Saturday, March 20, 2010

Concerns About National Childhood Obesity Awareness Month

Dear American Dietetic Association Leaders and Colleagues on the ADA-HOD Childhood Obesity Prevention Coalition:

I have become increasingly concerned about some efforts to address childhood obesity and ADA's participation in those efforts. This paragraph in the March 15th
On the Pulse has prompted me to put my thoughts into a cohesive form.
The House and Senate are considering resolutions that would recognize September as National Childhood Obesity Awareness Month. ADA is working with Congressional leaders on passing these resolutions and on how ADA members can participate in Childhood Obesity Awareness Month activities.
I am a passionate, long-time advocate for optimal childhood nutrition and for healthy school environments. My professional work and much of my personal life is dedicated to ensuring that all children are fit, healthy, and ready to succeed. However, the current drum beat of childhood obesity is often negative and narrowly focused. I believe that we need to reframe the discussion to be positive and inclusive. We need to move from a focus on childhood obesity to a discussion of the healthy habits that promote achievable, realistic, healthy weights for children (and adults) of all shapes and sizes.

Based on a growing body of evidence, I am seriously concerned that "obesity awareness" may have unintended consequences. If we look at such an event from the perspective of an overweight young person -- the individual it is designed to help -- it may cause significant harm. This Monday's New York Times featured a very thoughtful essay on
For Obese People, Prejudice in Plain Sight ( The final paragraphs apply directly to the question of childhood obesity awareness activities:

Dr. Bacon tells the story of an overweight teenage girl whose high school was going through a “wellness campaign.” Hallways were plastered with posters saying “Prevent teenage obesity.” After the posters went up, the girl said, schoolmates began taunting her in the halls, pointing at the obese girl on the posters and saying, “Look at the fat chick.”

She said heavier students were now made to feel guilty about their lunch choices, but the thin ones could eat anything they wanted without comment — even if it was exactly what the fat kids were eating.

“Stigmatization gives the thinner kids permission to think there’s something wrong with the larger kids,” Dr. Bacon, the nutrition researcher, said. “And it doesn’t help them look at their own health habits. There’s got to be a way to do this more respectfully and more effectively.”

I am absolutely in favor of programs to encourage delicious Nutrition from the Ground Up and fun ways to make Let's Move be part of every family's weekend plans. However, I strongly believe that any efforts to address childhood obesity should not cause more problems, especially for young people who already vulnerable from being teased or bullied.

My voice is just one of many who are concerned about the current course of action. Before you make any childhood obesity awareness plans, please watch this profound video (featuring young actors) made by the Rudd Center at Yale: The Rudd Center's distinguished experts argue persuasively for a scientific and thoughtful examination of the effects of weight stigma and bias, especially when it comes to vulnerable youth like those portrayed in the video (

Pasted below is an essay that Dr. Rebecca Puhl from the Rudd Center (who spoke at FNCE in 2009) posted last month on Medscape directly addressing the connection between weight and school performance. Please read it: The study she discusses and her conclusions may surprise you.

For me, the goal will remain what can we do to help young people of all weights, shapes, and sizes to be healthier, happier, and perform better academically? With all our expertise as the American Dietetic Association and as a profession, I know that we can find many ways to do this respectfully and effectively. ADAF's RD Coach program and the Healthy Schools Partnership are an excellent example of an effective, health-centered model.

Let's celebrate positive actions for all young people and their families this September. Personally, I could really get behind Kid's Eat Smart Month (perfect for back to school) or Family Food, Fun, and Fitness Month (lining up with Family Day: A Day to Eat Dinner with Your Children on September 27th).

Thanks for taking the time to thoughtfully consider these issues. Please feel free to contact me about them at any point. You may share this letter with anyone. I plan to share it widely with other ADA members, colleagues in school nutrition, and my Congressional representatives in urging them to vote NO on childhood obesity awareness month. Childhood obesity is much more than a current political buzz phrase; it involves the the emotional well-being, the physical health, and even the educational futures of millions of American children.



Dayle Hayes, MS, RD


Why are Obese Kids Performing Worse in School?
Rebecca Puhl, Feb 11, 2010
In the past few years, there have been increasing studies reporting that overweight and obese children have poorer school performance than their normal weight peers. While this may be true, these findings are often interpreted without consideration to the psychosocial factors that may play a mediating role, and have instead pointed to missed school days as a result of ill health associated with obesity, or even inferior cognitive abilities among obese youth. A few studies speculated that weight-based victimization could be an important variable to examine, but none had studied it.

As more of these studies appeared in journals, I became increasingly concerned about the potential take-home message that obese youth are cognitively inferior to normal weight youth. The stigma stemming from such findings could be considerable, and would be yet another harmful outcome in addition to the emotional and social consequences that obese children already face as a result of stigma.

But recently, a study was published in the International Journal of Pediatric Obesity (1), that examined the links between body weight of children and their academic performance. The authors conducted a random parental telephone survey of 1,071 public school students in Arkansas, and like other studies before it, found that overweight status was a significant predictor of poorer school performance. However, the authors also specifically assessed whether weight-based teasing predicted poorer school performance. They found that it did, with worse school performance among overweight children who were teased about their weight. This is the first published study I've seen that identifies weight-based teasing as a possible mediator in the relationship between children's body weight and their academic performance. And it makes so much sense.

Obese children aren't doing worse in school because they're not as smart as thinner students. They're doing worse in school because they face frequent (and often daily) victimization and harassment from peers because of their weight. (2) They are afraid to walk down the hallways because of negative remarks they receive from schoolmates. They are made fun of in physical education classes, mocked in the school cafeteria, and teased on the bus. Anecdotes from participants in our own studies also suggest that many students skip classes or miss days of school because of this torment. And we already know that overweight and obese youth who are victimized because of their weight have higher risk of depression, anxiety, low self-esteem, poor body image, and suicidal behaviors. (2) How could this not impact school performance?

My hope is that more studies like this will continue to surface, and that we can increase awareness among educators, health providers, and policy-makers that weight-based teasing and victimization is a widespread problem facing today's overweight youth, and that is has real consequences for their emotional well-being, their physical health, and even their educational futures.

1. Krukowski RA, Smith West D, Philyaw Perez Z, Bursac Z, Phillips MM, RAczynski JM. Overweight children, weight-based teasing and academic performance. Int J Pediatr Obes. 2009; 4(4): 274-280.

2. Puhl R, Latner J. Obesity, Stigma, and the Health of the Nation's Children. Psychological Bulletin, 2007; 133(4) 557-580.


  1. Dayle,
    Thank you for your thoughtful and timely commentary. At a recent meeting in Washington DC that Judy Rodriguez, Connie Diekman, Pat Babjak and I attended with Secretary of Agriculture Tom Vilsack, this very issue was raised in the context of how it could promote disordered eating. That is why it is so important for ADA to be part of the dialogue. We have consistently worked to promote a positive message when engaging in the discussion, especially around children, in regards to overweight and obesity. For this reason the ADAF adopted the language Healthy Weight for Kids as its mantra. The prevention intervention (counseling) provided by RDs in the BMI2 project does not even use the word obesity with parents and focuses on specific nutrition and physical activity habits. You have provided invaluable service as a content development consultant for our Healthy Schools Partnership RD Nutrition Coach curriculum, helping us ensure that we stay this important course. We will direct our Washington staff to raise these concerns on our behalf and encourage our elected leaders in the House and Senate to follow ADA’s example of delivering a positive message that will resonate and motivate rather than alienate those children who are at risk or suffering from the stigma of obesity. Thanks, again Dayle for your volunteer leadership on this issue.

    Jessie M. Pavlinac, MS, RD, CSR, LD
    ADA President

  2. I saw a news report about a program that both brings fitness into the classroom and promotes awareness for the need of physical activity in the lives of children. Many kids today are not getting the amount of exercise they need and are also uneducated about the health risks of eating poorly. The campaign helps to reinvent recess by increasing students’ activity through alternative and creative movements, with the help of dance instructors.

    The program initially was only implemented in Connecticut schools, but with its success and the overall concern of the issue at hand, it is now available to schools across the country. As part of the launch program, a video contest has been announced for children and young teens in grades 2-8 with efforts to address childhood obesity. I found this information on their site,