Strong4Life 101 —

We’ve had a sudden surge in searches for CHOA, Strong4Life and those oh-so-controversial billboards, also known as Phase 1 of Strong4Life’s advertising campaign.

Everybody’s got an opinion because that’s what people do. But I hope that before you make up your mind one way or another as to whether it is okay to use this kind of media strategy to raise awareness of obesity, you’ll take the time to research what the experts are saying. I’d also like for you to consider the possibility that the long-term psychological damage that these ads will have on the children of Georgia may contribute significantly both to childhood obesity and adolescent eating disorders.

Before you dismiss EDs as the lesser of two evils, you should know that anorexia has the highest mortality rate of any mental illness, affecting at least 3% of teenagers and having a mortality rate of 15% or more. There are approximately 22 million teens aged 15 to 19 in the United States according to the 2010 Census (PDF), so of an estimated 660,000 teenagers who are anorexic, the health risks are lifelong, if not life-ending, according to the National Alliance on Mental Illness:

The starvation experienced by persons with anorexia nervosa can cause damage to vital organs such as the heart, kidneys, and brain. Pulse rate and blood pressure drop, and people suffering from this illness may experience irregular heart rhythms or heart failure. Nutritional deprivation along with purging causes electrolyte abnormalities such as low potassium and low sodium. Nutritional deprivation also leads to calcium loss from bones, which can become brittle and prone to breakage (osteoporosis). Nutritional deprivation also leads to decreased brain volume. In the worst-case scenario, people with anorexia can starve themselves to death. Anorexia nervosa has the highest mortality rate of any psychiatric illness. The most frequent causes of death are suicide and complications of the malnutrition associated with the disorder.

While attempting to “cure” obesity, let’s not set into motion the unintended consequences of inducing eating disorders in Georgia’s youth. I recently spoke with Dr. Rick Kilmer, Clinical Director for Atlanta Center for Eating Disorders, in an interview that I will be publishing in the near future.

Question for CHOA: Have you contacted any of the eating disorder clinics around Georgia to see what effect the Phase 1 ads have had on their patients?

I did, and Dr. Kilmer explained to me how their patients with anorexia and bulimia have seen the ads as confirmation of their worst fears: that if they gain even a pound that society will attack them for being so disgustingly fat.

And that’s not even taking into consideration the devastating effect that the ads may be having on fat children. In May 2011, when the Strong4Life campaign launched, Children’s Healthcare of Atlanta (CHOA) received a dire warning from Dr. Rebecca Puhl, Director of Research and Weight Stigma Initiatives at the Rudd Center for Food Policy and Obesity at Yale University. From The Today Show interview:

This campaign is an example of what not to do in obesity presentation and they perpetuate prejudice toward children who are affected by obesity who are already vulnerable to pervasive teasing an bullying because of their weight.

If you click just one link in this entire blog post, I hope that it will be THIS ONE, wherein I outline every single medical and ethical reason why the Strong4Life campaign is not only cruel, but counterproductive to the very goal they claim to be pursuing. I also provide a rational, evidence-based alternative to Strong4Life’s shame-based campaign.

“But we have to raise awareness,” CHOA assures us. After all…

But here’s the thing about that 75% statistic: it doesn’t exist.

On January 9th, I shared screencaps from three separate references to this 75% statistic, each with a different claim:

1. “Our research showed that 75% parents w/overweight or obese children didn’t know there was an issue.”
2. “Our research showed that 75% of parents of overweight or obese children did not recognize their child was obese.”
3. “Before our campaign, our research showed that 75% of parents of overweight/obese kids don’t recognize/aren’t aware of the issue.”

These are three distinct claims for a single statistic, so I asked Strong4Life for the research results because when someone presents you with a statistic, it is best to read the original survey to see what questions they asked, as well as to check their methodology. But in that same Today Show interview, Strong4Life Chairman, Ron Frieson, gave a hint as to what one of the questions may have been when he said, “The parents said it was more important for their kids to be happy than to focus on their weight, assuming they would grow out of their weight issues.”

If someone called you up and asked you, “Assuming your child would grow out of their weight issues, is it more important for him/her to be happy or to focus on their weight?”

Now, I have no idea if that is one of the actual questions because I have not seen the research in spite of Strong4Life telling me over Twitter on January 11 that “research bkgrd is being collected” and that the research was forthcoming in a January 13 email from Kevin McClelland, External Communications Director for CHOA:

We are coordinating with our clinical research leader to determine the right time to publish the research we have conducted so far, but do intend to share some of it soon. I can tell you that the study we cite was conducted through a third-party research and statistically significant differences were at the 95% confidence level. [emphasis mine]

Since then, we’ve heard absolutely nothing.

Now, the same thing is happening with their latest research, which they say proves that their ads aren’t having any negative effects on the children of Georgia. They have released snippets of information and statistics, but in order to truly understand what the research is says, they need to release the research to the public so data analysts can see whether it actually says what CHOA claims it says.

Question for CHOA: When will you release any of your research so that we can see the questions, methodology, sample sizes and overall quality of these studies?

Because until we actually have this research in hand, CHOA is essentially telling the people of Georgia, “Trust us, we’re not harming your children!” And frankly, my fears are not assuaged by their reassurance. Why not?

Well, for one, on February 9, the National Institutes of Health did something they have never done before: the NIH issued a public condemnation of a private healthcare organization, warning of the dangers of shame and stigma in childhood obesity campaigns.

I agree with you that this campaign carries a great risk of increasing stigma for those children who are overweight or obese which, in turn, can reinforce unhealthy behaviors (e.g., overeating). A number of research studies over the last decade have supported this concern. For example, studies suggest that overweight children who are teased about their appearance are more likely to binge eat or use unhealthy weight-control practices, and weight-based victimization has been correlated with lower levels of physical activity. Not surprisingly, stigmatization of obese individuals, particularly adolescents, poses risks to their psychological health.

The NIH is no panic-driven group of fatties. The NIH is “the primary agency of the United States government responsible for biomedical and health-related research,” so if any group knows about the danger of stigma, it’s the NIH. And the NIH isn’t the only organization to condemn Strong4Life’s ad campaign. A coalition of organizations have opposed Strong4Life, including the National Eating Disorders Association, the Obesity Action Coalition, and the Academy of Eating Disorders, as well as celebrities like Dan Savage, Alton Brown, Roseanne Barr, and, most recently, Jillian Michaels.

In response to this impressive array of professional and celebrity voices calling for an end to Phase 1, how did Strong4Life respond? They banned the Weighty Eight from their Facebook page, changed their rules of engagement to forbid any mention of Phase 1, and revamped their website and Facebook page to remove all photos from Phase 1. One would think this means that they are moving on to Phase 2, the more positive, solutions-oriented phase of their campaign. And while that’s what Strong4Life hopes the public will believe, the reality is that they have simply shifted their focus from all of Georgia to two of the poorest neighborhoods in Atlanta: South Fulton and South Dekalb.

This sleight of hand is intended to placate their critics, but I, for one, am not satisfied just because they no longer targeting middle class families. Stigma and shame hurt poor children just as much as they hurt middle class children and, if anything, this bit of misdirection is even more reprehensible.

We know that poverty and obesity are strongly correlated, and this link is explained by what the World Health Organization refers to as the social determinants of health. In a nutshell, the social determinants of health are all of those conditions that people are born into (e.g., poverty, family education level, access to healthcare) that influence how much control a person really has over their lifestyle choices.

Poverty is one of the greatest social determinants of health, limiting access to better food and better healthcare, while the chronic stress of poverty contributes significantly to metabolic disorders. So, rather than hearing these voices of dissent and moving on to Phase 2, CHOA has simply decided that they will continue targeting the most vulnerable populations.

This is unacceptable.

And this is why we are calling Carter’s to join us in pressuring Strong4Life to end Phase 1 entirely. We have tried using the voice of reason, we have tried appealing to their clinical understanding of the issues, we have tried sharing the opinions of the most powerful and important voices on these issues, and their response was to mislead the public and continue their assault on those they hoped nobody would care to defend.

As company with a robust corporate responsibility program, Carter’s knows how important their influence can be on improving our society. They understand that corporations have an obligation to ensure that their support does not cause undo harm, and as a corporation that has a long and vibrant history of supporting children’s health and welfare, the serious ramifications of the Strong4Life campaign should be just as alarming to them as it is to all of us.

We understand that Carter’s may not be directly funding the Strong4Life ads, but by donating over $100,000 in clothing and money, they free CHOA up to redirect their own $100,000 to this condemned campaign. We understand that CHOA has done some amazing work in the past, but we cannot disentangle the good works of their physicians, nurses and healthcare professionals from the reprehensible decisions of CHOA’s marketing and management.

If CHOA will not listen to outrage and they will not listen to reason, then we have to go for the ultimate weapon: money. By disrupting their corporate funding, we are hoping that they will no longer be able to ignore us. We are pleading with Carter’s to defend the children of Atlanta and to help us apply some deep hurting to CHOA’s pocketbook so that they will finally end this campaign.

Carter’s has the power to do what this amazing coalition of parents, bloggers and professional health organizations has been unable to do: put an end to Phase 1 completely. And you, as patrons of Carter’s, have an opportunity to help us convince Carter’s that opposing Strong4Life is in their best interest.

So, please, join us in asking Carter’s to stop supporting Strong4Life and to call for an end to this harmful, offensive campaign immediately. You can also join our Strong4Life Solutions Facebook page, where we are discussion compassionate, healthful alternatives to shame and stigma.

Nobody is saying that we shouldn’t try to improve the health of the children of Georgia. We are saying that by relying on stigma and shame, Strong4Life is doing even more damage to the health of those children.

Thank you for reading and I hope you will join us.