After all the hubbub about that Strong4Life campaign in Georgia and the talk of fat shaming, I’ve decided to finally throw my hat in the ring. The first part of this post is a dissection of a recently poorly-written response to a study on the impact anti-obesity campaigns have on eating disorders. The second part of the post is me tossing my hat in the ring.
Today on Babble, Julie Miner wrote about the C.S. Mott Children’s Hospital National Poll on Children’s Health. The study looked at the impact that in-school anti-obesity campaigns had on rates of eating disorders (or behaviors indicative of them) in children 6 to 14 years of age and concluded that there may be a correlation between the campaigns and the disordered eating.
Unfortunately the actual study PDF is small (meaning it’s not a research paper), and in a font that my computer cannot read, so I’m left to rely on the press release. The take home message from the study’s author was:
“The issue of childhood obesity is a serious problem. In order to intervene in what seems like an epidemic of childhood obesity, everyone needs to be involved,” says David Rosen, M.D., M.P.H., Clinical Professor of Pediatrics, Internal Medicine, and Psychiatry at the University of Michigan Medical School and Chief of Teenage and Young Adult Medicine in the Department of Pediatrics.
However, Rosen says, “When obesity interventions are put in place without understanding how they work and what the risks are, there can be unintended consequences. Well-intentioned efforts can go awry when children misinterpret the information they’re given.”
“Many of these behaviors are often dismissed as a phase,” says Rosen, “But given what we know about the association of these behaviors with the development of eating disorders and knowing that eating disorders are increasing in prevalence, they should be taken very seriously.” Source.
And here’s the only figure they provide:
Seems to me like a measured conclusion based on the data. No shrieks of “Anti-obesity campaigns cause eating disorders!” or “Teaching kids to be healthy makes them fat!” or any such nonsense. At least not from the C.S. Mott Children’s Hospital.
For the nonsense, we need to turn to Julie Miner who apparently read the same study (although she didn’t link to it or otherwise facilitate her readers making their own determinations) and concluded, “Essentially, [the study concludes] that anti-obesity programs are scaring kids into starving themselves or over-exercising.” (Source.) Somebody needs to bone up on her reading comprehension, and I don’t think it’s me.
Having set up this straw man, Miner proceeds to knock it down with four main points.
“1.This is one poll. There are thousands of studies that show that anti-obesity education programs effect positive behavior change.”
Well, since Miner provides not a single citation and I already have a full-time job, I’m not going to PubMed search “thousands of studies.” However, I’m going to venture an uneducated guess that the “positive change” she’s alluding to is weight loss or decreased rates of obesity. Fair enough. The CS Mott study’s authors didn’t look at the efficacy of anti-obesity campaigns, only the prevalence of behaviors associated with disordered eating (ie over exercise, refusing meals, pre-occupation with food labels/calorie counts, etc.). If the “thousands of studies” Miner mentions but fails to cite, had weight loss/obesity rate as the readout of success, there is nothing to rule out the possibility that the “positive change” was affected by such increases in disordered eating.
“2. These headlines may discourage future obesity prevention and health promotion programming in schools.”
Well, I can’t say that it won’t, although I can attest to the public being kind of slow to come around to the science, so I doubt this will happen. That said, if these anti-obesity campaigns are having detrimental consequences for the emotional and physical well-being of school kids, then I certainly hope these programs are discouraged/discontinued. Although, like the authors of the study, I hope it isn’t a result of this study alone, since they authors draw no firm conclusion that there is a problem, just suggest that there may be a problem and it warrants further study. (However, that measured conclusion doesn’t make for a good straw man, so it’s easier to overstate the conclusions when trying to refute them.)
“3. Childhood obesity is perhaps the most important pediatric Public Health issue this country is facing.”
I’m guessing that the authors of the CS Mott study wouldn’t argue with this- you know seeing as how they work at a children’s hospital, treating children, and studying obesity and all. However, I’m guessing they would disagree that they should keep their scientific findings to themselves because, as Miner puts it, “That mixed messages exist about the importance of prevention education is troubling. That a lack of clarity could diminish our commitment to solving this problem is unacceptable.” As far as I can tell, the authors of the CS Mott study think that prevention education is super important. They would probably argue that their study points to a major need to do more research, get clarity on how best to implement prevention education, and get on with the business of educating. Just because science doesn’t necessarily agree with the current methods being used, doesn’t mean it is at odds with the overall goal. Miner’s argument here basically boils down to, “It doesn’t matter if our current approach isn’t working, or is having detrimental, unintended consequences. We need to forge ahead blindly! Ignore that science.”
“4. There is no clear consensus on the right way to do this and these findings only muddle the issue further.”
Uh, what? If there is no clear consensus, shouldn’t we do more research? Isn’t the fact that this study points to a potential problem with current anti-obesity campaigns reason to do more work to understand the problem? Why would you throw out good science that doesn’t fit with your fore-drawn conclusion if your ultimate goal was to prevent childhood obesity? I hate to be the one to break it to Julie Miner, but that’s not how science works. Scientists are always muddling their hypothesis- with data. If the data muddles the hypothesis, that means you do more experiments, not ignore the results and stick to your hypothesis. Further, clarifying the hypothesis doesn’t always mean proving it right- lots of times it means your hypothesis was wrong. Scientists are invested in the outcome whether they are proven wrong or right (although like everyone else, they prefer to be right). Putting one’s head in the sand so as not to upset the status quo is not a good way to make public health decisions and I’m dumbfounded as to why Miner would suggest doing so.
Now, scientist hat off, I have some other comments on this particular Babble post, as well as Georgia’s Strong4Life campaign that’s been the focus of so much debate, see samples below.
In a recent piece for XOJane, Lesley Kinzel hit the nail on the head when she wrote, “The only thing you can tell for sure by looking at a fat person is the degree of your own bias against fat people.” So I would like to encourage you to investigate their own biases and prejudices before you address this topic, especially before addressing the science of this topic.
My main objection to Georgia’s campaign and what drives eating disorders- is SHAME. Most of these efforts to prevent obesity Miner mentions revolve around shaming overweight kids and sending a message to all kids that thinner is better. As Miner said in her Babble post, “There are a myriad reasons and correlative effects that could account for the negative behaviors noted in the [CS Mott] survey. The most significant of which is the age of the students in question (they ranged in age from 6-14). It is precisely at this age when body image begins to affect behavior…”
These programs amount to ridicule, harassment, and shaming of overweight kids by their peers as a motivator to get them to change their ways. (If you doubt me, imagine that the posters from the Strong4Life campaign were drawn by some middle school kids and taped to some overweight kid’s locker- somebody would be going to the principal’s office.) They also plant the seeds of weight being a measure of self-worth in all kids. Even if those efforts succeed at goading kids to lose weight- is it worth the emotional and psychological toll? Are we, as a society, willing to torment kids to get them skinny?
Also, what of the skinny kid who sits at home playing video games, eating junk food, but thanks to genes and metabolism isn’t overweight? Is that kid healthy just because he/she is thin? Is weight the measure that matters most? Nobody is taking up the banner that we find a way to shame that kid into getting outside and exercising after a healthy snack.
I agree that schools should teach about how we keep our bodies healthy- what fuels/foods are best and how exercise is beneficial, dental hygiene, sex ed, etc. What I disagree with is that the only metric that anyone seems to care about for measuring health is weight. As Lesley Kinzel wrote, “The only thing you can tell for sure by looking at a fat person is the degree of your own bias against fat people.” As a scientist, I know that weight is not the sole predictor of health. As a mom, I don’t want my kids to equate their weight (or any other aspect of their outward appearance) with their self-worth. As a fat woman, I’m sick of people thinking they know everything about me- my health status, my ability to do my job, my worthiness to be loved- based on my size.
Shame isn’t a wide-spread tool for spreading messages of public health. We are constantly trying to “remove the shame/stigma” from problems as a way of encouraging people to address them- child abuse, sexually transmitted diseases, domestic violence, drug addiction, alcoholism, etc.
I propose a thought experiment. Look at the poster above meant to “encourage” kids to lose weight and parents to help them do it. Does that seem effective?
Now, how would you propose we reach out to teenaged girls to discourage them from having unsafe sex? Would we mount campaigns to shame kids into not having sex? What would that poster look like? A young girl with a caption that says, “It’s hard to be a little girl if you’re a whore.”
What about domestic violence? Would we depict battered women as objects of ridicule who need to come to their senses and make better choices? What would that poster look like- A women with a black eye and some cuts on her face with the caption “It’s hard to be a good mom when you’re a punching bag.”
If these ideas sound like a terrible public health campaign, why then, do we do this with fat kids/people? If you think being fat is a choice, then ask yourself two things. 1- given how derided fat people are, why would someone choose to be fat? 2- how much do you know about obesity, metabolism, and weight loss? Then read this and stop being prejudiced against fat people and kids.
Now, I am a scientist, and I am careful never to equate anecdotes with evidence. I may only be a sample size of one, but I have lots of fat friends and family that would back me up on this one. Shame is not a motivator to lose weight. I have been shamed, tormented, ridiculed and disparaged for my weight from the moment I started kindergarten. I remember feeling fat and ugly as a kindergartener. Having people around me want nothing more than to make me feel miserable about myself did not result in my losing weight. Further, there were times when I felt like crap and turned to food to comfort myself. It resulted in my having to work extra hard to maintain a sense of self-worth apart from my size. My good grades, public service awards, scholarships, friends, family, Ivy League education- all of those things can still be negated by one teenager screaming, “F*ck you, you fat whale!” because I deigned to ride my bike in the crosswalk and he nearly hit me with his car.
If Strong4Life thinks these ads are going to make a lightbulb go off for these fat kids and they are going to get off the school bus, holding back tears so their tormenters don’t see them cry, then go home, eat a carrot, and exercise, they are deluding themselves. If anything, those kids are going to run home (hey, at least it’s exercise!) so they can burst into tears the moment the door to their house closes, turn on the TV to try to forget the bus ride home, and eat the Chunky bar to which they were likened by the *ssholes on their school bus. Then their attempt to forget what pieces of cr*p they are to the kids at school will be foiled by an ad from Strong4Life interspersed with their TV show to remind them that it isn’t just the kids on the bus who think they are piece of cr*p, it’s everyone.
We cannot ignore the emotional consequences of being overweight in a society that readily shames people, nor should we capitalize on it in the name of public health. You want a public health campaign to help combat obesity? How about we educate people how to be healthy instead of just how to be skinny? How about we teach people that fatties aren’t just lazy, fried-twinky eating, dolts trying to drive up insurance premiums? How about we clue people in to just how hard it is to lose weight and keep it off so that they stop blaming/shaming themselves and others for their size and just focus on being as healthy as they can be in the body they’ve got?
Further reading, posts and articles that resonated and informed me in the past few weeks:
The Fat Trap by Tara Parker-Pope of The New York Times
What’s Wrong With Fat-Shaming? by Lesley Kinzel of XOJane
Leave Paula Dean Alone by S.E. Smith of XOJane
School obesity programs may promote worrisome eating behaviors and physical activity in kids by CS Mott Children’s Hospital.