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.