Letter to the First Lady

Dear Ms. Obama:

We would like to applaud you for your efforts to eliminate food deserts and create healthy environments in which children will thrive. We recognize the importance of access to the tools and means for healthy living – including affordable produce, information, and recreational space. Like you, we value improvements to the built environment, education, and food supply chains to address the problems associated with inadequate access to healthy living.

But we disagree that "the overall goal [is] solving childhood obesity in this generation."¹

The medical problems associated with low-produce diets and insufficient physical activity cover a wide spectrum. While some of the more severe conditions, like diabetes and heart disease, can occur alongside above-average weights, weight is not the underlying cause of these public health problems.² As you have noted, access to fresh foods and physical activity in our neighborhoods is essential for achieving childhood health. Access to these fixtures of a healthy living environment is particularly missing in many low-income communities and communities of color. To address this, we recommend a simple reframing of our shared long-term goals: to create healthy food and exercise options for all young people.³

We believe that targeting weight as the desired public health outcome diverts our efforts from the important changes to the natural and built environments that are necessary for fostering healthy lives.

Moreover, we recognize that this kind of undue attention on weight is extremely harmful.⁴ We know too well the relationship between body image, mental health, and eating disorders, particularly among women and girls. We know, also, that the examples set by adults can fuel harmful bullying among young people. There is a significant risk that emphasizing the dangers of a given body type is having a far-reaching, negative effect on public health.

We share with “Let's Move” a recognition that the problems are best framed as related to access and addressed via changes to the environment, rather than personal attributes. Placing emphasis on personal attributes can result in finger pointing and stigmatization,⁵ and those most often stigmatized for their body size tend to be low-income people and people of color. We choose to focus our efforts, instead, on positive changes that we can make to our community’s environments in order to improve the availability of affordable, healthy eating and exercise options.

Research shows that it is not possible for everyone to achieve and maintain weight loss.⁶ Many children may be deterred by this fixed goal. Furthermore, a focus on weight control may actually backfire; not only is dieting to control weight among youth ineffective, it may actually promote weight gain.⁷

A healthy lifestyle, on the other hand, is a goal that can empower everyone and that everyone can achieve. Evidence supports that people are much more effective at improving health and maintaining those changes when the emphasis is placed directly on health behaviors – as opposed to weight.⁸

The real task before us is to expand the availability of food options and activity options and to create environments that promote healthy living. We all agree on the central problems of diet- and exercise-related illnesses and the primary tactics for addressing them. Let's develop a common, positive platform that is inclusive and works to promote public health for all of us. Let's work together to foster healthy communities in which our children will thrive.

Sincerely,

Beth Herz	Ogonnaya Dotson-Newman	Anna Kirkland, Ph.D.
Linda Bacon, Ph.D.	Sander Gilman, Ph.D.	Eric Oliver, Ph.D.
Carol Boyd, Ph.D., MSN, RN	Glenn Gaesser, Ph.D.	Jill Richardson
Deb Burgard, Ph.D.	Kimberly Greenberg	Abigail Saguy, Ph.D.
Paul Campos, Ph.D.	Nicole Grijnsztein	Carrie Schiff

Notes
¹ Obama, Michelle. http://www.letsmove.gov/blog/youalltookastand_1.html

² Farrell, S.W., Braun, L., Barlow, C.E, Cheng, Y.J., Blair, S.N. “The relation of body mass index, cardiorespiratory fitness, and all-cause mortality in women. ” Obesity Research 10.6 (2002): 417-423.
Gaesser, G.A. “Thinness and weight loss: beneficial or detrimental to longevity? ” Med. Sci. Sports Exercise 31.8 (1999): 1118-1128.
Hahn, R.A., Heath, G.W., Chang, M.H. “Cardiovascular disease risk factors and preventive practices among adults—United States, 1994: A behavioral risk factor atlas. ” Morbidity and Mortality Weekly Report 47. SS-5 (1998): 35-69.

³ Daníelsdóttir, S., Burgard, D., Oliver-Pyatt, W. “AED Guidelines for Childhood Obesity Prevention Programs. ” Academy for Eating Disorders. http://www.aedweb.org/media/Guidelines.cfm

⁴ Neumark-Sztainer, D., van den Berg, P., Hannan, P., Story, M. “Self-Weighing in Adolescents: Helpful or Harmful? Longitudinal Associations with Body Weight Changes and Disordered Eating. ” Journal of Adolescent Health 39.6 (2006): 811-818.

⁵ Latner, J.D., Stunkard, A.J. “Getting worse: The stigmatization of obese children. ” Obesity Research 11.3 (2003): 452-456.

⁶ Coakley, E.H., Rimm, E.B., Colditz, G., Kawachi, I., Willett, W. “Predictors of weight change in men: Results from The Health Professionals Follow-up Study. ” International Journal of Obesity 22.2 (1998): 89-96.
Kassirer, J.P., Angell, M. “Losing weight – an ill-fated New Year’s resolution. ” New England Journal of Medicine 338.1 (1998): 52-54.

⁷ Field, A.E., Austin, S.B., Taylor C. B., Malpeis, S., Rosner, B., Rockett, H.R., Gillman, M.W., Colditz, G.A. “Relation between dieting and weight change among preadolescents and adolescents. ” Pediatrics 112.4 (2003): 900-906.

⁸ Bacon, L., Stern, J.S., Van Loan, M.D., Keim, N.L. “Size acceptance and intuitive eating improve health for obese, female chronic dieters. ” J. Am. Diet. Assoc. 105.6 (2005): 929-936.

The Resource List

Food politics and food justice

“Building Healthy Communities Through Equitable Food Access,” Judith Bell, PolicyLink, and Marion Standish

“The Grocery Gap: Who Has Access to Healthy Food and Why it Matters,” PolicyLink and the Food Trust

Closing the Food Gap: Resetting the Table in the Land of Plenty, Mark Winne



Fat politics and health at every size

Health at Every Size, Linda Bacon

The Obesity Myth: Why America's Obsessions with Weight is Hazardous to Your Health, Paul Campos

Big Fat Lies: The Truth About Your Weight and Your Health, Glenn Gaesser

Fat Politics: The Real Story behind America's Obesity Epidemic, Eric Oliver

bullying and weight, from Pediatrics journal

If we know that for children in a higher weight bracket, bullying is significantly worse and we know that childhood bullying is related to mental health problems later in life...

...maybe we'll consider shifting the focus away from weight in the public discourse?

The researchers also tried to determine if overweight children from certain backgrounds were more vulnerable than others, and if some had social skills or other characteristics that protected them from bullying.

...

“The child who was obese was simply more likely to be bullied than the child who was not; none of these things affected it at all,” said Dr. Julie C. Lumeng, an assistant professor of pediatrics at the University of Michigan and the lead author of the paper, in the journal Pediatrics.

Times coverage here.

Feministe post and Alternet article

Last fall's post by Lisa Jervis on Feministe, beautifully sums up the steps that the food movement (still) needs to take.

More recently, Jill Richardson - of La Vida Locavore - captured Linda Bacon's case for health at every size in her article on Alternet. Jill gets right to the point:

All in all, while inspiring individuals to improve their diet and exercise habits in order to promote public health is laudable, the number one issue we should address on a societal level to decrease the rate of chronic diseases like diabetes is poverty. Lower-income people are more prone to obesity as well as the health problems associated with weight gain. Major risk factors for obesity and disease are in place for each of us before we are born: our parents' income level, educational level and ethnicity, to name a few.

...

The best way to accomplish Michelle Obama and Jamie Oliver's goals is to address social injustice and to reduce poverty in America. Why aren't either of them talking about that?

op-ed on the stigma of being overweight

As Harriet Brown writes, weight stigma can diminish employment opportunities, lead to direct interpersonal discrimination, and impact mental and physical health. Research on doctors' attitudes shows how deep-seated our prejudices are:

More than half of the 620 primary care doctors questioned for one study described obese patients as “awkward, unattractive, ugly, and unlikely to comply with treatment.” (This last is significant, because doctors who think patients won’t follow their instructions treat and prescribe for them differently.)

...and the negative effects this can have on patients:

Even if doctors don’t directly express weight-based judgments, their biases can hurt patients. One recent study shows that the higher a patient’s body mass, the less respect doctors express for that patient. And the less respect a doctor has for a patient, says Dr. Mary Huizinga, the study’s lead author and an assistant professor at Johns Hopkins School of Medicine, the less time the doctor spends with the patient and the less information he or she offers.

Other studies are flipping the assumption that because overweight and obesity are often associated with mental and physical illness, obesity itself causes these illness. In fact, controlled studies show, the stigma attached to weight may be a more significant cause of illness.

Dr. Peter A. Muennig, an assistant professor of health policy at Columbia, says stigma can do more than keep fat people from the doctor: it can actually make them sick. “Stigma and prejudice are intensely stressful,” he explained. “Stress puts the body on full alert, which gets the blood pressure up, the sugar up, everything you need to fight or flee the predator.”

Over time, such chronic stress can lead to high blood pressure, diabetes and other medical ills, many of them (surprise!) associated with obesity. In studies, Dr. Muennig has found that women who say they feel they are too heavy suffer more mental and physical illness than women who say they feel fine about their size — no matter what they weigh. [emphasis added]

Read the full op-ed for more.

multiple perspectives from the Times

Can medical professionals emphasize health and healthy living rather than weight?

Five writers examine how public health initiatives can promote good habits without also reinforcing size discrimination in Room for Debate.

"A focus on health would emphasize adding positive behaviors rather than fixating on weight loss. It would support people in incorporating fruit and vegetables in their diet, or taking a 10- or 20-minute walk every day, or learning relaxation breathing to help manage stress. These small steps are important and achievable, while long-term weight loss, for most people, is not."
- Harriet Brown

a look at the data

Michelle Obama has pledged to improve the quality of school lunches, educate parents about healthy diets, and improve access to grocery stores in poor and rural areas. But first she has to reframe the obesity epidemic in terms of America's children. At every campaign stop, the first lady repeats the same facts and figures: Childhood obesity rates have tripled over the last three decades; nearly one in three children is now overweight or obese; and the youngest generation is on track, for the first time in the nation's history, to have a shorter lifespan than their parents.

As the war on child obesity escalates, we can expect to hear these statements repeated over and over again, spreading from one politician to another, through opinion columns and television newscasts. Before that happens, let's take a quick look at what the campaign rhetoric really means.

...the full article by Daniel Engber