Skeptics warn of 'war on obesity' 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 children 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."

The spotlight on obesity intensified last year when Obama unveiled her 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 it 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 children.

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 children 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."

Dr. Sandra Hassink, who chairs American Academy of Pediatrics obesity work group, said she witnesses the toll of weight-based bullying on a daily basis at her clinic in Wilmington, Del.

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."