Friday, January 06, 2012

What's wrong with Georgia's childhood obesity campaign

My Aunt Selma was a fat teenager. Like most fat kids, she was deeply ashamed of her body. She tried many times to lose weight, and eventually hit on two strategies: cigarettes and bulimia. She died in excruciating pain, in large part from the abuse she’d heaped on her body for many years. But she died—and lived—thin.

I think about Selma every time I hear about yet another new initiative to fight childhood obesity. The latest is Georgia’s “Strong 4 Life” campaign, which features black-and-white images and video clips of children talking about being fat. Several of the kids say they don’t like to go to school because they get picked on. One asks his mother dramatically, “Mom, why am I fat?”

The answer is implicit in the advice found on the campaign’s website: Eat less junk food and more fresh fruits and vegetables. Be physically active. Limit screen time. All great ideas, except that doing these things won’t necessarily make kids thinner. Over the last decade, dozens of school programs have used nutrition education, junk food bans, and farm-to-school projects to try to slim schoolkids. None have worked. They’re positive programs that support kids’ health. But they’re considered failures because they don’t reduce weight.

Like virtually every other effort to combat childhood obesity, the Georgia campaign suggests that obese kids and adults can get thin by making moderate lifestyle changes, a fact not borne out by research or experience. Rudolph Leibel, an obesity researcher at Columbia University, has demonstrated over and over how biology makes maintaining weight loss difficult to impossible for most people.

And like most such efforts, the Georgia campaign fails to take into account the connection between obesity and stress—specifically, the stress of being stigmatized over weight. When Jaden tells the camera he likes to play video games alone because other kids pick on him, the screen reads, “Being fat takes the fun out of being a kid.” The implication is clear: The problem is with Jaden. It is his fat, and the fact that he is fat, that make the other kids taunt him. The ad follows up with a taunt of its own: “Stop sugarcoating it, Georgia.”

Peter Muennig, M.D., of Columbia’s Mailman School of Public Health, researches the connections between weight and health. He believes stigma and weight bias are responsible for at least some, and possibly most, of the adverse health effects associated with obesity. In other words, it may not be weight itself that makes people sick, but rather the stress of being fat in a fatphobic society. Kortni Jones, a physician’s assistant in Michigan, looked at the relationship between weight stigma and health care in her master’s thesis, and found that messages of overt stigmatization from health-care providers translate to worse health care for people who are obese. Rebecca Puhl of Yale’s Rudd Center for Food Policy & Obesity has come to similar conclusions after doing a series of studies on how stigma affects obesity.

Clearly, shaming people about weight is not an effective public health strategy. So why are we still doing it? Why, for instance, is there nothing on the Georgia campaign website about educating kids not to tease each other over weight? Why do people who would never dream of telling a joke about blacks or Jews tell fat jokes without flinching?

Efforts like this one emphasize the idea that weight loss is a matter of personal responsibility, and they demonize fat children and teens in the name of helping them. How do kids feel when they see kids who look like them being targeted as not OK? They already know it’s bad to be fat; in one recent study, children as young as three showed a strong preference for thinness over fat, and made comments like “I hate her because she has a fat stomach” and “She’s fat and ugly.”

I have a better idea for a public health campaign, one that’s supported by research and experience. Let’s take the best ideas from campaigns like this one and frame them around health instead of weight. Instead of trying to make fat kids thin, the goal would be making all kids healthier.

We don’t fully understand why some people become obese and others don’t. But we do know that all of us, no matter how old, no matter how fat, benefit from eating well and getting exercise. We know that friends are good for our health and that bullying hurts the bully as well as the victim. We know that shame drives people like my Aunt Selma to self-destructive behaviors. In my campaign, the word obesity would never be mentioned. But the words health, respect, and compassion would be on every page.


Deah said...

Thank you for a clear voice of sanity in an arena fraught with hate and misplaced emotions.
Warmly, Dr. Deah Schwartz,

Bill Fabrey said...

Amen! This deserves to be an Op-ed piece in the NY Times.

People, including kids, have always come in all shapes and sizes. To attempt to shame people into losing weight simply doesn't work, and kids are an especially defenseless segment of the population.

These ads are discriminatory, pure and simple. As a director of the Council on Size & Weight Discrimination (, I have protested these cavalier experiments with the well-being of our children, by signing a petition that was put up today by BEDA (Binge Eating Disorder Association). The link for the petition is:

--Bill Fabrey

Jeanette DePatie said...

This is a truly wonderful post. Thank you. Do you know where I can get access to Peter Muennig or Kortni Jones' research? Thanks again!

Bonnie said...

Hi Harriet
Your latest blog brings up a serious health issue.If children as early as three show signs of preference for thinness over fat.Maybe it starts early with parenting, babies come in all shapes and sizes. We are very joyful when they arrive HEALTHY.

Mother Bear caring for her cub

Harriet said...

Parenting plays a role for sure, Bonnie. Because we parents are human, and we live in this society, and we want the best for our children, so we're easily made anxious about whether our kids are OK or not.

Also, I know I was guilty of making self-deprecating comments about my body and my weight in front of my daughters when they were young. How I wish I could take it back now.

Marsha Hudnall said...

Thanks so much for this, Harriet. It so clearly spells out the problems with this damaging campaign and with weight stigma, and will help a lot of people understand why we must take a stand against both.

I've posted links to this on Facebook as well as Twitter and signed the petition Bill mentions above and encourage others to do so, too.

Paul Ernsberger said...

The link between stigma and illness is obvious. Why work to take care of a body you hate?

Harriet said...

Definitely part of the picture, Paul.

Shivaun Nestor said...

Thank you for your excellent, evidence-driven response to this horrific campaign. Twenty+ year working with youth and young adults as a public health educator has given me an intimate understanding of the link between low self-efficay and self esteem on children's ability to adopt healthier behaviors. As someone who has also done a great deal of work with young MSM around HIV prevention, I can testify first hand to the impact that bullying has on health risk. This ad campaign is nothing so much as an invitation to further bully a group of youngsters who are already at the mercy of a fiercely fat-phobic society. With great respect.

Anonymous said...

I tried signing it but it wouldn't let me. It kept saying my city "can't be blank", even though I filled in my city, and also tried entering it as city comma state. Now what?


Bill Fabrey said...

To Mulberry:

To sign the petition, you have to "join" the site first, which is free. I had trouble at first, too, assuming that it was my old browser. The site is not user-friendly, but it's still worthwhile.

Tracy Benham said...

Great post! Thanks for sharing your insight.

Marti said...

Have you all looked at the growing obesity rates in the U.S.?
How can you look at this data and not see clearly that America as a whole has a problem? It doesn't take a rocket scientist to figure out that the increased processed foods we put in our bodies in addition to our more sedentary lifestyles, increased portion sizes, increased time in front of TV--all of these things are contributing factors.
I feel like the author of this piece as well as the commenters before me all have blinders on to the fact that we own this problem ourselves and that it is ours to fix.
On the whole, Americans are not fat because of an image problem--quite the contrary. Our image as Americans has made us feel, albeit somewhat subconsciously, that we were invincible. We can do, eat, watch, sleep, sit, work whenever, whatever, and wherever we'd like. It has caught up with us in our poor health and it's now time for us to change our lifestyles to better our bodies.

Harriet said...

I think you're missing the point. Several points, actually.

First, no one really knows or understands why people in America got fatter over the last 30 years. The elements you mention likely have played a role, but there are other contributing factors too, which we don't fully understand. Why have lab animals also gotten fatter over the same period of time? Their diet and exercise levels are known, yet they too have gotten fatter. There's good evidence that pollution, hormones in the food supply, and other as-yet-unknown factors are contributing as well. These things we cannot "own" by resolving to eat less and exercise more.

One thing that has definitely changed is the definition of obesity; a change in the categories of the BMI chart in 1997 meant that overnight, millions of people were suddenly obese.

Second, no one here is arguing that we shouldn't pursue health--it's just that we should pursue it for its own sake, not as a means to lose weight. Weight is often used as a proxy for health, and if you do a little reading you'll come across a concept known as the "obesity paradox," so-called because in some cases, especially as we age, higher weights actually confer lower mortality. It is not always better to be thinner. We're getting taller, too--should we be concerned about the height epidemic?

Your last line suggesting we "change our lifestyles to change our bodies" is reasonable, but again, only as long as the end goal is not weight loss. If you've been reading the series of New York Times pieces on weight you'll see that for people to lose significant amounts of weight and keep it off for more than a year or two, they must make weight loss their top priority and engage in a lot of obsessive behaviors that are a lot like eating disorder behaviors. It's not a question of making some moderate changes for most people.

Finally, the main point of this commentary was to look at the link between weight stigma and health, which after all is not just a question of numbers on the blood pressure meter. We are whole human beings whose mental and emotional health affects our physical health, and vice versa. Stigmatizing people in the name of health is just bad policy and bad practice.

Jane said...

Dieting predicts weight GAIN over time. The research is clear. If the Georgia campaign increases dieting in kids it will worsen the situation.

Sharon said...

If an anti-obesity campaign like this had been around when I was in elementry school or middle, I think I serioulsy would have been even more introverted and unsocial and possibly suicidal.

Amanda Kramer said...

Harriet - This is such a great piece. (Joan Fischer passed it along to me - we're here in Madison)...Excellent opinion on this campaign.