Do we want to help overweight kids, or insult them?

Fat camps, prohibitions on junk food advertising, bans on sugary drinks in school canteens, Medicare subsidies for private weight loss programs, chair-free classrooms, food pyramids. Bariatric surgery, school weigh-ins, public service announcements telling kids to take more exercise, public hospital weight management clinics for the young. Bulging childhood waistlines as risk factors for diabetes, heart disease, escalating health care costs and social exclusion. Childhood obesity as lifestyle choice, disease, biological destiny or the result of parental ignorance, sloth or permissiveness. And in 2006, a three-fold increase in the number of Melbourne children – some as young as 10 – admitted to hospital with eating disorders resulting from their morbid fear of fat.

And of winding up unloveable and unloved?

Surely, I am not the only person who has noticed that not only has our current approach to the “youth obesity epidemic” been ineffective in reducing our children’s collective girth, but also violates the first-order principle of medical ethics that above all, we must do no harm.

How does calling our kids tubby harm them? These days everyone knows that “fat” is more than a physical description of body mass, but a negative assessment of physical attractiveness and moral worth. Despite protests outside the White House by overweight Americans holding placards insisting that “fat is not a four letter word”, children today are well aware of the connection in the popular mind between the generously waisted and the indiscreet, the lazy, the pitiful, the asexual and the wildly out of control. Cultural researchers say it is no coincidence that in times of sexual permissiveness and consumerist plenty, thinness is idealized for representing virtue, self-denial and self-control.

Children’s bodies change rapidly right up to their early twenties, with the pre-teen and teen years critical moments for the development of self-identity and self-esteem. It’s hard to imagine a worse time for children to be told their developing bodies are an eyesore and evidence of poor moral character.

Just as damning is the inevitable failure of any behavioural change approach obsessed with cataloguing and stamping out fat. Behavioural change relies on our feeling good about ourselves, something just as true for children as for adults. The higher the temperature surrounding the moral panic about our children’s expanding girth, the worse overweight children are likely to feel about themselves, and the less likely they are to feel worthy of their own efforts to change.

This counterproductive behavioural circularity that begins with low self-esteem is familiar to addiction counsellors, and is no less evident – should we care to listen – in the testimony of the overweight. “You get in a vicious circle about losing weight,” Diane O’Mara told the Age earlier this year. “You eat the wrong thing, then you feel bad, then you eat more.” The nexus between harsh social judgments of the obese, their low self-esteem and consequent inability to lose weight is summed up by American professor and author Peter Stearns. “If you fail to lose weight you are demonstrating you’re a bad person. It’s a big burden. Faced with this additional pressure you are even more likely to say `The hell with it! I’m going to get ice cream. I am such a bad person I need to solace myself.’”

Of course, the poor correlation between negative self esteem and successful weight loss serves the diet industry well. Studies suggest that only when consumers hate their overweight bodies, and believe them unattractive, are they motivated to dig deep for the diet products and services worth more than 500 million a year in Australia. As well, the now accepted paradox that dieting makes you fat ensures that the vast majority of consumers will “fail” and – dragging their bedraggled self-esteem behind them – return for second and third helpings of expensive but ineffective “therapy”.

But if insults are counter-productive and hand wringing is out, what should we be doing? In general terms, we need to stop talking about the depravity of fat, and focus instead on the desirability of good health. Focusing on obesity inevitably leads to “don’t” and “shouldn’t” messages that problematically posit guilt and counterproductively idealise penitent self-denial. In contrast, promoting good health lends itself to messages of “do” (eat healthy foods) and “desert” (as in, you deserve it) that connect self-nurture with the bodily well-being necessary to enjoy the good things in life.

Positive messages are also more likely to be effective in promoting behavioural change, and insofar as they focus more on the importance of staying active rather than on what we eat, may even be more consistent with the medical evidence. Paul Campos, Professor of law at the University of Colorado and author of The Obesity Myth argues that activity is a better predictor of health than weight and that “There is no good evidence that significant long-term weight loss is beneficial to health”.

We need to speak to our children, and about them, in ways that make our love for them, and approval of the people they are becoming, crystal clear. Teaching them how to nurture themselves by eating healthy food and participating in physical activity they enjoy is the most ethical and effective way for us as parents, and as a society, to offer them the gift of good health.

Publication history

The state-sanctioned bullying of fat kids  Spiked - London,UK
2008-07-30
http://www.spiked-online.com/index.php?/site/article/5530/

Do you want to help overweight kids, or just insult them?  The Age
2007-01-07
http://www.theage.com.au/news/opinion/do-we-help-overweight-kids-or-just-insult-them/2007/01/07/1168104864898.html