In the 1960s, more and more medical practitioners and physicians in West Germany warned against a new range of chronic diseases, such as cardiovascular diseases. Increased cholesterol and high blood pressure, brought on by an unhealthy diet and harmful behaviours like smoking, a lack of physical activity, and excess weight, were seen as important contributors. By looking at the topics of nutrition and physical activity2 my paper gives some insight into how television addressed changes in the state-run health system in West Germany, as well as new problems and preventative policies.3
I will open with a brief description of the reasons that led to a sharp increase in obesity and cardiovascular diseases in West Germany. I then underline the potential that had been attributed to the medium of television with regard to health education. I propose two main points to consider. Firstly, my analysis deals with a period in which West German viewers could only choose between the two public service channels, Arbeitsgemeinschaft der öffentlich-rechtlichen Rundfunkanstalten der Bundesrepublik Deutschland (ARD [Consortium of Public Broadcasters in Germany]) and Zweites Deutsches Fernsehen (ZDF [Second German Television]), and the multiple regionally broadcast so-called third channels.4 My second point is that the provision of advice and information with programmes focusing on advice was an important broadcasting objective. In 1965 for example, Karl Holzamer, then Director General of ZDF, emphasized television’s public duty “to humanize the objectified world by providing concrete advice on how to cope with everyday life”.5 As a result, the proportion of counselling-oriented programmes dealing with issues of daily life such as education, nutrition, health, school and transport, increased steadily in the 1970s. Thirdly, I show that the 1970s marked the beginning of behaviour-oriented health education in West Germany, using individual TV programme formats and campaigns as examples. I ask: what television formats did health education programmes adopt? And how was this perceived and evaluated by the viewers? The 1970s was the decade of the “trimmers”, as the people who took part in the Trimm Dich programmes were called. These activities belong to one of the largest populace-oriented campaigns for promoting physical activity in Germany.6 What institutions were involved in these fitness campaigns? Television, as well as the press, had a great influence on the level of awareness of these campaigns and was an important partner or (co-)initiator in some cases, such as Gesundheitsmagazin Praxis. Lastly, I address the question of the long-term efficacy of this form of health communication on the basis of relevant sources by asking, did media forms of health communication or health education actually have an effect on the behaviour of the audience?
2 Prosperity Means Rich Food
If we look back on the post-war period in West Germany, the 1950s was a time when some of the population experienced the so-called economic miracle, which brought growing prosperity to some areas.7 Social security and full employment led to an uninhibited lust for consumption that, alongside the new craze for tourist travel, could also be seen as a ‘orgy of gluttony’-wave. After the deprivations experienced during the war and the post-war years, many Germans happily ate their way through the 1950s and 1960s, their paunches being a visible sign of their overindulgence. The increasing standard of living accompanied by an excess availability of food in the new supermarkets led – in Germany just as well as in other industrial countries – to a change in food preferences and eating habits along the lines of ‘the richer, the better’. Real butter, lots of meat, cups of real coffee drunk with nice cream cakes: rich food was in demand and a symbol of this newly won prosperity.8
Between 1950 and 1960, the average annual consumption of pork rose from 19 to 30 kg per year per capita. Alcohol consumption was also on a continuous rise; the average German drank about 100 litres of beer per year.10 As a healthier alternative, the Westdeutsche Milchwirtschaft [West German dairy industry] promoted daily milk consumption with the slogan “Milch macht müde Männer munter” [Milk makes tired men merry]. By the early 1960s, sugar intake per year had settled at on average 29 kg per capita.11 Adverts for cigarettes in print magazines, in cinemas, and on TV were part of normal life and there were programmes where smoking in front of the camera was a matter of course. In the entertainment show Was bin ich?, the German version of the American What’s my line?, presenter Robert Lembke smoked away just as happily as the presenters and guests in the talk shows Zur Person [Close Up and Personal] and Zu Protokoll [On the Record].12 On Internationaler Frühschoppen [The International Morning Pint] it was expected that the five invited journalists who, every Sunday morning, discussed current affairs with their host Werner Höfer in a meet-the-press show, while drinking wine and smoking. It was only from the 1970s that cigarette smoking and its presentation in the media were addressed as a health risk. Following advertisement bans, the depiction of people smoking on TV was consciously restricted.13
Pleasure and delicious food were central themes of West German everyday life. As was what was on television. The first TV chef was Clemens Wilmenrod, an actor by profession, who cooked on NWDR (later the WDR channel) from 1953 to 1964 on his own programme called Clemens Wilmenrod bittet zu Tisch [Clemens Wilmenrod Asks You to Dinner].14 In his recipes, Wilmenrod touched on the audience’s longing to see other countries while his dishes were often based on classic recipes jazzed up with “exotic” ingredients, such as his famous “Hawaii Toast”, a slice of toast with ham, canned pineapple, melted cheese and a cherry on top. Canned fruit and vegetables, sliced processed cheese and ketchup were regular ingredients and were seen as quick, practical and modern.
However, not only were culinary preferences changing, but recreational activities also saw significant changes during that decade. Between 1950 and 1960, weekly working hours fell from 48 to 44.5, people had more paid time off and television became an important leisure time activity.16 Since the mid-1960s, West German viewers had, with ARD and ZDF, two full programmes of public broadcasting plus regional channels at their disposal. Whereas, in 1960, only 24 per cent of the population had had access to a TV, by 1971, this had increased to 88 per cent.17 Average television consumption in 1970 was nearly two hours per day.18
3 Obesity as a Disease of Affluence
After the threat of infectious diseases had decreased at the end of the 1950s, chronic diseases such as cardiovascular diseases were increasingly diagnosed. One consequence of new prosperity and individual behaviour was the significant increase in average body weight for a growing majority. About one third of men and 40 per cent of women were overweight. In Germany, the alleged link between an unhealthy lifestyle and cardiovascular diseases was the focus of the health care system, influenced to a large extent by research in the United States. From the 1960s, the Framingham studies initially highlighted tobacco consumption, later a fatty diet, obesity and lack of exercise as possible risk factors for cardiovascular disease.19 Obesity and its effects become the new disease of affluence. The public health system, politicians and physicians were alarmed and were looking for solutions. Correlated with increased cholesterol and blood pressure in particular, behaviours such as smoking, lack of exercise and poor nutrition were linked to the development of these chronic disease.20 Preventive efforts then shifted to individual behaviour. The 1970s marks the beginning of behaviour-oriented and propagating health education with recommended dos and don’ts and many campaigns.
The importance given to these topics within the health system of the Federal Republic of Germany is illustrated by an international conference held in November 1974, Ernährung und Bewegung: Die Rolle der Gesundheitserziehung [Nutrition and physical activity – The role of health education]. The conference, which the Bundeszentrale für gesundheitliche Aufklärung [Federal Centre for Health Education] had organized on behalf of the Federal Minister of Youth, Family Affairs and Health was held in collaboration with the World Health Organization’s Regional Office for Europe and the International Cardiology Federation.21
The conference aimed, according to the conference booklet, “to find out how health education can be used efficiently in changing such eating behaviour and habits in relation to physical activity that are deemed harmful especially in terms of cardiovascular diseases”.22 Over three days, medical practitioners and scientists from all over Europe discussed theoretical approaches to successful health education and data derived from national programmes and measures. One of those was the Trimm Dich! fitness campaign of Deutscher Sportbund [German Sports Confederation, DSB], which was very successful in Germany and will be discussed in more detail in section 5.2.
4 Television as a High Potential Medium
In the 1970s the public health system, the sphere of politics and health insurers in West Germany were all optimistic that, for the purposes of health education, large parts of the populace could be reached and informed about the interdependencies between lifestyle and health risks by television. At a conference held in 1978 by the German Medical Women’s Association on Medicine and the Mass Media, Hedda Heuser, the then chairwoman of the German Medical Women’s Association, emphasized the importance of media coverage by saying in her opening speech,
“Most early diagnosis and screening campaigns in recent years have only been so successful because the media had provided proper coverage. I therefore claim that the people’s health awareness has never been as sustainably influenced as by television.”23
Due to its potentially very wide reach, television was considered to have a high potential for setting topics for health education. ZDF journalist Hans Mohl recalls in 1994:
“In the past, when we only had two channels, it was possible to make health the talk of the nation with one programme. […] We could practically reach even those circles that were not interested in health at all.”24
Winfried Göpfert, head of the health telemagazine ARD-Ratgeber: Gesundheit [ARD Health Advisor], judged the effect of these telemagazines to not lie in the prompt change of behaviour, but to broaden the viewers‘ knowledge, which over time would strengthen their motivation to change their behaviour. The telemagazine was not about “introducing the audience uncritically to all kinds of technological developments, new devices, new methods etc.”, said Göpfert. “But instead, we wanted to strengthen the competency of each individual, their sense of their personal responsibility.”25
This was contradictory, however, as the health problems of the population could also be aggravated by television. Due to the increasing consumption of television as a popular leisure activity, the daily movement of viewers decreased. At the same time, television had become a vehicle through which products that were damaging to health, such as alcohol, cigarettes and unhealthy food, could be advertised to the public. In addition, it offered only limited opportunities to address specific target groups directly and – with the exception of some more detailed formats such as documentaries – to provide extensive or detailed information.
5 Health Education in Magazine-type Formats: Gesundheitsmagazin Praxis
Health-related programmes were, right from the early days of television, part of the common TV repertoire,26 but it was in the 1970s that there was an extension of non-fictional broadcasts focusing on health, disease and medicine. The programmers preferred the magazine as a format for series, and which offered great flexibility for health communication. Its ‘modular principle’ made it possible to present the various aspects of a topic in a variety of audiovisual elements. Short film contributions, moderation, animations and studio discussions enabled both monothematic and multi-topic programmes about illness and health.27 Long-running telemagazines popular with an adult audience included Gesundheitsmagazin Praxis [Practice Health Magazine] (ZDF 1964-2004), ARD-Ratgeber: Gesundheit [ARD Health Advisor] (ARD 1971-2004), Die Sprechstunde [Open Surgery] (BR 1973-2007) and Gesundheit im Dritten [Medicine on your regional channel] (WDR 1975-1985). In contrast to the monthly broadcast schedule of the other magazines mentioned, Die Sprechstunde, moderated by Dr. Antje-Kathrin Kühnemann, a medical doctor, was broadcast weekly.
At this point I would like to go into more detail about Gesundheitsmagazin Praxis, which played an important role in addressing health and disease as topics of public awareness. The ZDF magazine was launched in 1964 as a factual series, which according to the programme’s creator and presenter, Hans Mohl, aimed to,
“…convey the most important information from the practice of medicine to the everyday practice of the audience as something that provides support in the fight against the unresolved health risks in our affluent world – lack of physical activity, obesity, drink, tobacco and drug abuse.”28
The monthly health magazine programme was a fixture of West German television for over 40 years. Shown on Fridays at 9:30 p.m. in its first year, in 1965 the 45-minute show was moved to a new prime time slot – Monday evenings at 8:15 p.m. – where it remained for the next 18 years. Mohl, who was not a medical doctor, saw himself as an interlocutor between the world of medicine and the audience’s everyday-life as expressed by the programme’s credo, “More health through more information”.29 The monthly programme at ZDF was supplemented by a large number of medical documentaries and discussions.
Particularly loved by the audience – in its first ten years, the programme’s audience ratings averaged at 30 per cent (12 million viewers)30 – where the tests and quizzes allowed the audience to test their fitness, their knowledge about health issues, their eye vision, etc. The episode with a fitness test called ‘Check your shape’, with a 45 per cent audience rating, proved to have been particularly popular.31 Frequent competitions in which viewers could participate were also a major contributor to the programme’s popularity as shown, for instance, by the 19,000 viewers who entered the competition for the best health slogan in 1968. The high-profile jury, including the president of the Medical Association and the Federal Minister of Health, awarded the prize to the slogan, “Rauche nicht und trinke mäßig, laufe viel, sei nicht gefräßig” [Don’t smoke, take drink in moderation, do walk a lot and do not gorge yourself beyond your satiation].32
The introduction of the various health magazines, however, was not only due to the extension of television broadcasting schedules, but also to changes in government health policy. While the post-war decades up to the beginning of the 1970s were characterized by a steady expansion of health care and the promotion of medical progress, cost containment became the primary goal of West German health policy from 1975.33 The global economic crisis that began in 1973 and 1974, with low economic growth rates and rising unemployment figures, led to a broad consensus in politics that the costs of health care would have to be significantly reduced. In order to achieve this, more emphasis was now placed on individual responsibility for one’s own health. Individual behaviour, and the associated avoidance of illness, also became an important topic in health magazines. Whereas in the 1960s the focus was primarily on successes in medical technology and new methods of treatment, health-damaging behaviours as well as avoidance and prevention measures were now more strongly addressed.
6 Health Communication as If-Then Communication
The presence of abundant food and obesity also led, at this time, to the propagation of an ideal weight as a necessary prerequisite for long life expectancy. Individual behaviour was now seen as a risk factor for illness that lay within an individual’s own responsibility. Due to the media coverage and press, radio and TV advertising, the West German population became widely convinced that slimness was merely a question of the correct diet and, most of all, of the strength of one’s will. Obesity became a character flaw.34 Happy gluttony was replaced by calorie counting, which became the new measure just as slimness became the new beauty ideal, omnipresent in the media.
The following examples illustrate the predominant behaviour-oriented character of health education in the 1970s and 1980s, which addressed its target groups with concrete imperatives: Trimm Dich! [Keep fit] or Iss das Richtige [Eat the right stuff]. The example of the advertising campaign Du darfst [You may] will also be used to show how the food industry reacted to the change in health awareness.
6.1 Du darfst [You may] Advertisement
At the end of the 1960s being overweight was no longer a sign of prosperity. Instead, it triggered the creation of so called “diet foods”, whose share in the entire food market amounted to around 20 per cent at the start of the 1970s. This was a booming market for the food industry with an estimated annual growth rate of 15 per cent.35
Systematic market monitoring at the end of the 1960s showed that 48 per cent of those older than 15 years had a weight problem, with 30 per cent wanting to lose weight and 44 per cent wishing to be slim, the number of women was disproportionally high.36 The realisation that the people’s eating habits were changing gave birth to the idea of the Du darfst to market a range of low-calorie products to resolve the conflict between a healthy, calorie-conscious diet and the pleasure of eating. With its various products, the brand is still successful on the German market today. The later wave of light products was the consequent continuation of this product development.
Instead of the otherwise common ‘don’ts’ and recommendations of moderation, Union Deutsche Lebensmittelwerke, a subsidiary of Unilever Deutschland GmbH, put their bets on the advertised promise that, if you used their products, tellingly labelled “Du darfst”, you did not need to change your everyday diet. The advertisement therefore embodied, firstly, a philosophy of life (i.e., slim is beautiful) and, secondly, an eating philosophy (Du darfst helps to control your weight and to stay in shape). This was made particularly clear in this TV commercial showing a modern, self-confident young woman who values her good figure and enjoys her image in the mirror with the jingle, “Ich will so bleiben wie ich bin”, [I want to stay the way I am].
Du darfst was advertised as a dietary alternative. Countless commercials on television and page-sized advertisements in magazines suggested the supposed carefree enjoyment of the products without the risk of weight gain. The advertising message was underlined by pictures of slim, young active people.
6.2 Trimm Dich! – A Nation on the Jog
Another phenomenon of the 1970s and 1980s was the fitness boom. These the decades of the Trimmers, a word that, although it already existed in the German language, now acquired a completely new meaning. The Trimm Dich! activities belong to one of the largest populace-oriented campaigns in Germany for promoting physical activity.38 The aim was to motivate and influence the public to adopt a more physically active life style. Developed by the German Sports Confederation (DSB), the campaigns were based on the 1967 Norwegian “TRIM” campaign and similar campaigns carried out in Sweden, Finland and the Netherlands in 1968. The Norwegian “Trim” became the German “Trimm Dich! Mit Sport!” [Keep fit with sports]. The very first campaign under the “Trimm Dich” slogan had an annual budget of 12 million Deutsche Marks of which only 5 percent was funded by the DSB. The remainder was funded by industrial sponsors (e.g. adidas, Puma, Flora-Soft, amongst others) and the media (television and radio broadcasters, newspapers and print magazines).39 “Trimmy”, the mascot, and the campaigns, reached 94 per cent public awareness.
The campaigns, which ran for over 16 years, had a variety of foci. The first campaign, Trimm Dich! Mit Sport [Keep fit with sports, 1970-74), aimed to encourage the wider public to get involved in sports activities. Through the mass media and high-visibility events, these Trimm Dich! Activities were intended to appeal to the whole population. There were 16 different free brochures with guidance and advice on what to do (i.e., keep fit tips), numerous TV commercials, ads in newspapers and magazines, and posters. In 1970, they produced ten short TV films, some of them featuring celebrities, which were broadcasted by ARD and ZDF. Besides small ads in about 300 newspapers and magazines, they also placed so called “Trimm-Tips”, short fitness suggestions and, in 1971, two million posters in 16 designs were displayed all over Germany. There were also ads on beermats, matchboxes, bumper stickers, t-shirts and proper shirts used for the events. The 1972 Olympic Games in Munich also gave the “Trimm-Dich!” movement a big boost.
The second campaign focused on endurance. The slogan “Ein Schlauer trimmt die Ausdauer” [Take the smarter cure – endure] was used between 1975 and 1978 to promote slow, endurance running. According to Mörath, the increasingly popular jogging movement in the USA played an important role in finding ideas for the endurance campaign.41
In contrast to the first three campaigns43, the fourth campaign placed a stronger focus on the issue of health and the contribution sport could make to a healthy lifestyle. The campaign was based on the assumption that sport was particularly effective for health if it was practised three to four times a week. The pulse rate was used as a guideline for the intensity of sporting activity; approx. 130 beats per minute were to be achieved and maintained during exercise.44Trimming 130 – Bewegung ist die beste Medizin [Keep fit 130 – exercise is the best of remedies] was launched on 10 January 1983, starting with a reception by the then Federal President Karl Carstens in Bonn, followed by a federal press conference.
10 million viewers watched the 45-minute opening broadcast of the campaign, which was embedded as a special show of Gesundheitsmagazin Praxis. Television was intensely used for promoting the campaign – Gesundheitsmagazin Praxis aired, at irregular intervals, tips and suggestions for Trimming 130, and introduced the “Fit in 30 days” workout programme. The return of 262,000 postcards in the Trimming 130 prize competition was quite considerable.46 A new TV series, Sport und Gesundheit – Trimming 130 [Sports and Health – Keep Fit 130] with advice and guidance for recreational athletes was launched in collaboration with WDR’s “Leisure and Recreation” team. The German Sports Confederation also produced a number of additional TV adverts.
Rolf Rosenbock47 evaluated the Trimm Dich! campaigns with a comprehensive approach, firstly aimed at informing and sensitising the entire population/target group, which was reached via the mass media, and secondly aimed at behavioural modifications. For the health policy evaluation, however, it was not whether mass media were used or not, but whether they also changed the living and behavioural conditions of the population that was important. Trimm Dich! can be compared with two other major population-based campaigns in West Germany: the seat belt campaign in the 1960s and the HIV/AIDS campaign from the mid-1980s onwards. Rosenbrock, however, points to this as a limiting factor:
“All three campaigns show that great and lasting effects can only be achieved by coordinated and interlinked activities of a broad alliance of actors over several years.”48
Media response to the campaign was high and the public’s keen reception of the Trimm-Dich! parks and trails that were built all over the country seemed to prove the campaign organisers right. In 1974, a survey conducted by EMNID, a polling company, showed that 37 per cent of the population were actively pursuing sports – from tennis to hiking and 19 per cent thereof – i.e. 9 million people – stated that they had started to participate in sports because of the campaign.49
6.3 I.d.R: Iss das Richtige [Eat the right stuff]
In 1977, the ZDF Gesundheitsmagazin Praxis [Practice Health Magazine] started a campaign called I.d.R.: Iss das Richtige [Eat the Right Stuff] with the aim to provide viewers with advice on proper diet and behaviour to motivate them to lose weight. For this purpose, they ran a six-month food challenge that followed ten people on their way towards a healthier bodyweight. The candidates, who had been selected for the “behavioural therapy programme” from all social classes, regularly reported on their experiences, successes and problems during the programme. There were recipes in every episode from the then very popular TV chef Max Inzinger. However, although the crew responsible had aimed for a slow but steady weight reduction in their candidates, some of them stopped following the experts’ advice and recommendations after some time and, instead, reduced their food intake excessively so that the audience witnessed massive weight reductions over 24 weeks. These obvious achievements spread the campaign’s popularity far beyond the original TV magazine. With 17 million viewers, I.d.R. became a national movement that was also featured in the printed press, who supplemented it with their own articles. The book on the programme, titled Schlank für immer mit I.d.R. [Forever Slim with Eat the Right Stuff], contained medical recommendations, eating tips and cooking recipes and became a bestseller.
How successful were these campaigns and activities in terms of a sustainable change in the people’s health-related behaviour? Without doubt, mass media and particularly television made a major contribution to achieving maximum awareness of both content and campaigns. In her assessment of whether these primarily prevention-geared campaigns did indeed achieve a maximum change in the behaviour of those who got involved, Verena Mörath, in her large-scale study of the Trimm-Dich! campaigns, remains cautious,
“The results allow the conclusion that – beyond their immediate active exercise-triggering effect – the Trimm-Dich campaigns had a prolonged influence on the social climate in terms of an increased attention to, and openness for, sports activities and physical fitness.”50
Nevertheless, the first campaign drew about 8.5 million people onto the Trimm-Dich trails and the number of people who joined sports clubs rose in West Germany from 10.1 million (1970) to 17 million (1980).
Hans Mohl’s assessment of the long-term effect of discussing the issue of health risks and of activating the audience was, in retrospect, quite critical. In 1979, he concludes,
“Overweight and obesity are one of the most major risk factors when it comes to our health. The required changes in behaviour can only be brought about faster by providing constant informational support. Experience and studies show that changes in behaviour can too easily be stopped and that relapses occur too quickly if the change of behaviour is not constantly supported by providing renewed assistance through new, or by reminding of, advice. This would however require weekly broadcasts for nutritional counselling alone.”51
The audience, too, was sceptical of such education through the media. In a representative survey conducted in 1978-1979, the participants expressed clear criticism of the information on nutrition and eating as provided by the media: 40.9 per cent said that the media provided too little information on nutrition and eating, 63.3 per cent regarded the information as inconsistent, 26.5 per cent as biased and 38.4 per cent even stated that the information incomprehensible. A repeat of that survey in 1989-1990 showed that this trend had grown stronger in all aspects: 55.3 per cent criticised that there was too little information on nutrition and eating, 70 per cent said that it was inconsistent, 36.8 per cent that it was biased, and 45.6 per cent that it was incomprehensible.52
The broad consensus in politics in the state-run health system in West Germany since 1975 was, that the costs of health care has to be significantly reduced. In order to achieve this, more emphasis was now placed on individual responsibility for one’s own health. Individual behaviour, and the associated avoidance of illness, became an important topic in the media. Health-damaging behaviours as well as avoidance and prevention measures were now more strongly addressed. Although the tv magazines for example generated stable viewing figures and had for a long time been part of the West – and East – German television, their effect remained limited. The magazines usually attracted only those viewers who already had a general interest in the issue or had a specific need for information because they were ill. And also the Trimm-Dich! campaigns appealed above all to people who had also been active in sports before.
In summary, it can be said that for West Germany, that media influence on eating habits has to be seen as very ambivalent. Seen in retrospect, health communication in the media, in relation to nutrition and physical activity, could be regarded as something that is very heterogeneous that rather makes people insecure, and that has only little lasting effect on their behaviour.