Collateral damage in the war on obesity

In a recent New York Times opinion article, author Aubrey Gordon claims that since a visit to her pediatrician in fourth grade she has felt like an “enemy combatant in the nation’s war on childhood obesity.” (“Leave Fat Kids Alone,” Nov. 13, 2020).

At that unfortunate encounter, she recalls being told that “You’ll be thin and beautiful ... If you can just stay the same weight.” In retrospect she feels that the comment by her well-meaning but misguided physician “planted the seeds of depression” that have plagued her ever since.

Ms. Gordon goes on to list the many national and local initiatives that have done little to bend the curve in this country’s obesity trajectory but have succeeded in targeting bodies like hers as an epidemic and have resulted in her and thousands of other children being treated as “its virus personified.”

It is deeply troubling to read of her journey through life as collateral damage in a failed war effort, but Ms. Gordon offers little advice to us other than that we stop doing what we have been doing. It hasn’t been helping and it’s not working.

I suspect she would agree that obesity is one of our nation’s most serious public health problems. There is voluminous evidence of the association of obesity with cardiac disease, cancer, mental health challenges, and more recently COVID-19 – just to name a few. If blaming obese children who are the victims is counterproductive where do we point the finger? It is tempting to blame parents and certainly they deserve some culpability. Some parents could have created less obesity-enabling environments through healthier menu choices and done a better job discouraging sedentary behaviors. However, some families lack the access to, or the resources to, provide less calorie-dense food options. We know that many obese children have parents who have been obese themselves since childhood and we know that breaking the obesity cycle can be extremely difficult. Do we extend the sweep of our finger-pointing to include grandparents and great grandparents?

While guilt can be a powerful motivating force, obesity seems to be one of those conditions in which by the time it becomes obvious to a family, the die is cast and blaming the victim or her parents is going to do little more than engender bad feelings. We have done more than enough. In fact, Ms. Gordon’s commentary suggests we have gone too far in creating public opinion that being lean is healthy and being overweight is bad. More motivational testimonials will merely add to the shaming.

Obesity is clearly a societal problem and selectively targeting the victims is not the answer. A famine would certainly lower our national body mass index, but not even the most callous among us would include it on the list of options. Attempts at levying a hefty tax on sweetened beverages have been attempted sporadically around the country without much success. We are a nation that cherishes our personal freedoms and unfortunately this includes the freedom to do some things the aren’t in our own best interests.

You could argue that this leaves us with education as our only hope of turning the tide. However, educating without characterizing the obese among us as bad, ugly, and undisciplined people is a public relations challenge of heroic proportions. Choosing language and images that somehow convey the idea that although obesity is bad being obese doesn’t make you a bad or ugly person is walking along a fine semantic edge.

If I sound discouraged, you are reading me correctly. As pediatricians, we are left doing the few things that have been shown to make a difference. This means promoting breastfeeding and encouraging thoughtful introduction of solid foods; both strategies can be done before the child can hear our well-intentioned but misguided words of encouragement.
 

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Other than a Littman stethoscope he accepted as a first-year medical student in 1966, Dr. Wilkoff reports having nothing to disclose. Email him at [email protected].

In a recent New York Times opinion article, author Aubrey Gordon claims that since a visit to her pediatrician in fourth grade she has felt like an “enemy combatant in the nation’s war on childhood obesity.” (“Leave Fat Kids Alone,” Nov. 13, 2020).

At that unfortunate encounter, she recalls being told that “You’ll be thin and beautiful ... If you can just stay the same weight.” In retrospect she feels that the comment by her well-meaning but misguided physician “planted the seeds of depression” that have plagued her ever since.

Ms. Gordon goes on to list the many national and local initiatives that have done little to bend the curve in this country’s obesity trajectory but have succeeded in targeting bodies like hers as an epidemic and have resulted in her and thousands of other children being treated as “its virus personified.”

It is deeply troubling to read of her journey through life as collateral damage in a failed war effort, but Ms. Gordon offers little advice to us other than that we stop doing what we have been doing. It hasn’t been helping and it’s not working.

I suspect she would agree that obesity is one of our nation’s most serious public health problems. There is voluminous evidence of the association of obesity with cardiac disease, cancer, mental health challenges, and more recently COVID-19 – just to name a few. If blaming obese children who are the victims is counterproductive where do we point the finger? It is tempting to blame parents and certainly they deserve some culpability. Some parents could have created less obesity-enabling environments through healthier menu choices and done a better job discouraging sedentary behaviors. However, some families lack the access to, or the resources to, provide less calorie-dense food options. We know that many obese children have parents who have been obese themselves since childhood and we know that breaking the obesity cycle can be extremely difficult. Do we extend the sweep of our finger-pointing to include grandparents and great grandparents?

While guilt can be a powerful motivating force, obesity seems to be one of those conditions in which by the time it becomes obvious to a family, the die is cast and blaming the victim or her parents is going to do little more than engender bad feelings. We have done more than enough. In fact, Ms. Gordon’s commentary suggests we have gone too far in creating public opinion that being lean is healthy and being overweight is bad. More motivational testimonials will merely add to the shaming.

Obesity is clearly a societal problem and selectively targeting the victims is not the answer. A famine would certainly lower our national body mass index, but not even the most callous among us would include it on the list of options. Attempts at levying a hefty tax on sweetened beverages have been attempted sporadically around the country without much success. We are a nation that cherishes our personal freedoms and unfortunately this includes the freedom to do some things the aren’t in our own best interests.

You could argue that this leaves us with education as our only hope of turning the tide. However, educating without characterizing the obese among us as bad, ugly, and undisciplined people is a public relations challenge of heroic proportions. Choosing language and images that somehow convey the idea that although obesity is bad being obese doesn’t make you a bad or ugly person is walking along a fine semantic edge.

If I sound discouraged, you are reading me correctly. As pediatricians, we are left doing the few things that have been shown to make a difference. This means promoting breastfeeding and encouraging thoughtful introduction of solid foods; both strategies can be done before the child can hear our well-intentioned but misguided words of encouragement.
 

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Other than a Littman stethoscope he accepted as a first-year medical student in 1966, Dr. Wilkoff reports having nothing to disclose. Email him at [email protected].

In a recent New York Times opinion article, author Aubrey Gordon claims that since a visit to her pediatrician in fourth grade she has felt like an “enemy combatant in the nation’s war on childhood obesity.” (“Leave Fat Kids Alone,” Nov. 13, 2020).

At that unfortunate encounter, she recalls being told that “You’ll be thin and beautiful ... If you can just stay the same weight.” In retrospect she feels that the comment by her well-meaning but misguided physician “planted the seeds of depression” that have plagued her ever since.

Ms. Gordon goes on to list the many national and local initiatives that have done little to bend the curve in this country’s obesity trajectory but have succeeded in targeting bodies like hers as an epidemic and have resulted in her and thousands of other children being treated as “its virus personified.”

It is deeply troubling to read of her journey through life as collateral damage in a failed war effort, but Ms. Gordon offers little advice to us other than that we stop doing what we have been doing. It hasn’t been helping and it’s not working.

I suspect she would agree that obesity is one of our nation’s most serious public health problems. There is voluminous evidence of the association of obesity with cardiac disease, cancer, mental health challenges, and more recently COVID-19 – just to name a few. If blaming obese children who are the victims is counterproductive where do we point the finger? It is tempting to blame parents and certainly they deserve some culpability. Some parents could have created less obesity-enabling environments through healthier menu choices and done a better job discouraging sedentary behaviors. However, some families lack the access to, or the resources to, provide less calorie-dense food options. We know that many obese children have parents who have been obese themselves since childhood and we know that breaking the obesity cycle can be extremely difficult. Do we extend the sweep of our finger-pointing to include grandparents and great grandparents?

While guilt can be a powerful motivating force, obesity seems to be one of those conditions in which by the time it becomes obvious to a family, the die is cast and blaming the victim or her parents is going to do little more than engender bad feelings. We have done more than enough. In fact, Ms. Gordon’s commentary suggests we have gone too far in creating public opinion that being lean is healthy and being overweight is bad. More motivational testimonials will merely add to the shaming.

Obesity is clearly a societal problem and selectively targeting the victims is not the answer. A famine would certainly lower our national body mass index, but not even the most callous among us would include it on the list of options. Attempts at levying a hefty tax on sweetened beverages have been attempted sporadically around the country without much success. We are a nation that cherishes our personal freedoms and unfortunately this includes the freedom to do some things the aren’t in our own best interests.

You could argue that this leaves us with education as our only hope of turning the tide. However, educating without characterizing the obese among us as bad, ugly, and undisciplined people is a public relations challenge of heroic proportions. Choosing language and images that somehow convey the idea that although obesity is bad being obese doesn’t make you a bad or ugly person is walking along a fine semantic edge.

If I sound discouraged, you are reading me correctly. As pediatricians, we are left doing the few things that have been shown to make a difference. This means promoting breastfeeding and encouraging thoughtful introduction of solid foods; both strategies can be done before the child can hear our well-intentioned but misguided words of encouragement.
 

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Other than a Littman stethoscope he accepted as a first-year medical student in 1966, Dr. Wilkoff reports having nothing to disclose. Email him at [email protected].