 ] Available at https://www.ota.com/.

8. Nicolia A, Manzo A, Veronesi F, Rosellini D. An overview of the last 10 years of genetically engineered crop safety research. Critical Reviews in Biotechnology. 2014; 34(1):77–88.

9. Biotechnology in agriculture: Agronomic and environmental considerations and reflections based on 15 years of GM crops – A.M. Mannion, Stephen Morse, 2012[date unknown]; [cited 2022 Mar 15 ] Available at https://journals.sagepub.com/doi/abs/10.1177/0309133312457109.

10. Ames BN, Profet M, Gold LS. Dietary pesticides (99.99% all natural). Proc Natl Acad Sci U S A. 1990; 87(19):7777–81.

11. Jenkins DW, Cauthon DJ. Barefoot running claims and controversies: a review of the literature. J Am Podiatr Med Assoc. 2011; 101(3):231–46.

12. Hollander K, Heidt C, VAN DER Zwaard BC, Braumann K-M, Zech A. Long-Term Effects of Habitual Barefoot Running and Walking: A Systematic Review. Med Sci Sports Exerc. 2017; 49(4):752–62.

13. Warne JP, Gruber AH. Transitioning to Minimal Footwear: a Systematic Review of Methods and Future Clinical Recommendations. Sports Med Open. 2017; 3(1):33.

14. Thomas DT, Erdman KA, Burke LM. American College of Sports Medicine Joint Position Statement. Nutrition and Athletic Performance. Med Sci Sports Exerc. 2016; 48(3):543–68.

15. Hawley JA, Burke LM. Carbohydrate availability and training adaptation: effects on cell metabolism. Exerc Sport Sci Rev. 2010; 38(4):152–60.

16. Gleeson M. Immunological aspects of sport nutrition. Immunology & Cell Biology. 2016; 94(2):117–23.

17. Wang DD, Li Y, Bhupathiraju SN, et al. Fruit and Vegetable Intake and Mortality: Results From 2 Prospective Cohort Studies of US Men and Women and a Meta-Analysis of 26 Cohort Studies. Circulation. 2021; 143(17):1642–54.

18. Fear Is Stronger Than Hope When It Comes To FitnessScienceDaily. [date unknown]; [cited 2022 Mar 12 ] Available at https://www.sciencedaily.com/releases/2007/11/071127101909.htm.

19. Seal E, Nicholson M, McNeil N, Stukas A, O’Halloran P, Randle E. Fear of judgement and women’s physical (in)activity experiences. International Review for the Sociology of Sport. 2021;10126902211016632.

20. Horne J. Sport in consumer culture. Houndmills, Basingstoke, Hampshire; New York: Palgrave Macmillan; 2006. [cited 2022 Mar 12 ] Available at http://search.ebscohost.com/login.aspx?direct=true&scope=site&db=nlebk&db=nlabk&AN=197483.

21. Bissell KL, Birchall K. Playing Like a Girl: Perceived Influence of the Media & Parents and Body Self-Esteem in Adolescent Female Athletes. undefined [Internet]. 2007 [cited 2022 Mar 12]; Available at https://www.semanticscholar.org/paper/Playing-Like-a-Girl%3A-Perceived-Influence-of-the-%26-Bissell-Birchall/6c1cec595351e178e6ff3dba2d332092d2e524d5.

22. Diehl BJ, Baghurst T. Biopsychosocial factors in drives for muscularity and muscle dysmorphia among personal trainers. Cogent Psychology. 2016; 3(1):1243194.

23. Leit RA, Pope Jr. HG, Gray JJ. Cultural expectations of muscularity in men: The evolution of playgirl centerfolds. International Journal of Eating Disorders. 2001; 29(1):90–3.

24. Krishen AS, Bui M. Fear advertisements: influencing consumers to make better health decisions. International Journal of Advertising. 2015; 34(3):533–48.