Fat kids: the blame and shame game?

Who knew an ad campaign promoting a healthy weight for kids could become the target of so much controversy?

The campaign, called Strong4Life, was rolled out last summer by Children’s Healthcare of Atlanta, Ga., prompted by concern for the future health of overweight children and data suggesting many parents fail to recognize when their child is overweight. Its newest addition is a series of billboards and ads containing photos of fat children, the word “warning” in red letters and messages such as “Fat kids become fat adults,” “It’s hard to be a little girl if you’re not,” and “Big bones didn’t make me this way. Big meals did.”

Public reaction has been swift, to say the least. It’s being blogged and talked about coast to coast this week.

Organizers of the campaign have said the shock tactics are deliberate. “We felt like we needed a very arresting, abrupt campaign that said: ‘Hey, Georgia! Wake up! This is a problem,'” Linda Matzigkeit, a senior vice president at Children’s Healthcare, told the Atlanta Journal-Constitution.

Few would argue we should all just look the other way when it comes to overweight children. But is an in-your-face approach appropriate? More to the point, does it work?

This campaign has drawn a lot of criticism, much of it well placed. (Read more here, here and here.) Public health experts who’ve weighed in say there’s little evidence that shaming is effective in getting either kids or adults to change their behavior. Some worry the harshness of the ads could make children and parents even more reluctant to seek help in losing weight. Others point to the complex influences on children’s weight – family income levels and lifestyle, food availability, the community environment, even the national school lunch policy – and the difficulty of applying simplistic solutions to childhood obesity.

But score at least a couple of successes for this campaign. It has highlighted, rather painfully, the fine line between attacking the problem vs. attacking the person who has the problem. It also has highlighted how difficult it is to have a national conversation about obesity without descending into shrill self-righteousness on one side and angry defensiveness on the other.

The firestorm surrounding the Georgia campaign actually is nothing new. Some years ago, a local medical clinic had to revamp its advertising for a pediatric weight loss program after hearing complaints from parents who objected to the imagery – a sad-looking child sitting alone while his peers played together in the background.

It’s not easy to know how to convey the message in a way that’s constructive. And make no mistake, “constructive” should be the operative concept here.

Since the goal of the Georgia campaign ostensibly is to prod parents of overweight children into taking action, it seems fair to ask: Are these parents genuinely in denial? There’ve been a number of studies examining parents’ perceptions of their child’s weight and most have found that families aren’t very good at recognizing when a child crosses the threshold for being overweight.

I had to look it up online: Among kids ages 2-19, overweight is defined as having a body mass index between the 85th and 95th percentile on the growth chart for children of the same age and gender. Obesity is defined as a BMI above the 95th percentile. I suspect many parents don’t know this formula off the top of their heads. Moreover, they may have trouble accurately applying it, especially for a child who’s actively growing.

Even when parents do recognize their child is overweight, they can be reluctant to add the obesity label (or any label, for that matter) to his or her medical record early in life. There also seems to be a persistent amount of misinformation about childhood obesity, one of the myths being that most kids eventually outgrow it.

It would seem that helpfulness and better information are called for here, rather than judgment or scare tactics.

And let’s not overlook another important fact: The medical community traditionally has had little to offer overweight children and their families other than the standard advice to eat less and be more active. Nor is there much evidence yet that interventions for adults, such as weight-loss surgery, are safe or effective for kids.

For the record, I dislike the Georgia campaign. Kids who are fat already know they’re fat; their peers are telling them so every single day. Harping on it may highlight the symptom but it does little to address the deeper causes. And if the ad campaign is meant to galvanize parents into taking action, why manipulate kids into the position of being a shameful symbol of parental failure?

If we’re going to recognize that the people who designed this campaign were motivated by concern for kids’ health, let’s also recognize that those who object to the ads are motivated too by concern for what’s best for kids. How about dialing down the rhetoric and meeting somewhere in the middle?

Image: Children’s Healthcare of Atlanta