Children’s Healthcare of Atlanta is hearing strong criticism from some camps for its in-your-face advertising campaign designed to attack Georgia’s childhood obesity epidemic. But the pediatric health system stands firmly by its approach, saying the grim advertisements featuring overweight kids are necessary to get families to recognize the widespread public health problem.

Using tools such as television commercials and billboards late this year, the campaign has offered stark black-and-white images of overweight children sharing bold and often uncomfortable messages. In one, a child named Bobby sadly asks his obese mother, “Mom, why am I fat?” His mother simply sighs heavily and the commercial fades out.

Some public health experts, however, say the approach could be counterproductive when it comes to childhood obesity. The commercials and billboards do not give families the tools they need to attack the problem, some critics say. Others say the images will simply further stigmatize obesity and make it even less likely for parents and children to acknowledge that their weight is unhealthy and should be addressed.

Children’s Healthcare decided on the approach after finding in research that 50 percent of people surveyed did not recognize childhood obesity as a problem and 75 percent of parents with overweight or obese kids did not see their children as having a weight issue. Across Georgia, which ranks second nationally for childhood obesity, about 1 million children are overweight or obese, according to data compiled by the campaign.

“We felt like we needed a very arresting, abrupt campaign that said: ‘Hey, Georgia! Wake up. This is a problem,’ ” said Linda Matzigkeit, a senior vice president at Children’s Healthcare, who leads the system’s wellness projects.

Scare tactics?

The campaign — called Strong4Life — is planned as a $50 million project to be rolled out over five years. Children’s Healthcare has committed to paying half the costs while seeking donations to cover the rest. The Blue Cross and Blue Shield of Georgia Foundation recently kicked in $95,000 to support the campaign.

The ads, which appear on the campaign’s website, strong4life.com, are modeled after blunt — but effective — campaigns attacking methamphetamine use and smoking.

In one spot, an overweight girl named Maritza says: “My doctors say I have something called hypertension. I’m really scared.” And in another, that ends with “Being fat takes the fun out of being a kid,” a child named Tina says she doesn’t like going to school because the other kids pick on her.

Critics say the ads will further ostracize children such as Tina. In posts on the Strong4Life Facebook page, they accuse the campaign of building a “climate of hate.”

“Stop the shame, shocking statistics, and scare tactics and start offering these kids and their parents suggestions and solutions,” one post says.

Public health experts say the criticism may have some validity, although the ads are only one part of a program that also connects overweight children and their families with specialists who can help them attack the problem.

Marsha Davis, who researches child obesity prevention at the University of Georgia’s College of Public Health, said the campaign’s approach is controversial within the public health community.

“I know [the ads] are startling; they get one’s attention,” Davis said.

But the disagreements arise when it comes to the central question: Will the ads work? While the harsh approach has proved effective in combating smoking, research has found that making people feel badly about their weight doesn’t work as an agent of change, Davis said.

“I guess it depends on what we want to do with these ads,” she said. “If we want to get attention to say obesity is a problem, maybe they will be effective. In terms of the social stigma about weight — it might actually make people feel worse about that.”

It might be more effective, Davis said, to highlight behaviors that lead to obesity and offer help to those who want to change. “We need to fight obesity,” she said, “not obese people.”

Karen Hilyard, a health communication researcher at UGA, said information about what a family can do about the problem is crucial.

“We know from communication research that when we highlight a health risk but fail to provide actionable steps people can take to prevent it, the response is often either denial or some other dysfunctional behavior,” she said.

Hilyard added that “this is a problem that has so many different causes.” She cited not just poor food choices and sedentary lifestyles, but also difficulty in finding safe places for kids to exercise and limited availability of affordable, healthful foods as playing a part in the problem.

Maya Walters, a teenager with high blood pressure who appeared in one of the ads, says she has made changes in her lifestyle. She is using less salt in her food and no longer feels winded when climbing stairs. She strongly supports the ads.

“I think it’s really brave to talk about the elephant in the room,” she told The Atlanta Journal-Constitution in September, shortly after the ads started to run in the metro area. “It’s very provocative and makes people uncomfortable, but it’s when people are uncomfortable that change comes.”

Obesity’s costs

Children’s Healthcare doesn’t mind the controversy associated with the campaign. “There are people who don’t like it and people who like it,” Matzigkeit said. “In the end, I think people are saying it really is time for a wake-up call. We have to do something about this or our state is in jeopardy. It’s not good for business if your state has the second-highest obesity rate. Obese children turn into obese adults.”

Children’s Healthcare commonly sees children with heart disease and diabetes, or who need knee replacements, because of their weight. “We never used to see those kinds of things,” Matzigkeit said.

The campaign tested the spots in Columbus and Macon this year. Matzigkeit said 85 percent of those exposed to the campaign who were interviewed in follow-up research said the approach was appropriate. The campaign is measuring the effectiveness of its message in Atlanta but does not yet have any results.

In addition to the advertisements, Children’s Healthcare has a clinic for overweight children to help address their problems in a yearlong program. The children are set up with a team that includes a physician, nutritionist, psychologist and exercise coach to work with the family to help the children lose weight and get healthy.

The program has also trained more than 600 metro Atlanta pediatricians on how to talk to families whose children are overweight and help them attack the problem at home.

More ads upcoming

Gayla Prestage Grubbs, whose 15-year-old son is working hard to address a weight problem, said she supports the tone of the advertisements.

“They are in your face,” she said. “But I know, for me, I was not offended by it. I was more like — oh, my gosh, that’s right.”

Grubbs and her son, Samuel, enrolled in the Children’s Healthcare clinic after seeking advice from their pediatrician. “What I love about the program: It is comprehensive; it is not a quick fix,” she said.

A total wellness program has helped Samuel take responsibility for making his own healthful choices. Although the busy family often opted in the past for a fast-food meal, the program has prompted them to cook more often at home and to go to the gym several times a week. The program has already helped Samuel, she said. “His self-esteem has increased dramatically,” Grubbs said. “He has gone from a child who kept to himself and had issues of bullying and that sort of thing — and he has done a 180.”

While their decision to take on Samuel’s issues started before the campaign hit, Grubbs said she believes it could prompt others to follow her family’s lead.

“People have a tendency to blame others or to blame their situation,” she said. “But we have to own the choices that we make, and that’s why I feel it’s not too strong of a message. Our children are at risk, and as parents we have to own that.”

Strong4Life is getting ready to launch the next phase of its campaign. Matzigkeit said those who didn’t care for the first phase may not like the next phase either. But that doesn’t bother her. “The whole goal of this is to get the discussion going,” she said. “I love that it sparks dialogue, and a great dialogue has two sides.”

– Carrie Teegardin

Posted January 3, 2012.