Time To Trim

# Leave the Fat Kids Alone

## Efforts to fix childhood obesity are aiming at the wrong target.

Read about Slate’s project to generate new ideas for fighting childhood obesity here, and submit your own idea here.

Let’s get one thing straight: I wasn’t a fat kid; I was husky. At least that’s what it said on the labels of my pants. Maybe not the navy sweats I wore to school three times a week, but the other pants—the slacks, the dungarees, the husky dungarees.

Did the other kids notice my husk? Did they care? At camp one summer, a French boy called me a cochon. A third-grade jock who would later play minor-league baseball whispered about my fat ass on the bus. But while I was ready for much worse, it never came. I wasn’t that big, after all—just a little wide—and then I was distractingly weird, the kind of kid who entertained himself by trying to write out the digits of a googolplex in class. A cochon, maybe, mais aussi et surtout, a nerd.

So why is this image so vivid in my mind: A rectangular grid, with dots penciled in between rounded lines, marking off my weight in six-month intervals between the ages of 10 and 13? I can summon that piece of graph paper from memory and mentally trace its growth curves—there were five of them, one for the average boy and two each for the “accelerated” kids and the “retarded” ones. I was ahead of my peers. My father, a mathematician, took the measurements and applied the dots, connecting them with a jagged line that dipped toward the mean while Reagan was in office, then surged up the Y-axis. This is how I learned about standard deviations: See Daniel at 11, in his new aviator-style glasses, weighing 45 kilograms, and fatter than 68 percent of the kids his age. Now, a year later, prepping for his bar mitzvah and approaching the 95th percentile. Obesity. Be careful with your diet, my father told me. It might be time to stop buying cranberry muffins after school; they’re like slices of cake.

I didn’t give up the muffins, but never mind: A growth spurt stretched me into the “normal” range, and husky pants became a thing of the past. Yet that homespun screening—the charts and measurements and recommendations for lifestyle change—didn’t fail to leave a mark. They helped create in me a lasting, if mild, preoccupation with body size that’s no less disturbing for its banality. Among women, at least, or the women I know, such concerns are hardly worth mentioning—they’re a given. But these anxieties don’t arrive encoded in our genomes. We may emerge from the womb with a propensity for overeating or fat storage. Ceaseless self-scrutiny: That’s the sort of trait that develops later on, in childhood or adolescence. If most of us end up a wee bit anorexic—or manorexic, as the case may be—our early experiences write the script.

When it comes to fat, public-health officials love to talk about the formative years. We’re told that three-quarters of obese children grow up to be obese adults, at which point they have a hell of a time losing weight and keeping it off. So maybe we ought to target the fatties in the bloom of youth, when their rosy cheeks are just starting to fill out with subcutaneous adipose tissue. You can change a child’s habits when he’s still impressionable, the argument goes, when his body is still in flux. That’s one of the theories behind Michelle Obama’s Let’s Move! program, and it’s at the core of Slate’s newest Hive project: Get to kids early, and try to make a difference.

What sort of difference you’ll make isn’t so easy to figure. It’s nice to imagine there’s some critical period of development when our physiologies can be reprogrammed for thinness. But the same logic applies just as well to the mind as the body. Tell a little kid he’s fat (or obese, or at elevated risk of obesity, or whatever clinical spin you put on it) and you might help him to eat his fruits and veggies—but watch what happens to his bendy little brain. Get in there early enough, and even the best intentions can metastasize into a deep-seated anxiety. What happens in the mind of an adolescent could be inscribed there for years to come.

The war on obesity includes plenty of tactics that aren’t likely to make anyone feel bad. Some of the proposals that receive the most attention—increasing supermarket access, ending farm subsidies, and so forth—have nothing at all to do with individuals. But these calls for systemic change often come alongside a more insidious argument—sometimes made by public-health experts and spilling forth from other corners—that it helps to make things personal now and again. A little bit of stigma can go a long way. The problem with America, we hear, is that we’re mollycoddling the heavies, too afraid of hurting their feelings to say what needs to be said. Happy, fat-themed sitcoms teach Americans that it’s trendy to be fat. Obesity—ugly, life-threatening obesity—has gotten normalized.

This idea—that we’ve gone soft in more ways than one—has come up again and again in Slate’s effort to crowdsource a remedy for overweight children. “Schools should actively stigmatize being fat,” writes one member of the Hive; “few things are more terrifying to a kid than being an outcast.” Another declares, “We need to stop telling children to ‘love themselves the way they are.’” A third suggests that the government take custody of any child with obese parents, as a way to “get both parents and children motivated to exercise and eat healthy.”

These proposals are so plainly ill-advised, so thoroughly at odds with the available evidence on the causes of obesity, and so utterly detrimental to the welfare of our children, that I can only indulge in the fantasy that they’re meant as satire. Let’s be realistic, though: They’re not. And their presence in the Hive—among many other suggestions, to be sure—reflects the danger of equating a child’s health with the shape of his body.

Let’s consider what’s known about weight stigma. If it’s really true that America suffers from a lack of tough love, and that’s why we got so fat in the first place, then you might expect the nation’s swelling obesity rates to have arrived on a wave of warm fuzzies. But we’ve seen just the opposite, says Rebecca Puhl of Yale’s Rudd Center for Food Policy and Obesity (a leading advocate for the soda tax, among many other aggressive anti-obesity interventions). No one has been giving fat people a free ride. In fact, the prevalence of weight-based discrimination has increased by two-thirds since the mid-1990s; even middle-schoolers are getting meaner. The Hive tells us that to fight obesity we must “go on the offensive against obese people.” Just look at the data. We tried that approach, and it didn’t work.

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?