Amid 'war on obesity,' skeptics warn of stigma

[Bad_Daddy 2,209]

http://news.yahoo.com/s/ap/20110501/ap_on_re_us/us_obesity_backlash

By DAVID CRARY, AP National Writer – Sun May 1, 10:00 am ET

The images are striking: Overweight boys and girls staring somberly from billboards and online videos, real-life embodiments of the blunt messages alongside.

"Chubby kids may not outlive their parents," for example. Or: "Big bones didn't make me this way. Big meals did."

The ads — part of a new "Stop Child Obesity" campaign in Georgia — won some enthusiastic praise for their attention-grabbing tactics. But they also have outraged parents, activists and academics who feel the result is more stigma for an already beleaguered and bullied group of children.

"Billboards depicting fat kids are extraordinarily harmful to the very kids they are supposedly trying to help," said the National Association to Advance Fat Acceptance, which called for the billboards' removal.

The Georgia Children's Health Alliance, which created the ads, said they were necessary to jar parents of obese kids out of a state of denial that their children had a problem.

The furor reflects a broader nationwide phenomenon as states, cities and the White House itself — led by first lady Michelle Obama — expand efforts to curb obesity. For all the public support of these efforts, there's also a vocal and passionate corps of skeptics and critics worried that widespread discrimination toward the overweight and obese will only increase.

"Stigma is not an effective motivator," said Rebecca Puhl, a Yale University psychologist who is a leading expert on weight discrimination. "Whether children or adults, if they are teased or stigmatized, they're much more likely to engage in unhealthy eating and avoidance of physical activity."

Research by Puhl and her colleagues at Yale's Rudd Center for Food Policy and Obesity suggests that weight discrimination is pervasive — at schools, in the workplace, in the media, among health care providers. Yet efforts to combat it frequently founder: Only one state, Michigan, outlaws weight discrimination, and the anti-bullying policies proliferating in schools often lack specific content related to teasing of overweight children.

The spotlight on obesity intensified last year when Michelle Obama unveiled her national public awareness campaign, "Let's Move." Its goal, she said, was to eliminate childhood obesity within a generation by helping parents make better food choices, serving healthier food in schools, and encouraging children to exercise more.

Many aspects of "Let's Move" won near-universal praise. But activists in the fat-acceptance movement and experts who espouse a "health at every size" approach were upset that the campaign encouraged the monitoring of children's body mass index, or BMI, and thus might contribute to stigmatization of heavier kids.

"The idea of a BMI report card is horrible," said Paul Ernsberger a professor in the nutrition department at Case Western Reserve University's School of Medicine in Cleveland.

"To declare we're going to eliminate childhood obesity — that's actually a very stigmatizing thing to say," Ernsberger said. "The overweight child hears that and thinks, `They wish I wasn't here.'"

Linda Bacon, a nutrition professor at City College of San Francisco, is the author of "Health At Every Size" — a manifesto for a movement stressing a healthy lifestyle rather than weight control. She said the focus by "Let's Move" on BMI was of dubious medical value and posed potential problems for kids at all weight levels.

"It's done much more damage than good," Bacon said. "The larger kids feel bad about themselves, and the thinner kids feel it doesn't matter whether they exercise or eat well."

Deb Lemire, president of the Association for Size Diversity and Health, credited Michelle Obama with good intentions and commended various nutrition-related aspects of "Let's Move." But she said the emphasis on weight risked worsening the problems of teasing and bullying.

"The message that gets to the kids is, `There really is something wrong with me,'" said Lemire, of Cuyahoga Falls, Ohio.

"We're saying we love you, we want you to have wonderful lives and be successful, but right now you're just not good enough."

The first lady's press office declined to respond in detail to the criticism, but defended "Let's Move."

"There will always be critics, but our approach is comprehensive, nurturing and working, with success already seen across the country," the office said in an e-mail.

There's no question that "Let's Move" has broad, high-powered backing, from groups such as the American Academy of Pediatrics. Its supporters note that one in three American children are overweight or obese, putting them at higher risk of serious health problems while billions of dollars are spent yearly treating obesity-related conditions.

Dr. Sandra Hassink, who chairs the pediatrics academy's obesity work group, said she witnesses the toll of weight-based bullying on a daily basis at her clinic at the A.I. duPont Hospital for Children in Wilmington, Del.

However, she defended the use of BMI as a screening mechanism.

"We know that elevated BMI places you at elevated risk of health problems," she said. "It's a screening tool to start a conversation with a child and family about health behavior that will reduce that risk."

Weight loss doesn't necessarily need to be the overriding goal in every case, she suggested, but it can be a vital part of countering diabetes, liver disease, sleep apnea and other obesity-related problems.

Critics of "Let's Move" say it could have struck a more positive tone about the diversity of body sizes and the possibility of being both large and healthy simultaneously.

"Regardless of her intentions, the first lady is making things worse," said San Francisco attorney Sondra Solovay, who teaches and writes about weight-based discrimination.

"I invite her to talk to fat adults who have experienced the hatred and discrimination firsthand," Solovay said, "and ask them how this program would have impacted them as kids."

Several local and state anti-obesity initiatives also have drawn fire from weight-discrimination watchdogs — notably Arizona Gov. Jan Brewer's recent proposal to levy a $50 fee on state Medicaid recipients who are obese and don't follow a doctor-supervised slimming regimen.

"This proposal does nothing to improve public health, and only perpetuates further stigma toward thousands of individuals whose quality of life is already reduced because of prejudice," Puhl wrote in her blog on Medscape.com.

One form of such prejudice is harassment at school. Peggy Howell, spokeswoman for the National Association to Advance Fat Acceptance, protested when members of Congress recently introduced a bill that addressed bullying based on race, ethnicity, gender, disability, sexual orientation and religion, but made no mention of body size.

"Why are weight and height missing?" Howell asked. "Multiple studies indicate that fat children are the group being most bullied."

Puhl says too little attention is paid to such bullying.

"Youth who are obese cannot conceal their weight — their stigma is very visible," she said. "And yet their voices are not being heard. They are so vulnerable to victimization, with such devastating consequences."

Indeed, weight-related bullying is being cited by family members as a possible factor in the decision of two 14-year-old Minnesota girls to commit suicide together on April 16.

Puhl, who has studied weight discrimination for more than a decade, was lead author of a 2007 study of overweight children that concluded their quality of life, due to stigmatization by peers, was comparable to that of people with cancer.

She also has examined how obese people are portrayed in ads, news reports, movies and TV shows. Too often, says Puhl, they are depicted in needlessly negative ways — slouching on a sofa, eating junk food.

"We need to be sure we are fighting obesity, not obese people," she says.

Among other initiatives, the Rudd Center has compiled a gallery of photographs portraying obese individuals "in ways that are positive and non-stereotypical" — strolling outdoors, shopping for fresh produce.

Puhl says her research indicates Americans would support legislation to prohibit weight discrimination, particularly in the workplace. Yet only Michigan and a handful of cities, including San Francisco and Santa Cruz, Calif., have such laws in place.

There's been little serious discussion in Congress or most legislatures about following Michigan's example by outlawing weight discrimination at the federal or state level. A bill introduced several times in Massachusetts has failed to advance; a similar proposal died in Nevada's legislature this year after employers objected.

Michigan's law, enacted in 1976, has resulted in only a handful of weight-related complaints each year, according to Michigan State University human resources professor Mark Roehling. He says many overweight workers may be hesitant to pursue legal remedies even if they do feel discriminated against.

One of the few high-profile lawsuits in Michigan involves two former waitresses who claim Hooters fired them in 2009 because they weren't sufficiently slim. Hooters officials say the state law shouldn't apply because the appearance of their waitresses was a legitimate concern. The case remains unresolved.

Meanwhile, fat-acceptance activists continue to struggle against what they perceive as bias — on matters such as airline seating and seatbelt standards that don't account for extra-large people.

Marilyn Wann, San Francisco-based author of the book "FAT!SO?," says she's proud to call herself fat, and objects to the terms "overweight" and "obese."

She became an activist partly because she was unable to buy affordable health insurance, and is grateful that the Obama-backed health care overhaul now enables her to get coverage. But she wishes the White House would do more to counter weight bias.

"I had a painful childhood, and it would be worse now because weight stigma has increased," she said. "It would be amazing if federal government took a stand against weight discrimination."

Hassink, the Delaware pediatrician, said obesity and weight discrimination should both be combatted firmly and compassionately.

"The environment is pretty tough for people struggling with their weight," Hassink said. "But we need to have the conversation. We're all in this together."

[Ban Hammer 13,696]

But they also have outraged parents, activists and academics who feel the result is more stigma for an already beleaguered and bullied group of children.

because self esteem ranks higher than getting clogged arteries.

[Bad_Daddy 2,209]

because self esteem ranks higher than getting clogged arteries.

Welcome to the age of politically correct, xbox, iphone, facebook, and fat kids.

[Trompe le Monde 1,107]

Allowing children to become obese is child abuse. If you let your child spoke a spliff they would be taken away and that's far less dangerous for their health than obesity.

[Danno 1,228]

Allowing children to become obese is child abuse. If you let your child spoke a spliff they would be taken away and that's far less dangerous for their health than obesity.

Thats what I have been saying for years.

These parents crack me up, light up a smoke around their chubby kid and they act like you are exposing them to crack.

The most unhealthy people I have known have been the obese people in my circle ... not the smokers.

Smoking is playing Russian roulette.... Obesity is playing Russian roulette with 5 rounds in the gun.

[Peikko 1,575]

Thats what I have been saying for years.

These parents crack me up, light up a smoke around their chubby kid and they act like you are exposing them to crack.

The most unhealthy people I have known have been the obese people in my circle ... not the smokers.

Smoking is playing Russian roulette.... Obesity is playing Russian roulette with 5 rounds in the gun.

Both are equally bad for your health. I guess you smoke which is why you try to downplay its effects?

None the less those who have obesity issues really don't need to be stigmatized. I don't think they are genuinely oblivious to their health problems and self esteem issues, particularly in children are not going to be very encouraging towards making the necessary changes. It's a difficult problem to try to solve and a very sad one when it affects children who have not really chosen to be the way they are at all.

[Danno 1,228]

Both are equally bad for your health. I guess you smoke which is why you try to downplay its effects?

None the less those who have obesity issues really don't need to be stigmatized. I don't think they are genuinely oblivious to their health problems and self esteem issues, particularly in children are not going to be very encouraging towards making the necessary changes. It's a difficult problem to try to solve and a very sad one when it affects children who have not really chosen to be the way they are at all.

NO they are not "equally bad for your health", you see many old smokers, heavy people start to fall apart early on and go much quicker..... and why wouldn't they, their weight effects so many systems.

Neither condition is healthy but being fat not only takes you to an early grave but seriously hampers your life in many ways...with kids their social life is often damaged, many experience emotional scars.

I have smoked 1 cigaret in the last 4 years and only off and on before that.

I doubt I will ever be a smoker again.

Negative add campaigns work, portraying smokers as unhealthy, unpopular, dirty, smelly, outcasts, has actually worked to some degree.

Posters of a skull with a wig and a cigaret clenched in the teeth hung in my doctors office along with 6 other anti-smoking posters or signs.... why no anti-fat propaganda.... and what would it look like?

Edited May 2, 2011 by Danno

[Peikko 1,575]

NO they are not "equally bad for your health", you see many old smokers, heavy people start to fall apart early on and go much quicker..... and why wouldn't they, their weight effects so many systems.

Neither condition is healthy but being fat not only takes you to an early grave but seriously hampers your life in many ways...with kids their social life is often damaged, many experience emotional scars.

I have smoked 1 cigaret in the last 4 years and only off and on before that.

I doubt I will ever be a smoker again.

Negative add campaigns work, portraying smokers as unhealthy, unpopular, dirty, smelly, outcasts, has actually worked to some degree.

Posters of a skull with a wig and a cigaret clenched in the teeth hung in my doctors office along with 6 other anti-smoking posters or signs.... why no anti-fat propaganda.... and what would it look like?

It's not exactly easy to point the finger of blame when it comes to obesity. The anti smoking ads demonize the cigarette smoking, not the smoker, the inhalation of cigarette smoke, not inhalation. How would you propose demonizing obesity without demonizing the obese?

[Danno 1,228]

It's not exactly easy to point the finger of blame when it comes to obesity. The anti smoking ads demonize the cigarette smoking, not the smoker, the inhalation of cigarette smoke, not inhalation. How would you propose demonizing obesity without demonizing the obese?

In the same way as we did demonize smokers as well I suppose.

Picture of fat girl home alone getting a text from her friend on a blind date... signaling he's a winner.

Poster of fat kid sitting by the side of the pool with his shirt on while everyone else is swimming.

Picture a scene where a guy in a drive-in buying a supersized burger meal can barely fit in his car.

These are not even exaggerated caricatures but rather scenes from everyday life... why pretend anymore?

Oh thats right.."self image".

Okay those are a little strong to start with but, rather than show a photo of a black set of lungs, we could picture...... gut-over hangs alongside fatty food products.

Or how about "Eating yourself fat is not cool"

http://i133.photobucket.com/albums/q43/guardgirlfhs10/inspirational/notcool.gif

[Peikko 1,575]

In the same way as we did demonize smokers as well I suppose.

Picture of fat girl home alone getting a text from her friend on a blind date... signaling he's a winner.

Poster of fat kid sitting by the side of the pool with his shirt on while everyone else is swimming.

Picture a scene where a guy in a drive-in buying a supersized burger meal can barely fit in his car.

These are not even exaggerated caricatures but rather scenes from everyday life... why pretend anymore?

Oh thats right.."self image".

Okay those are a little strong to start with but, rather than show a photo of a black set of lungs, we could picture...... gut-over hangs alongside fatty food products.

Or how about "Eating yourself fat is not cool"

http://i133.photobuc...nal/notcool.gif

You brave soul. Which 'fatty food products' are you going to demonize Danno? Cigarettes can be demonized fairly easily, there is nothing ambiguous about it. Cigarettes deliver nicotine (and other nasty additives that the tobacco industry laced them with to enhance the addictive properties) which is a single substance that is harmful in a very specific and calculable way. Fatty foods? What specifice harmful substance do they deliver and in what way can a direct cause and effect be established? The tobacco industry found many ways to avoid being targeted in this way for years before it was finally successful (if it really is, I am not even sure that it is, but let that pass) do you think the food industry is just going to lie down and accept 'fatty food products' as the culprit without a fight? One that is much, much harder to prove and what about sugar? Why is that left off the hook?

[Bad_Daddy 2,209]

You brave soul. Which 'fatty food products' are you going to demonize Danno? Cigarettes can be demonized fairly easily, there is nothing ambiguous about it. Cigarettes deliver nicotine (and other nasty additives that the tobacco industry laced them with to enhance the addictive properties) which is a single substance that is harmful in a very specific and calculable way. Fatty foods? What specifice harmful substance do they deliver and in what way can a direct cause and effect be established? The tobacco industry found many ways to avoid being targeted in this way for years before it was finally successful (if it really is, I am not even sure that it is, but let that pass) do you think the food industry is just going to lie down and accept 'fatty food products' as the culprit without a fight? One that is much, much harder to prove and what about sugar? Why is that left off the hook?

Choices. Some people can eat fatty foods and not get fat, and some eat those foods and get fat as a house. Fat people are unhealthy people. It's a choice to be fat or not to be fat. Kids on the other hand...that's on the parents.

[Trompe le Monde 1,107]

Choices. Some people can eat fatty foods and not get fat, and some eat those foods and get fat as a house. Fat people are unhealthy people. It's a choice to be fat or not to be fat. Kids on the other hand...that's on the parents.

Kids also generally have a much better metabolism that adults....for a kid to become obese takes some doing

[Peikko 1,575]

Choices. Some people can eat fatty foods and not get fat, and some eat those foods and get fat as a house. Fat people are unhealthy people. It's a choice to be fat or not to be fat. Kids on the other hand...that's on the parents.

See Danno, demonizing fatty foods is not going to fly. All that is left is to demonize fat people and really, if you know the actual cause of obesity you know it isn't some people 'choosing' to eat fatty foods knowing it will make them fat but doing it anyway out of deliberate perversity. People eat badly for all kinds of reasons including ignorance of what are proper food choices and using food as an emotional crutch. Neither of those issues will be addressed by putting up pictures of fat people on billboards as a health warning.

[Peikko 1,575]

Kids also generally have a much better metabolism that adults....for a kid to become obese takes some doing

Sadly it does. The only thing I can think of when parents see their children getting fat is that they can't bear to confront their child on the problems that cause the obesity, that and sometimes they are obese themselves which makes facing reality rather difficult to accomplish. That is not to excuse the behaviour, but I just can't see how fat people on billboards as a health warning could achieve all that much.