Amid 'war on obesity,' skeptics warn of stigma

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 against 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 the teasing of overweight children.

Many aspects of Let's Move won praise. But activists in the fat-acceptance movement and some other experts 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.

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 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,'" Lemire said. "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.

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.

Sandra Hassink, chairwoman of 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 BMI screening.

"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 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.

"Regardless of her intentions, the first lady is making things worse," said San Francisco lawyer 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, of Cuyahoga Falls, Ohio, 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 April 16.