Children’s Healthcare of Atlanta, a pediatric medical group, recently launched a highly controversial ad campaign intended to reverse Georgia’s alarming rate of childhood obesity. Second only to Mississipi, one million of Georgia’s children (40%) are overweight or obese and the pediatricians behind the campaign report seeing kids in need of knee replacements due to their obesity, as well as children with Type 2 diabetes and hypertension.
Called “Strong 4 Life,” the campaign’s television ads feature overweight children addressing the camera to discuss the negative effects of obesity on their lives. The ads end with a visual stating that 75% of Georgia parents with overweight or obese children don’t recognize the problem, followed by the tag line, “Stop sugarcoating it, Georgia.”
Here’s one such ad:
These campaign also employs billboards and bus signs like this one:
Other print slogans include “Big bones didn’t make me this way. Big meals did.” and “Fat prevention begins at home. And the buffet line.”
The Atlanta Journal-Constitution reports that the campaign will be rolled out over five years at a cost of $50 million, of which half is to be raised from third parties. The Blue Cross and Blue Shield of Georgia Foundation has already contributed $95,000 toward the campaign.
Reactions have been heated, with some experts worried that ads will result in even greater stigmatization of obese children. There’s also the concern that guilt and shame are relatively ineffective tools to encourage behavioral change. As Rebecca Puhl, director of research at Yale University’s Rudd Center for Food Policy and Obesity, said on yesterday’s Time magazine’s Healthland blog:
Childhood obesity is absolutely a public health problem, but this really just makes the problem worse . . . . When people feel stigma or shame, it only reinforces behavior that leads to obesity.
Interestingly, though, Dr. David Katz, editor-in-chief of the journal Childhood Obesity, took a somewhat more positive view of the campaign. Quoted in the same Time blog post, Katz said:
Getting this out of the shadows is potentially healthy . . . . Sometimes you’ve got to be a lightning rod if you want sparks to fly.
When I first saw the billboards with their provocative slogans I was, like most people, truly appalled. The tone struck me as ranging from snarky to cruel, the photos seemed to be overtly shaming overweight kids, and I was prepared to write a uniformly negative post about the entire campaign.
But I confess I had a slightly different reaction when I watched the television ads. Two of them focus on the bullying experienced by overweight kids and I agree with Salon writer Mary Elizabeth Williams that this angle, while addressing a real problem, is in its own way troubling:
. . . change so you won’t get picked on? That’s a terrible philosophy, especially for the less ectomorphically inclined. Some kids will always be big, even if they’re perfectly healthy. As a Facebook commenter beautifully explained, “Just wanted you to know that you’re doing a horrible thing. Fat kids shouldn’t stop being fat because they get bullied. It’s the bullies that should be stopped.”
But I was surprised to actually tear up while watching some of the other ads. I’m referring to one titled “Tina” in which a young girl discusses her hypertension and a second one (“Martiza”) in which we hear a mother’s voice explaining why she never thought her “thick” daughter had a problem until she developed diabetes.
Studies support the central concern of the Strong 4 Life campaign, which is that parents do tend to overlook or ignore unhealthy weight gain in their own children. (And they can overlook their own obesity as well. For more on obesity-denial, read this NPR story from Mississippi.) And while parents are certainly not solely responsible for their children’s weight gain (there are a multitude of factors at play, as we learned earlier this week discussing “The Fat Trap”), parents are indeed responsible for getting their children the medical attention and intervention they may need.
So while I would never condone the aspects of this campaign which could be seen as hurtful or shaming, I do understand and support the underlying motivation for it. There are many reasons why parents might not seek help for an obese child, from negligence to guilt to a belief that the extra weight is actually “healthy” (a not uncommon view in some communities), but these children are at risk, physically and often psychologically. If a parent won’t advocate on their behalf, isn’t a wake-up call needed?
Here’s my question to you: if the campaign could be tweaked to remove the shaming or potentially stigmatizing elements, would you be in favor of it? Or is the use of images of overweight children in this way never OK? Let me know what you think.
[Ads aside, I was a little disappointed in the quality of information provided to parents who are motivated by the ads to visit Strong 4 Life’s website. Under each discussion topic, from exercise to fast food, there are only a few rather superficial “quick tips” and no additional links (e.g., to local public health organizations or food and cooking sites) for parents seeking more concrete guidance.]
[Corrected on 1/5/12 to remove the description of Dr. David Katz as “former FDA commissioner.” In my haste to post I mixed up my Katz with my Kessler!]
Bri says
One thing to note about these campaigns: while the children speaking about bullying, fear surrounding their health, etc. are certainly powerful, the kids are paid actors. I’m not sure whether or not they’re really using their own experiences or if they’re working from coaching. Maybe that makes a difference, maybe it doesn’t, but if you’re going to do a campaign like this one I think I’d feel a whole lot more comfortable about it if it used only real kids and families who are not being compensated, but wanted to do the campaign in order to share their experiences and support the cause.
On another note: I don’t know if you CAN tweak a campaign like this to remove the shaming elements. The problem is that our society is already so fat-phobic that just showing an overweight child looking miserable will cause polarizing reactions on all sides of the debate. Also, the tone of this particular campaign is somewhat insulting to those parents — however few and far between they may be — who KNOW their kids are getting heavy, and who worry about it and try hard to address the issue. As if other adults weren’t already looking at them askance and thinking “how could you let your kid get like that?” Now there’s a whole public health marketing blitz to support the notion that if your kid is fat, you don’t care.
Bettina Elias Siegel says
Bri – I thought about that, too, that the kids are paid. But the fact is, they are also obese kids. So while the particular words may not be their own, I do think the sentiments they express are probably commonly felt by kids like them. I also note that one of the kids has come out in favor of the campaign. (See my comment to Chris Leibig somewhere in this thread for her quote.) But I take your point about some parents being unfairly criticized as a result of this campaign. I just don’t know if that’s a reason not to run something like it, if 75% of parents DO need a wake up call.
Bri says
I think a wake-up call is better served with education and resources, not with shaming. And as you’ve pointed out, as have others, the website for this project clearly received far less of the thought and the funding than the marketing. 🙂 I have a little bit of experience — note that I stress “little bit!” — with public health prevention/education campaigns, and one thing that seems to be widely believed and borne out time and again is that scaring and shaming don’t work. What does work is, of course, the sticky wicket. But I just can’t see how this campaign changes anything if it doesn’t strike meaningfully at the core of the issue. Even if all of those 75% go, “Wow, my kid IS fat. I don’t know how that happened,” it’s not as if they will all then wake up the next morning and instantly begin serving vegetables, unprocessed foods, and unplugging the kids’ video games in favor of family jogs. I think it’s irresponsible to spend so much money on a public health campaign without backing up the goods — this opens a Pandora’s box of emotion, sure, but then all you’ve got is all the little demons flying around and everybody up in arms feeling bad about the situation, and nobody telling them how to make the demons go away.
Kate says
Good reply by Bri.
My concern with the ad campaign, and with many of the food debates, is we really don’t know what message our kids are taking away from it.
I can’t imagine that an overweight kid would see the billboard, and feel better about himself.
As far as using overweight kids in such campaigns, I’m not sure there is one right answer or one universal way it will be percieved.
Grace @Eatdinner says
I, too, teared up at the ads. We must find a way to reach parents, educators, and physicians to confront this problem. We must also fix the broader environment that contributes to this problem (including processed foods, lack of activity).
Though I agree that light needs to be shed on this, I think the “shaming” ads are ultimately ineffective. It’s an outrage that you would build such a controversial campaign with little to no follow-up in terms of information and education on the website. Parents want to do better, for themselves and their kids; they need help–support and education– not shame.
Did you see Yoni Freedhoff’s take noting the policy environment? http://bit.ly/zSkkfB
Mrs Q says
I think I’d feel a lot more comfortable about this campaign if they gave valuable, actionable steps for kids, parents, and families to take away from viewing the ads. Directing people to a website isn’t enough.
Kate says
I have to also say that I dislike that in the print ads the kids are in ill fitting clothes and unsmiling, as if someone is wanting them to appear unattractive.
Watched a clip about this on the ABC news website, which was interpersed with an ad for Chef Boyardee…thought that was funny.
anthony says
i have a few thoughts about this.
first–i watched several of these and i do not see any element that is stigmatizing. as a mental exercise, i turned “fat” into “gay” to see how these ads felt when i tried them on, and none was offensive to me particularly. however, making that term switch (e.g., “being gay takes the fun out of being a kid”) does highlight the fact that the messages are inartfully drawn since the authors are not entirely accurate on cause-effect issues (thank you mary elizabeth williams).
second–i don’t really care what experts have to say on the issue of stigma. whatever they have to say about what might happen as a result of this campaign is just speculation and not information. did anyone ask obese kids in georgia what their reaction to this was? or test thin and normal weight kids in georgia to see if they were more likely to bully their obese peers after viewing these? to me, that would be meaningful information.
third–i think the most important observation in this piece is the parenthetical at the end regarding effectiveness. identifying an issue without providing solution opportunities is utterly useless. in the uselessness department, identifying a health issue without providing information on etiology is also a standout, and for the same reason–there is no basis for the viewer to formulate a plan for combatting the issue. (imagine a similar psa campaign in 14th century europe. what would be the message with the better utility? option 1: everyone in my town is dying of the black death. it makes me sad. option 2: everyone in my town is dying of the black death because we don’t bathe and we don’t segregate our garbage. )
fourth–solutions have to match the problems they are designed to solve in order to work. obesity is a complicated issue. weight gain is the end result of a multifactorial process (diet, exercise, emotional components, habits, culture, food availability, food affordability, etc.) and different children are overweight for different reasons. this campaign is essentially a very simple message. it looks a lot like throwing a thimble’s fill of water on a giant bonfire.
fifth–back on the stigma issue. i suspect that the use of the word “fat” is the touchstone for the backlash. should it be?
$50 million is a lot to spend on a project without having done pilot studies. my guess is that those studies exist (and if they don’t, there is a huge amount of fault to lay on children’s healthcare of atlanta). it would be worth finding out what those studies demonstrate. my bottom line on things like this is: will it accomplish anything? that’s a much more important question than whose nose is going to get bent.
Alicia says
I don’t fault the ad campaign too much because SOMETHING has to be done. Merely encouraging children and families to eat healthier foods and get more exercise isn’t enough, so I’m glad to see Georgia putting more effort into a campaign about this big problem. That being said, it does bother me that one of the messages seems to be that the reason to not be fat is to not be picked on…I do wish that the focus was more on the health benefits and quality of life benefits. As a side note, when I was teaching 5th and 6th grade, my experience was that the “fat kid getting picked on” is more of a problem of the past; with so many overweight kids, they are the majority now!
Kate says
I think fat kids get picked on definitely still exists, but it is often more subtle, especially with girls.
Karen says
Future “health” is such a nebulous concept. For a parent who may be getting by while obese, not particularly healthy, but not disabled by the consequences of their weight, the health benefits that may or may not accrue to their child may not be enough to spur action. Fear of bullying (and remembering what being shamed as an overweight child/adolescent felt like) may motivate some to take action, which is the goal.
Further, expressing the real distress caused by bullying overweight children may (and I know that this is a stretch for some) actually stimulate some empathy for children who are suffering in this way, a positive societal change.
It is so sad, though that all this money is being spent (wasted?) without providing any actual, efficacious treatment (Do jumping jacks during television commercials? Really? Well that’s the childhood obesity epidemic sorted, then). Community cooking classes, group activities for kids (& parents?), community kitchens where healthy foods are produced to take home, community gardens to stimulate interest in and access to fruits & vegetables, community dietitians & other support staff for weight loss, minimum standards for activity in schools, a return to teaching “home ec” in schools (include some basic financial literacy, as well), etc. I am sure that there are many excellent suggestions that might actually provide some of the tools that could make a difference in people’s lives.
Cathi says
actually, guilt and shame can be very useful in changing behavior. what really needs to change is parent education: how can you not notice that a 300 pound 13 yr old (yes, i had such a patient) is not “normal?” the correction needs to occur when a kid is 5-10 pounds outside normal limits for height
Kate says
When the message of guilt and shame reaches the overweight kids though, I’m not so sure that it is effective. A girl who is just starting to struggle with food/ body image issues is not going to get anything positive driving past a billboard with an unsmiling girl dressed in poorly fitting clothes.
Can you provide examples of guilt and shame are effective techniques?
Wilma says
I’ll have to agree that shame and guilt probably isn’t the best way to address this childhood obesity issue. The adds did bother me, and I don’t think one of the main reasons to focus on obesity is to not be picked on.
We all know there are PLENTY of other reasons to get healthy but bullying has been a hot topic for quite some time now and I think using the reason of bullying to “scare kids/parents thin” would actually work better than warnings of hypertension and diabetes. Unfortunately I have found parents’ eyes glazed over when talking about the risk of obesity related diseases but bullying does spark a sense of urgency in parents.
I have to give Kudos to Georgia for trying something… however it is far from the ideal campaign to reduce the rate of childhood obesity! Also, when I visited the website I did notice the lack of resources but the website is simple, easy to navigate, and a lot less intimidating than other websites that are saturated with articles and information parents have to sift through. I don’t see the website being the wealth of resources but rather a place to get started and where parents with really busy schedules can get quick tips on playing, fast food, and so on.
Have you ever gone to a website to read one article about a particular topic, then you find your self clicking on all the recomended articles listed below. I get sucked in and can spend hours at night reading and following the “rabbit trail” of articles and links from websites and news sources. Maybe this website is simple for a reason. Most parents (the one’s who can’t see that their child is obese) are not browsing health and wellness articles for hours a week and they probably aren’t requesting to be on emailing lists for those websites either. Honestly I can spend a ridiculous amount of time reading and keeping up with the health and wellness news but its my job and my passion.
Bettina (and all TLT readers), I would like to hear what you would do with $50 million dollars to spend on an obesity campaign?
Karen says
Community cooking classes, group activities for kids (& parents?), community kitchens where healthy foods are produced to take home, community gardens to stimulate interest in and access to fruits & vegetables, community dietitians & other support staff for weight loss, minimum standards for activity in schools, a return to teaching “home ec” in schools (include some basic financial literacy, as well), improve school lunches, open not-for-profit take out restaurants in disadvantaged neighbourhoods so that overworked, under-resourced or even just lazy parents can get cheap nutritious food for their kids, etc.
Those are things off the top of my head. 50 million is probably insufficient; it always seems to take so much money to get a public project underway.
Bettina Elias Siegel says
It’s interesting that some of you feel that focusing on bullying is NOT the way to encourage change (e.g., Shannon) and some of you (Wilma) think this tack will get parents’ attention.
As for your question about what would I do with $50 million . . . I’m thinking of putting this out to the whole readership tomorrow to see what people say, and I’ll share my ideas, too.
Bettina Elias Siegel says
OK, I wound up posting something else today, so let me just say here: I’m definitely NOT an expert on (a) what $50 million will buy me and (b) what public health experts believe are the best techniques to reach people and bring about real change when it comes to obesity.
But from reading and thinking about this issue so much over the last almost-two years, I believe that nothing is more important than getting kids to buy into a healthier lifestyle. Completely changing their environment is (a) very hard to do and (b) will do nothing if the child still wants to continue with the behaviors that led to the problem in the first place. So I’d like to use ads to really take on the food industry, showing kids exactly how these companies manipulate them — and manipulate their food products (see David Kessler’s book, The End of Overeating) — to make a profit off their health, just as tobacco companies do. We need to get to a point where kids feel that they’re savvier than these commercial forces and won’t be taken in. I’d also spend another chunk of my millions on education, reaching kids when they’re impressionable to teach basic food literacy and simple cooking skills. And finally, you have to educate parents too, with community kitchens, cooking classes, etc. since children are by necessity dependent on what parents serve at home. I realize that all of that is a HUGE task to accomplish, though, and might only have limited success . . .
What do the rest of you think? What would you do with $50 million?
Michele Hays says
From the aforementioned Freedhoff article: “Childhood obesity is the symptom. The environment is the cause. ”
I’ve written before, I have a lot of trouble with the focus on weight as the core problem, especially in a way that implicitly gives permission for kids to bully other kids. The problem is about health – and how it relates to diet and activity level. Is it any wonder that Sesame Street has never created a “fat” muppet who goes on a diet? Instead, they talk about healthy eating and healthy behavior, good choices and portion control (and if you note, the live-action kids come in all shapes, sizes, and colors.)
This campaign would do better if it provided a humorous (and culturally appropriate) take on the consequences of unhealthy behavior and how to replace those with healthy behaviors – the “Small Step” federal program had an excellent one (remember the commercial where they kept finding “love handles” by the mall stairs?)
Viki says
All good responses, but I have to agree with Michele, positive works better than negative. Education works better than shame. There are many reasons for a child to gain weight, to become obese. Even telling parents to take their kids to the doctor for advice may not help, because the doctor may not have information that isn’t wildly out of date or dangerous.
As for the shame and guilt, I’m really not positive that what they are going to actually get is resentment and anger from both parents and kids. No one really likes to be told what to do and the “in your face” way these ads come across is yet another “slap in the face” to those parents. Some of which are doing the best they can with what they have.
Everything comes back to education, education, education. Even then facts are slippery and what works for some doesn’t work for others. What works for most is Healthy Whole Foods, cooked at home instead of processed or fast food.
Bettina Elias Siegel says
I agree that ads like these are no substitute for education. But just on the issue of whether going to the doctor will help, I recall that this same pediatric group has also been training, I believe, something like 600 doctors in the state to better deal with obese patients and their parents.
Bri says
Bettina, do you have any articles about that? I’d be interested to see what they’re doing in that training. I’d be ESPECIALLY interested in the social-emotional component, which is often lacking in the medical training field. If better dealing with obese patients and their parents means adding compassion, encouragement, and empathy, along with providing solid resources and help, then great. But if it’s going to focus mainly on “getting real” and telling people what to do, even if that comes with some resources, then I’m wary of it. “Tough love” doesn’t work for everybody, which is why this campaign is so polarizing in the first place.
Bettina Elias Siegel says
Here’s what CHA says about its doctor training program: http://www.choa.org/Child-Wellness/Strong4Life-Programs/Providers
I am still looking for the article that gave the “600 doctors” figure but I know that’s the number I read.
Bettina Elias Siegel says
Michele – I actually haven’t heard of the Small Step campaign but I’m going to look for it now on You Tube. And I don’t disagree with anything you’ve said here. But we’ve reached such a crisis level — KIDS needing KNEE REPLACEMENT – that I wonder if humor is the right response? But I guess the “right” response is the one that leads to action, and many feel this campaign is, if anything, going to backfire in that regard.
Shannon Morgan says
I think these ads are powerful, however I think they should focus on the health risks these kids face. With so many overweight children these days, I really don’t think kids get bullied over weight issues like they did when I was a kid and all the kids were skinny. I see a lot of kids get bullied who aren’t anywhere near fat, let alone obese. The health risks are really the reason we are concerned for these kids and the parents need a good slap in the face, as far as I’m concerned. Good eating habits start at home.
Bettina Elias Siegel says
Shannon: I think that’s why the “Tina” ad affected me so much, because it did focus on the health issue (hypertension). Because, as you say, that’s really the issue here – not appearance, but health and longevity.
Kate says
I am surprised that no one is mentioning the issue that i find to be more troubling- that as long as high calorie, fatty, chemical laden food is cheaper and more readily available than healthier options, this epidemic will continue to unfold. When 30 wings are cost less than a half gallon of milk, what do you expect many people will choose? We are a fast food nation, and until government subsidies of factory farms change i do not expect that any ad campaign will make much of an impact.
Bettina Elias Siegel says
Kate: No question that obesity is caused by a multitude of factors and you’ve pointed out one of the leading concerns. But I think there’s a role for both government intervention and personal responsibility/education. I guess I’m saying I wouldn’t wait for a radical overhaul of farm subsidies, factory farms, etc. before also trying to reach individuals.
Chris Liebig says
I wonder about the effect of the ads on the particular kid who happens to be in the picture as the literal “poster child” against childhood obesity. Even if the ads were effective in reducing childhood obesity in general, I would be very uncomfortable with the idea of my own child appearing in such an ad.
Bettina Elias Siegel says
Chris – I know. Many have commented on that. For whatever it’s worth, the Atlanta Journal Constitution did report this:
Chris Liebig says
That’s actually a little reassuring. But I’m assuming that’s a kid from one of the other ads. The girl in the ad above does not look old enough to be a teenager.
Bettina Elias Siegel says
And of course, how this child feels looking back on the experience when she’s older and has more independent judgment remains to be seen . . .
Bri says
Something just occurred to me.
During my brief stint working in public health prevention and education campaigns, I was working largely in the field of sexual violence prevention and bullying prevention. There are tons of campaigns of this ilk in the sexual violence prevention world. And each one is eyed quite critically, before its release, for anything that smacks of victim blaming. Some people would argue that telling young women to be smarter about drinking too much at parties, wearing provocative clothing, etc. is a good message that may help prevent some sexual assaults. Most people in the SV prevention world are appalled by that notion, and would argue that you don’t prevent rape by telling girls not to do things that will “make” people rape them — you prevent rape by telling would-be rapists not to perpetrate in the first place, and addressing the factors that cause perpetrating behavior.
This campaign isn’t so different in that regard, is it? The bullying aspect, while emotionally moving, smacks of victim-blaming to me. Why should we accept the idea that parents should be told to stop enabling their kids to be overweight, because being overweight “makes” people bully them? We don’t tell parents to have their kids stop being smart, because being nerdy “makes” people bully them. We don’t tell them to help their kids conform and try to go along with the crowd, because nonconformism can “make” people bully them. We generally try, in other aspects of our society, to prevent bullies from bullying because that behavior is not okay. And yet here’s a major public health campaign that seems to want to say, “Bullying is not okay…but you should probably stop being fat/letting your kid be fat. Because fat people are targets.” Come on. Bullies will bully whether you’re fat or not — they’ll find another reason to pick on you, or move on to the next victim. Wrong message. Totally wrong message.
Amy says
I disagree about the so called “victim-blaming”. As a female who went to a college in the late 90s at a university that had a very high incidence of rape on campus, I very much appreciated the education I got on how to avoid putting myself in risky situations, such as not drinking too much, not walking alone at night, not loading myself down or looking distracted when walking from my car to my apartment, etc. I don’t see how teaching someone how to decrease their chances of being a victim is negative in any way. Of course if they are raped it is the rapist fault and not the victim’s, but I sure appreciate the education that allowed me to put myself in the best position not to be raped.
joanne says
Guilt and shame around eating behaviors and weight lead to eating disorders and body dysmorphic disorders. While I get the intent, the method is flawed and (IMO) will ultimately contribute to behaviors which are as unhealthy – and as deadly – as obesity.
Leslie Grant says
Thrilled to see the level of interest in these campaigns as they have kicked off some great discussions, as noted above. I dare say that whatever good, bad or indifferent effect the ads ultimately have, CHOA stepped out where many feared to tread. It is a terribly uncomfortable subject to breech and is left, many times to the pediatrician’s office for some uncomfortable, after-the-fact followup with parents who are a critical part of the cause and if willing – the solution.
As with most things…more education is essential, including physical education, and yes to more Home Ec, please! Love the idea of moving positively forward with the question of “What would you do with $50 million”
Ryan says
I find these Ads Offensive and Curious.
The children talk about not playing because other kids tease them “Being fat takes out the fun of being a kid”. That’s the message? How about having to be around horrible people that have no manners or etiquette sucks the fun out of just being!
Another has diabetes but the mom says I just thought she was big like her mother.
Most of these problems we are having in society is the blame game drama instead of addressing and fixing problems. Having a child ask his mom “why am I fat” as she is about to cry is not going to help. let us insert other social “problems” into this question “Why am I…gay…stupid…abused…raped…black…ugly…lonely…different”
These are all things that Children worry about but shouldn’t. They should feel safe and loved. not exploited not shamed by anyone because of what others see as a problem or a solution to some elses problem.
Instead of an ad campaign in general a campaign with in schools that reward children classes and schools. Remember the Presidential Fitness Awards Arnold gave out in the 80’s. and while you are at it teaching children to respect themselves and their friends and their Teachers make society better. and feeding them real food not hot pockets or that thing they pass as pizza or pink slime burgers but real food! Then teach them about how & why to eat! How to act in society! and give them a reason to love learning and life!
this campaign could have changed a lot of lives for the better. not just for the over weight but the underweight the gay or the kid that just doesn’t fit into the mold, good or bad, that his community has. instead it shames children and parents telling them that they are the problem for not being “normal” with no answers no hope!
Bettina Elias Siegel says
Ryan: You’re definitely not alone in criticizing this campaign, as you know. Thank you for sharing your views here.