Family Matters

Ads Featuring Overweight Children Make Some Experts Uncomfortable

Heavy children talk about their obesity in a series of ads that have experts debating whether aggressive public health campaigns are educational or exploitative

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Weight is a touchy subject, that much more so when it involves children. So it’s hardly surprising that ads in Georgia that feature overweight kids somberly assessing their situation have sparked their fair share of controversy.

The campaign, called Strong4Life, urges Georgians to “stop sugarcoating” the childhood obesity crisis. In one ad, a girl appears, arms crossed, above the message: “WARNING. It’s hard to be a little girl if you’re not.” In another, a boy pitifully asks his mother, herself obese, “Mom, why am I fat?” She ducks her head in response but has no answer; accompanying text says that 75% of parents of overweight kids “ignore the problem.” It’s the kind of edgy campaign that would make anyone, skinny or fat, squirm.

Critics have accused Children’s Healthcare of Atlanta, the pediatric health system behind the ads, of humiliating kids and their parents who watched as their children’s weight ballooned. There are no plans to pull the ads, says Linda Matzigkeit, a senior vice president at Children’s Healthcare, who leads the system’s wellness projects; she told The Atlanta Journal-Constitution that 85% of people who’ve seen the campaign view it positively. “We have to do something about this or our state is in jeopardy,” she told the newspaper. “It’s not good for business if your state has the second-highest obesity rate. Obese children turn into obese adults.”

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Perhaps the graphic messages are the only thing that may counteract Georgia’s childhood obesity rates, which are the second highest in the nation. Children there are now regularly being diagnosed with heart disease and diabetes or being referred for knee replacements due to weight problems — all conditions that used to be uncommon. The ads direct viewers to a website  that makes the case that, “Ignoring this problem is what got us here. It’s time to wake up.”

It may be the subject matter and not the ads themselves that are making people uneasy, says David Katz, editor-in-chief of the journal Childhood Obesity. “As a society, we are not comfortable talking about fat,” he says. “People look at the ad where the child is saying, Why am I fat, and they start projecting. The ads are being complicated by biases people carry with them.”

Experts differ on whether the campaign is appropriate; such “guerilla tactics” have also been deployed in ads warning against smoking and illicit drug use, with some success. More recently, a Milwaukee campaign seeking to stem the tide of infant deaths from co-sleeping featured a baby asleep next to a butcher cleaver. “This is the shock-and-awe strategy,” says Kerri Boutelle, an associate professor of psychiatry and pediatrics at the University of California, San Diego School of Medicine, who has researched how to curb children’s overeating. “Overweight kids don’t think they’re not overweight. You’re not telling them anything they didn’t know.” Still, she says, “this is a very aggressive campaign.”

But can it actually motivate kids to lose weight? The research on the effectiveness of such in-your-face advertising is not so clear. Studies that have tracked the use of guilt to effect change have found that the strategy doesn’t necessarily work, says Boutelle. “Guilt is a mediocre motivator,” she says. More effective, she says, would be pairing gutsy messages with advice for parents: buy more fruits and vegetables, for example, or schedule family mealtime instead of grabbing fast food. Calling attention to oversized portions, the cheap availability of unhealthy food and how sugar-laden cereals are marketed directly to kids could also raise public consciousness.

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Rebecca Puhl, director of research at Yale University’s Rudd Center for Food Policy and Obesity, finds Georgia’s approach misguided. “Childhood obesity is absolutely a public health problem, but this really just makes the problem worse,” says Puhl. “When people feel stigma or shame, it only reinforces behavior that leads to obesity.”

But Katz isn’t sure that the ads are actually shaming kids. In fact, the children who are at the centerpiece of the campaign appear to fully support it. Maya Walters, a teen with high blood pressure who appears in the ads, says she’s since cut back on salt and doesn’t feel so breathless when climbing stairs.

“I think it’s really brave to talk about the elephant in the room,” she told The Atlanta Journal-Constitution in September, shortly after the ads started to run in the metro area. “It’s very provocative and makes people uncomfortable, but it’s when people are uncomfortable that change comes.”

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While the ads could be spun more positively, Katz points out that a more information-based approach probably wouldn’t have generated the same sort of conversation that’s now bubbling up. “Getting this out of the shadows is potentially healthy,” says Katz. “Sometimes you’ve got to be a lightning rod if you want sparks to fly.”