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.

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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