As I've argued before, it could even be the case that all this stigma is making things worse. Columbia University epidemiologist Peter Muennig has found evidence that the life-shortening effects of obesity are more severe among women than men, and more severe among white women than black women. Women and whites also happen to be the two groups most affected by weight-based discrimination. According to Muennig, it makes sense that the more shame you feel as a result of being fat, the greater the toll on your body. So a widespread war on obesity, or indeed an effort to "fix" the nation's fat children, could serve to exacerbate the problem.
But you don't have to buy into the idea that fat shame is killing us. Research also shows that stigma doesn't help anyone slim down. Nor does it encourage healthy behavior (which is, after all, very different from weight loss). At the University of Minnesota, Dianne Neumark-Sztainer recruited nearly 5,000 adolescents for a long-term study of weight- and food-related issues, and according to her data, the teenage girls who were most dissatisfied with their bodies gained more weight over a five-year stretch than their classmates. In fact, these dissatisfied girls showed triple the increase in body-mass index, controlling for the possibility that they were fatter to begin with. All that self-hate didn't turn them into gym rats, either: The same group ended up getting less exercise than their peers.
The troubling numbers abound. Neumark-Sztainer's data suggest that kids who go on a diet are twice as likely to end up overweight. (Once again, that's not because they started out heavier.) Same goes for kids who were teased about their weight—a group that's also at higher risk for binge-eating, bulimia, laxative abuse, and other dangerous behaviors. Teasing may also help explain why the percentage of adolescent girls who suffer from extreme distress about their bodies seems to be much higher than the one-sixth who show up as obese on the CDC growth charts. As for the 9.3 percent of American high-school girls who attempt suicide every year, the mere belief that they're fat turns out to be at least as important a risk factor as whether they really are overweight.
It's clear enough that a war on childhood obesity might have some unintended consequences. Now the question becomes, are they worth accepting? Tell a kid she's fat, and you'll make her feel bad, however it affects her diet and workout schedule. Now let's make the dubious assumption that you really could reduce your child's risk of chronic disease by making him more self-conscious and ashamed. Trading one affliction for the other might strike you as a wonderful bargain. It's the Tiger Mother approach, to be sure. Does that mean it should be national policy?
Granted, mainstream anti-obesity reformers are generally aware of these issues, and there's some data suggesting that body-focused interventions have not caused schoolwide epidemics of disordered eating. In Arkansas, for example, a 2003 law that established a statewide BMI screening program in schools allowed for the systematic study of both its positive and negative effects. (The law also limits vending machines in schools, promotes gym and nutrition classes, and otherwise encourages better diets and more exercise.) A five-year study of the program found that students did not become any more likely to report teasing about their weight, skipping meals, or taking diet pills. Another study, published in 2005, looked at a school-based anti-obesity program in Massachusetts, and concluded that middle-school girls did not become more inclined to use purging, laxatives, or diet pills as a result of the intervention.
Yet my own experience leaves me wondering what's left out from these crude, self-reported measures of behavior. How do we know what it's like for the husky kid who has to run a gauntlet of anti-obesity flyers on his way to class? Even if our efforts to prevent obesity don't turn children into bulimics or pill-poppers, we might still be helping to create a new generation of kids who worry over every pound, or must endure a lifelong fear of muffins. Why risk it, especially when we don't know if these interventions work at all?
Instead of looking at this Hive as a way to fix the fat kids, we should be working to help every kid. The problem—the real problem, I mean—isn't that the number of children who fall on the wrong side of an arbitrary cut-off has tripled in the last few decades. It's that the underlying causes of chronic disease have grown more prevalent. Kids are consuming too much salt, and not enough fruits and vegetables; many lack access to quality health care; more than 15 million of them are living in poverty. Even after years of anti-smoking campaigns, one in four high-school students is still using tobacco, and that rate is holding steady. These are the issues we need to address, and we're desperate for good ideas.
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Happy Constitution Day!
Too bad it’s almost certainly unconstitutional.