Challenging Dogma - Spring 2009

Wednesday, May 6, 2009

Sergeant Choice- Failures and Solutions-- Hector Mendez


The overweight and obesity epidemic has been propelled into the spotlight of current health issues affecting America’s population, and particularly, America’s youth. Currently there are approximately 142 million people nationwide that are overweight or obese. A total of 17% of teenagers are carrying extra weight (1). It’s increasingly important that teenagers of all ages learn to live healthy lifestyles, in order for them to avoid deleterious health outcomes due to their weight. One particular phenomenon that affects our country’s young adults is the “Freshman Fifteen”: the belief that freshmen gain fifteen pounds in their first semester of college. Each September, college from all over the country travel by car, plane and train to reside at their school of choice. Even though some studies show that freshmen don’t actually gain the full fifteen pounds, it’s important that we look at this phenomenon in order to determine how we can prevent a lifetime of bad eating habits and promote healthy lifestyles (2). One particular health approach that seeks to promote healthy eating habits is the Sargent Choice. The goal of this approach is to “improve the eating choices and ultimately the health of the entire BU community”. The program’s recipes and healthy menu options are developed by registered dieticians, as well as graduate and undergraduate nutrition students. Although BU Dining Services and Sargent College have made healthy options available to students, Sargent Choice has failed to infiltrate the mindsets of BU students on the Charles River campus, particularly because of three main flaws: 1) as an innovation it has not been disseminated effectively, 2) it is based on traditional health models which assume that human beings behave rationally and, 3) it doesn’t teach individuals anything regarding healthy and nutritious foods, which would affect self-efficacy.

Ineffective Dissemination

The Sargent Choice program (SC) was started in 2004; they sought to offer healthier options in the dining halls, in an effort to promote a healthy campus. The program has evolved in the past 5 years, and currently has its own interactive website with videos, recipes, and tips on how to eat and live healthily. However, as an innovation, SC has not been adopted by most BU students. Most students don’t even know much about what the program is, or how they can use it to improve their health.

According to one of the Social Process theories, the Diffusion of Innovations (DOI), an important part of the adoption and implementation of an innovation into a community is the process of dissemination. This theory was developed by Everett M. Rogers, who claimed that an innovation must be effectively communicated through different “channels over time among member of a social system”. DOI theory defines dissemination as the “active knowledge transfer from the resource system to the user system” (4). There is a chronological set of events that leads to the innovation reaching all the target population; dissemination is one of the key elements.

Adoption of the SC has been minimal, particularly because the uptake of behavior requires knowledge regarding the innovation. In this case, most BU students are unaware of what exactly SC is and, more importantly, how to use it effectively. There has not been any significant effort by the part of Sargent College or by Dining Services to really create a positive attitude toward SC; most students are apathetic or have minimal understanding of the program, and believe that it’s not actually a healthier option. Essentially, students lack procedural, and principles knowledge. These are two of the three “knowledges” that influence and individual’s decision to adopt or take up a behavior or innovation (4).

There are other factors that also contribute to the rate and extent of diffusion that an innovation, like SC, can have. There is some level of compatibility with the target audience, however, it does not seem to have any “observability”, meaning that the results are not easily measured or observed. In addition, the innovation cannot truly be adopted without strict commitment. This is arguably one of the most important factors regarding adoption of SC. Most students don’t have the time to seek out SC in the dining halls; this is, in part, due to the lack of knowledge. If students actually knew what the benefits were, or how to measure their observable results, they would have more incentive to participate in SC.

Irrational Behavior

Sargent Choice is also partially based on some traditional health behavior theories that assume humans behave rationally and that intent is a direct determinant of behavior. One of the theories, the Health Belief Model (HBM), suggests that if an individual believes that if truly believes that adopting the behavior, Sargent Choice, will avoid a negative health outcome, the individual will uptake it. Students must also believe that they are susceptible to an unhealthy outcome and that the outcome can be severe and affect some aspect of their life; adopting SC must have some healthy outcome that will either diminish or completely prevent an undesirable health outcome. Assuming that there are no barriers preventing a student from incorporating SC into their daily routines, the student will adopt the behavior (5). This model makes the assumption that an individual’s intent leads to behavior without any other impeding factors.

HBM doesn’t take into account the students’ attitudes toward the behavior. In order for them to adopt the behavior they must believe that it will have some sort of positive outcome. If the social norm around campus is to eat healthily, this will also affect the intent to behavior pathway. The Theory of Reasoned Action (TRA) posits that attitudes and social norms affect a person’s intent and then lead to behavior. However, even though it is socially acceptable to eat options from the Sargent Choice menu, most students will disregard the signs when dining. Students choose what is most convenient and what seems most palatable; in general, the SC logo is disregarded. This traces back to the inefficient dissemination of information regarding SC.

It is evident on the SC website that the program is based on rational behavior. Sargent Choice assumes makes the claim: “Eating well will never be this easy again”(3). If students had knowledge about the nutritious ingredients used in SC, they would undoubtedly choose the SC menu option over anything else in the dining hall. This is the assumption made by the SC team. However, when other menu options that are not as healthy, are placed in front of students, they are less likely to choose the healthy choice. SC overlooks various factors that could affect a person’s decision making process, as it is by no means a linear one. Other determinants could include emotional status and cultural differences food palates and eating habits (4).

SC also assumes that students eat the correct proportions and in moderation. However, many students continue to eat even past satiety; even if a dish is healthy, if it is not eaten in moderation, it can also have deleterious effects on health if we’re eating more calories than are expended. Even if a student eats a healthy SC food item, there are other items there that are at the students’ disposal. SC promotes their food options as a kind of mindless way of choosing what is healthy; however, they need to incorporate nutrition education in order for students to be more health-conscious. More importantly, students should be made aware of the harmful health effects that eating an unhealthy diet. Students should understand the health problems that accompany being overweight or obese, which include, diabetes and cardiovascular problems(1). Since humans do not act rationally, SC has not had a major impact on the health of the Charles River campus. Even if students don’t perceive themselves to be susceptible to these health outcomes, knowing the severity can have an impact on their choice of foods according to the “principles knowledge” that is part of DOI. If students understand that the innovation can help reduce negative health outcomes, it can influence their decision to adopt Sargent Choice.

Lack of Self-Efficacy

Sargent Choice does not promote self-efficacy. The self-efficacy construct is “a person’s belief in his or her ability to take the action” (4). This major flaw is propagate because SC does not actually make a significant effort to teach students about eating healthy and making good choices when it comes to choosing the foods they eat. The website claims: “Sargent Choice foods aren’t available anywhere but here at BU” (3). If the dining halls were the only place students ate at, then SC would have better results. However, students have the entire city and towns surrounding campus, where they can choose from countless different eateries. Thus, what good is SC doing if it doesn’t educate the students and lay down a foundation on which to work. The new website is very much interactive; it includes numerous tips on how to eat healthy, who needs to eat healthy, and where you can get SC food options. Nevertheless, the website is not very well advertised throughout the campus, and most students do not visit it. If the resources available on the website were made available in the dining halls, students would access them more. In this way, students would be educated and empowered with the knowledge to eat well. Students need to feel that they can perform the health behavior, and they must feel that it is really going to make a difference in their lives.

If SC focused on educating students about nutrition and overall health, students would be able to make healthy decisions in and out of the dining hall. This would promote a sense of self-efficacy and even reciprocal determinism as postulated by Albert Bandura in his Social Cognitive Theory (SCT). Reciprocal determinism is the process by which a person acts according to individual and environmental factors, receive a response after adopting the behavior, and according to the response they will go back and adjust the behavior before performing it again. Reciprocal determinism ties into the idea of self-efficacy, since it promotes the idea that we can adjust our behavior and try it again. In regards to the Sargent Choice, this means that we can adopt the behavior, and depending on the results and response we receive from the environment, we can adjust and continue the behavior (4). These two ideas are important in implementing and maintaining a health behavior because students feel empowered and able to perform the behavior. When students truly understand how to use SC, and can apply the principles behind SC to their meals outside of the dining hall, then SC will truly have an impact on the overall health of the BU community.


Sargent Choice attempts to address an important problem facing America today: maintaining a healthy lifestyle despite the countless fast food and unhealthy food options. However, this public health approach aimed at BU students is based on some of the traditional health behavior theories that fail to incorporate some important ideas. One of the major flaws of the program is that it has not been properly publicized around campus. They have failed to really disseminate information regarding SC throughout campus. Many students are unaware of the benefits that eating healthy can have, or more importantly, unaware of the effects bad food choices can have on one’s health. Without sufficient knowledge about Sargent Choice, students fail to implement this innovation on campus, and therefore it is by no means maintained by very many students. Since it is based on traditional health behavior theories, it makes the assumption that students are going to think rationally and that they make a linear decision making process. The program must take into account that even though the healthy choice may be obvious, intent does not directly lead to behavior. Finally, the program does not educate students about making nutritional choices. Students must be educated on how to eat healthily, and maintaining a balance between diet and exercise. Once students know how to make healthy food choices in and out of the dining halls, they can truly incorporate SC principles into their daily lives. When this goal is reached, students can develop a sense of self-efficacy, meaning that they will feel apt to make good choices regarding foods, and continue to make the correct choices.

Reference List

  1. Crombie A, Ilich J, Dutton G, Panton L, Abood D. “The freshman weight gain phenomenon revisited”. Nutrition Reviews [serial online]. February 2009;67(2):83-94. Available from: Alt HealthWatch, Ipswich, MA. Accessed April 8, 2009.
  2. Mihalopoulos, Nicole L., Peggy Auinger, and Jonathan D. Klein. "The freshman 15: is it real?(Clinical and Program Note)." Journal of American College Health 56.5 (March-April 2008): 531(3).
  3. Why Sargent Choice. The Sargent Choice Website. Available at: Accessed April 6, 2009.
  4. Edberg, M.. Essentials of Health Behavior: Social and Behavioral Theory in Public Health. Ontario: Jones and Bartlett Publishers; 2007.
  5. Rosenstock, I.M. (1974). The health belief model and preventive health behavior. Health Education Monograph, 354-386.

The New Sargent Choice: Stay Smart, Eat Healthy — Hector Mendez

College students lead fast-paced, high-energy, and sometimes, unhealthy lifestyles. Oftentimes, they don’t have time to think about making healthy food choices. The current Sargent Choice Program at Boston University has several flaws that have rendered it ineffective among the student body. SCP doesn’t address the irrational behavior of human beings, the necessity for an approach that promotes self-efficacy and maintenance, and it has failed to effectively influence the community at large. An alternative and effective intervention is necessary to address the serious issue of obesity affecting all age groups of American society. One of the greatest increases in obesity has been seen in the 18-29 year-old age bracket. In 2001, the overall prevalence of obesity among 18-29 year-olds was 14%, and even higher among those with some college education, at 21% (1). Equally surprising is the data from the National College Health Risk Behavior Survey, which projects that 35% of college students are overweight or obese (2). When we look closer, we see that students aren’t engaging in healthy eating habits, and according to one study, approximately 70% of students are eating less than the recommended 5 servings of fruits and vegetables per day (1). Sargent Choice has established a pretty good foundation for an intervention aimed at improving the eating choices and ultimately the health of the entire BU community” (3). In order to make it a success and perhaps a model for other campuses, we must make sure that knowledge and information about the program is properly disseminated to every corner of campus. More importantly, it’s important that it mirror health models that incorporate the social and environmental context in which individuals live; the health behavior theories that focus on the context in which individuals make decisions account for “external factors” that can affect health behavior (4). One of the most important adjustments to the SC program, is going to be the incorporation of important facts that will provide individuals the knowledge to eat healthy not only in the dining halls, but elsewhere on campus. This knowledge will enable students to uptake healthy eating in general, and allow them to maintain the behavior.

We Must Reach Every Corner of Campus

In order for a public health intervention to be successful it’s important that individuals be aware of it. In designing an alternative approach to the current SCP, it’s important to borrow some principles from the Diffusion of Innovations (DOI), and Social Marketing theories. The proper definition of dissemination is the “active knowledge transfer from the resource system to the user system” (4). The identification of adequate communication channels is important to this transfer process. Without dissemination it is impossible to continue to the next step in the DOI process—adoption of the health behavior (4). According to a study by Valente and Fosados, there are few studies that have incorporated interpersonal communication as a part of dissemination. These researchers were focusing on STD/HIV prevention, and they concluded that interventions that included interpersonal communication were successful and “observed successes in health promotion”. They claim that a “social network analysis” may be an effective tool in designing appropriate and successful public health programs (5). As part of the new SCP, there will be a group of student health ambassadors that are knowledgeable yet approachable. They will visit the freshman dorms on the Charles River Campus to spread the word about the New Sargent Choice program (NSC), and let students know what NSC is all about and what they should look out for in the dining halls. Through this interpersonal communication, the student body will become aware of the intervention, and they can go on to the adoption phase of DOI.

Using another social process theory—Social Marketing (SM), the NSC will be treated as a “product” that we are marketing. Our goal in marketing NSC, is to have the student body adopt the new health behavior by their own volition. The four main principles of the SM approach include: product, price, place, and promotion. First, we need to market NSC as a product that includes many benefits. In this case, price would not be an issue, since students eating at the dining halls have meal plans that are paid for ahead of time. The place where NSC will be “distributed” is easy—the dining halls. In terms of promoting the product, interpersonal communication will be crucial. This can be student-to-student with the use of the student health ambassadors, but, the communication can also come from a professor or an academic advisor who meets with a student on a regular basis. Aside from that, other channels of communication can be used. In particular we can use the internet, e-mail, BU’s television channel, and the radio station (4). Ideas from the SM and DOI theories, really intertwine to help make dissemination of a health promotion program more effective.

A Rational Approach to Irrational Behavior

The old SC program seemed to mirror principles from traditional health belief models, like the Health Belief Model (HBM). HBM and other traditional health behavior models assume that intent is a direct determinant of behavior. However, HBM fails to incorporate “attitudes and beliefs” that are related to and account for “variance in behaviors” (6). Some important principles that are going to form the basis of the NSC, are going to include self efficacy, reciprocal determinism, and different internal and external factors from the Social Cognitive Theory (SCT). Individual characteristics include the principle of self-efficacy, which is the individual’s confidence in their capability to perform the behavior, as well as the individual’s expectations, self-control, and ability to cope emotionally. The environmental factors include an individual’s physical and social surroundings, reinforcements, and modeling of behavior from other individuals. Finally, reciprocal determinism is a process by which a person acts according to individual and environmental factors, receives a response from the environment and then goes on to adjust the behavior and perform it again (4). It’s important that NSC be easy to use; this will provide students with a greater efficacy expectation. This will have a strong effect on the ultimate performance of this target population. If NSC is marketed as an easy task, students will have a greater sense of self-efficacy, meaning that they feel competent enough to perform this task. Another important factor relating to self-efficacy, is generality. Students must feel that NSC can be generalized to other situations, such as eating at home, or at local restaurants. If there is generality, students feel that they can perform the task in an unsupervised setting (7). Essentially, they must believe that they have the necessary skills to achieve the goal—healthy eating choices. Therefore, we must provide them sufficient knowledge about nutrition for them to make intelligent choices beyond the walls of the dining halls; in this way, they will be empowered to maintain a healthy lifestyle.


The major flaw of the previous program was the lack of self-efficacy. However, with the NSC, we’re going to empower the students with the knowledge to make healthy eating choices to improve their general health and well-being. While the old SC claimed that SC foods were “exclusively at BU”, the NSC is going to provide students with more detailed information (3). Students should know the calorie value of all of the foods in the dining halls. How can students make healthy eating choices, if they don’t know how much they’re taking in? At BU’s dining halls in particular, they are an all-you-can-eat dining feast. Students are also free to stay at the dining halls for as long as they like. So as part of the NSC, students will have the ability to keep track of their calorie intake. Aside from that, NSC will continue to promote healthier eating choices, with an NSC menu full of whole wheats and other nutritious ingredients. The new interactive website is going to be a key tool not only to spread the word about NSC, but also to spread valuable knowledge that will provide students with the skills necessary to make healthy eating habits. The University should promote the website wherever and whenever possible-- at University-wide events, as well as smaller functions within the different schools and colleges. Another important part of NSC is going to be workshops that teach students how to maintain a healthy diet, and not just counting calories in the dining halls. Workshops should include many of the things discussed on the SC website, like what they call “macronutrients” – Carbohydrates, protein, and fat. However, with workshops, students will receive that interpersonal communication that is important in establishing a successful intervention (5). With these different measures in place, students will truly have a sense of self-efficacy that is a crucial component of Bandura’s SCT. Students will be able to understand NSC, what it can do for them, and how they can use it; as students incorporate it into their daily lives, it will change and reshape the health of the BU community.


The New Sargent Choice program really provides students with invaluable information and knowledge that is key to establishing healthy eating habits. Through different workshops on nutrition and healthy eating, through effective dissemination and awareness of the program, and through empowerment by self efficacy, NSC will really make a difference in the lives of students. When they feel competent and capable, they will be more likely to adopt the behavior. With the tools that NSC provides, like the website and the calorie displays, students will also be able to adjust their behavior once they have adopted the innovation or product. This is the main difference between the two approaches to healthy eating on BU’s campus—the empowerment of individuals to feel that they have the knowledge to make their own decisions outside of the dining halls, while having quick and easy choices that enable and promote healthy food options. As the program reaches out to every school and college at the university, and to every residence hall, students will learn about making good choices when it comes to foods, NSC principles will be incorporated into their lives, and they will be able to maintain this behavior.


  1. Huang, Terry T.-K, Kari Jo Harris, Rebecca E. Lee, Niaman Nazir, Wendi Born, and Harsohena Kaur. "Assessing overweight, obesity, diet, and physical activity in college students." Journal of American College Health 52.2 (Sept-Oct 2003): 83(4). Academic OneFile. Gale. Boston Univ, Mugar Memorial Library. 29 Apr. 2009
  2. Lowry R, Galuska DA, Fulton JE, Wechsler H, Kann L, Collins JL. Physical activity, food choice, and weight management goals and practices among US college students. Am J Prev Med. 2000;18:18-27.
  3. Why Sargent Choice. The Sargent Choice Website. Available at: Accessed April 6, 2009.
  4. Edberg, M.. Essentials of Health Behavior: Social and Behavioral Theory in Public Health. Ontario: Jones and Bartlett Publishers; 2007.
  5. Valente, Thomas W., and Raquel Fosados. "Diffusion of innovations and network segmentation: the part played by people in promoting health." Sexually Transmitted Diseases 33.7 (July 2006): S23(9). Academic OneFile. Gale. Boston Univ, Mugar Memorial Library. 30 Apr. 2009
  6. Janz, N., and Becker, M.. “The health belief model: A decade later”. Health Education Quaterly. 1984: 11(1), 1-47.
  7. Salazar, MK. “Comparison of Four Behavioral Theories: A Literature Review”. AAOHN Journal 1991; 39 (3): 128-135.

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