It used to be that a fat child was source of pride to her parents. Chubbiness was the sign of a well-nourished child; a member of a family who could afford not only to feed her, but to indulge her. Rounded rosy-cheeked babies and adolescent girls grew into the “well-endowed” and physically sumptuous bodies painted by all the great artists and loved as Hollywood screen goddesses – from Mae West to Jane Russell and Marilyn Monroe, all of whom would be considered “plus size” today. The right of shaming others for their socially-defined deficiencies was a privilege of the upper classes, and the condemnation of ragged, starving children as beggars and pests epitomized this culture. Who can forget Oliver Twist’s mournful cry, “Please, sir, I want some more.”
Today the situation has reversed, and an overweight child is no longer seen as healthy and beautiful, but as unhealthy and ugly; not a member of the rich and famous, but a creature to be mocked, teased, and shamed. In fact, today’s children are no longer just overweight, but diseased: obesity, a condition so horrifying it rivals cancer and other dread diseases as the bogey-man of terrible things that can happen to a child. The potential for future debilitating illness predicted for these children is enough to terrify anyone – heart disease, high blood pressure, cancer, diabetes, and the list goes on.
Fortunately, the causes of the disease have been identified, and not surprisingly, they are entirely consistent with the traditional, well-worn, and narrowly-focused medical and public health model – it’s all about lifestyle. Children today are lazy, spend too much time indoors in front of the TV or the computer, don’t exercise enough, eat too much junk food and drink too many sugary drinks, and their parents facilitate these bad habits by feeding them too much fast food because of their own hectic lifestyles caused by the fact that both parents work. The big red blinking “your fault” arrow targeted and launched!
Only passing mention is given to the role of the food industry and agribusiness in this discussion. Their role in the ascendancy of processed foods, the inclusion of sweeteners and sugars in products where they’d never been seen in the past (potato chips?), and the lack of availability of low cost, fresh food in many neighborhoods barely surface as factors to be considered. No mention at all is made of factors not usually connected to diet at all, such as exposure to toxic chemicals and the sharp increase in asthma in children in urban areas, which inhibits their ability to exercise – even if there were playgrounds in many neighborhoods safe enough and clean enough to play in.
By emphasizing lifestyle, the conventional wisdom leads to the conclusion that childhood obesity, unlike cancer or many other dread diseases, is not something that happens to some unlucky family by chance; to the contrary, an overweight child is the product of an unhealthy lifestyle, her own and, in many cases, her family’s, and can therefore be prevented by lifestyle alone. Thus, in spite of years of research and a library of literature which suggests a far more complex narrative about obesity in general, and childhood obesity in particular, doctors and public health practitioners around the U.S. have persisted in developing and promoting campaigns against childhood obesity that emphasize diet, exercise, and personal responsibility to the exclusion of anything else.
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Public health is a caring profession, and people go into it because they want to help communities get healthier and stay healthier. Education and outreach are integral components of all public health campaigns, especially those aimed at changing people’s behavior. Dramatic changes in smoking and seat belt use were achieved as public knowledge about the risks and dangers increased, and public opinion shifted. These are classic examples of how problems are approached from a public health perspective, and now they are the model for how obesity in children is being approached by well- meaning professionals: identify the problem– the child, first, and then, in most cases, her family – then do outreach, education, and focus on changing behavior.
This model depends on the assumption that the main actors – the child and her family – are also the locus of change. They will need help and support from the public health and medical communities, of course, which they will receive, but ultimately, they are the cornerstones on success or failure rest. And if they fail? Who will bear the responsibility and blame? Remember, success is success not only for the individual child and her family, but for the program and the funders. Failure reaches beyond the child and her family, with a great deal at stake for the public health agency that sponsored and conducted the campaign, provided financial support, and evaluated the results. What started out with the best intentions now have the potential to inflict the greatest harm: fostering feelings of shame, failure, and blame. For every success story reported, there are many more children who leave such programs disheartened and shamed, feeling that not only have they failed again, but they have failed the people who tried so hard to help them.
The funders and creators of these programs will indignantly deny that their intent is blaming the victim and shaming the children and their families, and will point to the very modest decline in childhood obesity as proof of success. There are few data, however, to support these claims and an active literature to refute the success of relying only on diet and exercise. Nonetheless, there is no reason to believe those who create and run the programs for obese children are anything other than sincere in their desire to really help these kids.
Why does social fat-shaming of children continue to happen?
The social fat-shaming of children continues to be rampant for many important reasons.
- Most programs and campaigns fighting the “childhood obesity epidemic” perpetuate rather than combat social fat-shaming of children. This include Michelle Obama’s well-meaning efforts.
As long as these programs stigmatize some children as being “obese” or “overweight” or “fat” and thus needing special attention, such as being told to eat differently and “better”, to exercise or “move around more” instead of “sitting at home in front of the TV eating chips” or something similar, fat-shaming will continue to flourish. Fat-shaming as a technique for motivating children to lose weight has been shown repeatedly to be counter-productive. Children whose weight varies from what others consider normal are not all the same, do not necessarily have the same issues, or any issues. They should never be lumped together and treated as some unique group in programs designed to help children learn about healthful lifestyles. This sets them up for social fat-shaming. There are other options for children who want to address their weight – programs that can be made available to them privately if they want them.
- Fat-shaming of children will not stop until fat-shaming of everyone stops.
Children copy adult behavior. When children see adults fat-shaming other adults and children on TV, in the movies, in any popular culture format, and in everyday life, they see this as acceptable behavior and permission to do it themselves. As long as fat-shaming is culturally acceptable to do to and by adults, it will acceptable to do to and by children.
- Fat-shaming of children will stop when all body types are socially acceptable; and when children whose weight exceeds the norm are no longer socially unacceptable.
Social fat-shaming of children will stop when parents and other family members love and are comfortable being anywhere with their child at any weight. Social fat-shaming of children will not end until family members stop judging their children, comparing them to others, and are no longer embarrassed or ashamed of their fat child. Many people believe that when a child’s body size is nonconforming, the whole family comes under scrutiny. They worry about the way they are being judged by others, by doctors and nurses, and people they don’t know. “Are the parents fat, too, is that why she’s so fat?” “Don’t those parents have any control over their kids?” The most important feelings for parents to be concerned about are those of their child, not those of strangers.
- Fat-shaming of children will stop when the health of a child is not measured only the by weight of a child.
Weight is not the only predictor of how healthy a child is. Many children at higher body weights are just as healthy or healthier than children at lower body weights.