Don't Get Smacked by Boston's Fat Smack Campaign

If you live in Boston and take public transportation, you’ve probably seen the posters in the stations and on the trains that show a young, attractive, African-American teenager holding a bottled beverage and wincing/giggling as they get or are about to get, literally, smacked by a glob of fat.  (I’m pretty sure they’re using fake fat — no real fat was harmed in the creation of this advertisement.) 

In case it’s not clear, this is part of a public health campaign to get kids off of sugary drinks.  It’s true — excess sugar can provide excess calories, which can lead to excess weight and fat.  It’s a reasonable message — I just don’t approve of how it’s being communicated.

Here is a data point from the website: obesity costs our health care system $147 billion per year.  As the site points out, that’s the amount of money it would cost to buy everyone in the country an iPad 2.  Wow — that’s a lot of money!

This is the abstract of the study they used:

In 1998 the medical costs of obesity were estimated to be as high as $78.5 billion, with roughly half financed by Medicare and Medicaid. This analysis presents updated estimates of the costs of obesity for the United States across payers (Medicare, Medicaid, and private insurers), in separate categories for inpatient, non-inpatient, and prescription drug spending. We found that the increased prevalence of obesity is responsible for almost $40 billion of increased medical spending through 2006, including $7 billion in Medicare prescription drug costs. We estimate that the medical costs of obesity could have risen to $147 billion per year by 2008.

A couple of things:

First, $147 billion is an estimate. 

Second, the clock of this study starts at 1998.  That’s a very interesting year, because it was in 1998 that the definition of overweight and obesity was revised downward.  With that change, millions of Americans who had been considered overweight suddenly became obese.  In other words, the sample of people you would look at to find health problems attached to the obese population became much larger after 1998.  Did they find more health problems and costs because those people really became legitimately unhealthier, or because there were simply more of them? 

Third, there is another interesting year in the story of obesity: 2004.  That’s the year that the CDC published a study that said that obesity was responsible for up to 400,000 deaths in the year 2000 alone.  Wow!  Well, suddenly, weight went from an esthetic issue to a huge health threat.  Some people might be motivated to lose weight who weren’t before (because, you know, they’re more concerned about their health than they are what other people think about their appearance).  Call me crazy, but that might lead to an increase in prescriptions for weight loss drugs or even stomach reduction surgery, and those just might be factored into the increased costs of obesity four years later in 2008.

There’s just one thing about that CDC study: it was roundly criticized by such varied outlets as Science Magazine, The American Journal of Public Health, and the Wall Street Journal.  In 2005, the Journal of the American Medical Association published a study which showed that mortality associated with obesity to be one-fourth (25 percent) of what the CDC study showed.  (I feel it’s worth noting here that being overweight was NOT associated with mortality.) 

I bet most readers “know” all about how dangerous obesity is, but they hadn’t heard about what Science, the American Journal of Public Health, the WSJ and JAMA had to say on the matter.  Well, we all know if it bleeds, it leads.  But is that fair to the kids who are the target audience of the Fat Smack ad campaign?

There are great reasons to avoid sugary drinks: they’re expensive and they contribute to tooth decay.  If you have a family history of Type 2 Diabetes, avoiding excess sugar is a good idea.  But encouraging a healthy behavior by preying on a fear our young people have about appearance is a bad idea, and using bad science to justify it is even worse.

Let’s do better for our kids.

This was crossposted on the author's blog and appeared on Jamaica Plain and South End patches.