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

Let's not use scare tactics (and bad science) to keep kids away from sugar.

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 MagazineThe 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.

This post is contributed by a community member. The views expressed in this blog are those of the author and do not necessarily reflect those of Patch Media Corporation. Everyone is welcome to submit a post to Patch. If you'd like to post a blog, go here to get started.

R. Mauré November 28, 2011 at 01:24 PM
Thank you for posting this. The 'obesity' problem is very complex, and should be treated as such. The Fat Smack ads seem to use fear & shame as a motivating force for reducing the amount of fat consumed by teenagers. Positive messages putting self-worth and good health together are what is needed. Access to this attitude, healthy food choices and education will work better than clever advertisements.
Matt November 28, 2011 at 01:37 PM
I think this campaign is great. It gets your attention, it's clever, and it has a great message. It doesn't make sense to me that you would target this campaign - of all misleading marketing out there - to criticize. Don't all ads use models? How is this any different? What about sugary cereals, drinks, processed foods, smoking, booze...? Aren't those more at fault for glamorizing things that are bad for you?
Sarah Lydon November 28, 2011 at 02:07 PM
I'm scratching my head here. How is this ad campaign "preying on the fears that young people have about appearance?" If anything it's playing more to a literal "it's gross, it's unhealthy, it sneaks up on you disguised as soda, etc." And I'd second Matt--compared to the constant barrage of advertising, imagery and messages that kids receive constantly around both unhealthy food and unattainable body images, how does this ad campaign even begin to compare?
Maura November 28, 2011 at 04:33 PM
I like this ad. It shows a not yet fat teenager getting snuck up on by the effects of his sugary drink. It gets your attention.
Rosa November 28, 2011 at 07:43 PM
I absolutely love these ads. The message is clear and should be communicated as such.
Kasey Hariman November 29, 2011 at 02:00 PM
Deb, I'm glad you started this conversation! I found the ads to be crude, but I think they ultimately do more good than harm. I think many people have no trouble associating obesity with obviously fatty foods like fried dough or KFC's Double Down, but have a harder time making the connection between sugary stuff, especially drinks, and additional body weight--this is opinion, though. A few years ago a study came out that linked drinking one soda a day to gaining an additional 15 pounds. An article about it is here: http://archive.newsmax.com/archives/articles/2006/8/10/135827.shtml I would love to see them expand this campaign to include other demographics besides teenagers--while it's absolutely important to target teens b/c of their heavy soda consumption (well, I had heavy soda consumption, as a teenager), those aren't the only folks who are knocking them back! Deb and R. Maure--would you be more okay with this if it wasn't just photos of teenagers?
Lita Newdick November 29, 2011 at 03:14 PM
I have been following nutrition studies and nutrition news and the activities of the powerful sugar lobby since the early Sixties.. The sugar lobby is a significant factor in pushing back against Science, which shows that sugar causes inflammation in the human body. The latest Scientific thinking is that inflammation is a major cause of heart disease, cancer and many other serious conditions. A few years ago I read with dismay in the New York Tines that the sugar lobby had successfully managed to change the language of the FDA's recommendations to the American people. The new language lessened the impact of the original recommendation from, basically, "cut sugar in your diet" to a less clear, more confusing recommendation. The moral of this story is: if you care for your health, limit seriously your intake of sugary drinks. .
Marc near the Park November 29, 2011 at 04:08 PM
If you have to "prey on their fears" about their appearance to get them to care about their habits and their long term health, I say, big whoop. As long as the message reaches them, I'm all for it, though I don't think these ads are particularly insensitive towards larger kids, or larger people in general. It's just a bold visual to say, Watch Out! I think making a connection to fear and shame is a huge leap. Unless there are different ads out there that I haven't seen (I've caught 3 or 4 of them) there haven't been any that show overweight kids with any hint of ridicule in the tone of the image.
Deb Nam-Krane November 30, 2011 at 01:54 PM
1. This campaign was worthy of my attention here because A) it is sponsored by the Boston Health Commission, B) aimed at teenagers and C) uses bad science. It's true- there are plenty of advertising campaigns that have negative messages, but I haven't seen any others that meet all three criteria. 2. "Don't Get Smacked by Fat" and then showing people getting hit with fat says "don't get fat". I do see the text on the ads about Type 2 Diabetes, but that's not the visual they're emphasizing. If we think it's okay to scare teenagers and children, then let's REALLY scare them: show them someone giving themselves insulin shots or walking around without toes because of gangrene and amputation. These are consequences that can result from Type 2 Diabetes, and I'd be much less critical if those had been presented. 3. As the study I reference above shows, being overweight- "fat"- is not a health risk. Being obese can be, but not nearly as much as we- and our children- have been told. We are telling kids not to be fat because we already know that they think it is, as someone here put it, "gross". 4. To those who say that they don't have a problem using fear and shame to communicate a health message to kids, I do. As the mother of a teenager and a preteen, as someone who worked with children in schools and as a former yoga/Pilates instructor, I've seen too much fear of bodies and fat. Encouraging it is unhealthy and shouldn't be done by the Boston Health Commission.
Sarah Lydon November 30, 2011 at 08:37 PM
Being overweight isn't a health risk? Again--scratching my head. This article cites the study you mention above but draws very different conclusions. http://www.nejm.org/doi/full/10.1056/NEJMoa055643#t=articleResults A few more facts. Type 2 diabetes is about twice as common in African-Americans and Latinos--rates are soaring among young people especially. Losing even a modest amount of weight--perhaps by cutting out soda and sugary drinks--can reduce your risk of developing diabetes by around half. I really think that's all this ad is about--whatever else you want to read into it. I'm still failing to see the "fear and shame" factor or any connection to teens' appearance. As far as I know the Boston Health Commission has no vested interest in how young people look--they just want them to stay healthy.
Deb Nam-Krane November 30, 2011 at 09:21 PM
The study you mention might have arrived at very different conclusions because they used very different samples of people and data collection methods. The study I reference in my post was done on a nationally representative group of people between the ages of 6 months and 74 years. Some of those people filled out questionnaires, and some were examined. This video explains some of the process: http://www.cdc.gov/nchs/video/nhanes50th_ppf/intro/ppf_intro.htm As is noted in the title of the study you link to, it is confined to people between the ages of 50 and 71. It would appear that both the baseline and follow up data were determined by means of a mail-in questionnaire. Further, the conclusion explicitly confines itself to people in that age group.
Deb Nam-Krane November 30, 2011 at 10:42 PM
Further, the populations in the study of the 50 - 71 years old were confined to California, Florida, Louisiana, New Jersey, North Carolina, Pennsylvania, Georgia (Atlanta only) and Michigan (Detroit only). These are diverse samples, but I would not call them nationally representative.
Sarah Lydon December 01, 2011 at 02:34 AM
If you read the discussion at the end of the NEJM article you'll see that they discuss the Flegal study and possible reasons for the results. Nowhere does anyone claim that there are no health risks associated with being overweight.
Marilyn December 01, 2011 at 03:02 AM
I'm glad to see these ads being challenged by Deb and their scientific merits being questioned and discussed. I feel like I'm being smacked by them every time I get on the Orange Line. I get that a specific population is being targeted in this campaign but are only teens of color negatively affected by sugary drinks? One might draw that conclusion looking at these ads.
Maura December 01, 2011 at 12:54 PM
I'm no scientist and won't pretend to be able to interpret study data. But it seems to me that being overweight for long periods of time can put stress on the body and that can't be good. And it is pretty well accepted that losing a little weight helps with diabetes, blood pressure, relieving stress on joints... I also like the idea of an ad campaign that shows gangrene or other health problems. I think that teens might not respond to that though. As a youngster I saw all kinds of graphic movies about the effects of smoking and it didn't stop me from picking up the habit. I say it's a good thing that the topic's being targeted to the teen demographic. I wonder what they think of the ads?
Deb Nam-Krane December 01, 2011 at 12:59 PM
Sarah, if you read the conclusions of the Results of the JAMA study, you'll see that they claim that overweight is not associated with excess mortality: http://jama.ama-assn.org/content/293/15/1861.abstract The NEJM discussion offers their justification for excluding smokers and using only an over 50 population and proposes that those differences might account for their different results re: the JAMA study. I'd be curious to see what their justification is for why they didn't use a more nationally representative sample. Marilyn, I find it hard to believe that only Boston's non-white teenagers are drinking too many sugary drinks. As it is my European side of the family that has been affected by Type 2 Diabetes, not my Asian side, I think it's a terrible disservice that that population of kids isn't being spoken to as well.
Sarah Lydon December 01, 2011 at 01:47 PM
Yes, I read that. It's clarified here: "Recently, Flegal et al. reported that overweight was not associated with an excess risk of death in the nationally representative samples of U.S. adults drawn from the National Health and Nutrition Examination Survey.29 They speculated that possible causes for their finding might be improved medical management of obesity-related chronic disease or differences between the U.S. general population and populations in other studies.29 Others have suggested that inadequate control for the combined effects of smoking and chronic illnesses could be the explanation." Makes sense to me--still does not say that there are no health risks to being overweight; again, I don't think you'll find anyone making that claim. Re the ethnicity of the teens in the ads--this is obviously a campaign targeted at urban kids of color who are particularly vulnerable to type 2 diabetes and obesity. No different from the ads targeting African-American women urging them to get regular mammograms, which appeared after studies showing that AA women had later diagnoses and higher mortality rates from breast cancer.
Deb Nam-Krane December 01, 2011 at 04:28 PM
Maura, I can only go by my pre-teen and teenager. They find it repulsive and offensive. Sarah/Maura, here are studies talking about the effects of being overweight: http://jama.ama-assn.org/content/298/17/2028.full http://www.ncbi.nlm.nih.gov/pubmed/19543208 From JAMA, again written by Flegal et al: "Overweight was associated with significantly DECREASED mortality from noncancer, non-CVD causes (−69 299 excess deaths; 95% CI, −100 702 to −37 897) but not associated with cancer or CVD mortality." [Emphasis mine] The Canadian study finds the same results for overweight and drills down even further into the mortality for the obese: Obesity Class II+ (BMI > 35) is associated with increased mortality but Obesity Class I (BMI 30-35) is not. They go so far as to say that being overweight is "protective against mortality". To make sure the point is clear: "Obesity class I was not associated with an increased risk of mortality." True, they do not use the exact words "not a health risk" to describe being overweight, but I suspect that they would consider something that is protective against mortality to be, at the very least, not a health risk.
Sarah Lydon December 01, 2011 at 05:51 PM
From the same paragraph you quoted from above: "In further analyses, overweight and obesity combined were associated with increased mortality from diabetes and kidney disease (61 248 excess deaths; 95% CI, 49 685 to 72 811) and decreased mortality from other noncancer, non-CVD causes (−105 572 excess deaths;" It just seems as if you're cherry-picking your facts here and side-stepping the very real health issues that are facing the teens that these ads are targeting--obesity and diabetes. We disagree, clearly, on the potential of these ads to offend but I'm glad to see any reasonable attempt to fight back against the powerful forces of the junk food lobbies and the Big Gulp culture. And I'd really rather have to look at a hunk of fat on my ride home than a photo of someone's gangrenous feet.
Deb Nam-Krane December 01, 2011 at 06:42 PM
As the numbers indicate and as is noted in the conclusion of the study the net effect is still a significant decrease in overall mortality for the overweight category. My previous comments stand.
Lita Newdick December 13, 2011 at 04:32 PM
Folks erroneously thing this issue is all about excess weight. Unfortunately it concerns an issue that's even more important: inflammation in the body. The latest scientific thinking is that eating sugar causes inflammation, which is responsible for many diseases, including heart disease and cancer. Limiting sugar is more than a way to control your weight; it's a way to prevent disease.

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