Monday, October 1, 2012

To hate the player or the game? That is the question in Minnesota, where Blue Cross Blue Shield recently produced an anti-obesity campaign that many alleged is centered around the shaming of fat people. Instead of addressing the issues surrounding the prevalence of cheap, non-nutritive foods and the need for urban planning initiatives that support active living, or the obesegenic nature of the American landscape, the campaign examines the role of parents in modeling food choices that promote weight gain. Here's one snippet:

I get a little squeamish when people start talking "personal responsibility." Not because I don't believe that, on every level, people are obliged to take control over their health and their body, to have some kind of agency that permits them to seek proper nutrition and exercise and, yes, to model good things to their children...but, rather, because the rhetoric smacks of something ugly.  It evokes language of blame, weakness, and vice and is a leading basis for inadequate government efforts, given the importance of environmental conditions in explaining high rates of obesity. The shaming of fat people and the process of assigning blame is cathartic at best, but does little to afford real solutions to the impact of childhood obesity and looming public health crisis encompassed therein. It's not as if all this chatter about "owning your choices" is placing priority on legislative and regulatory actions, like improving school nutrition, menu labeling, altering industry marketing practices, changing farm subsidies or even controversial measures like the use of food taxes that create healthier defaults, or the regulation of food coupons as they are employed to purchase only those most nutritive foods. Instead, it basically tells fat people what they already know: You should eat well and manage portion sizes while getting the requisite physical activity.

This brand of shaming is also a bit classist. After all, it assumes that people have a choice in the food they eat. For the 7% of Americans who rely of food pantries or provisional meals at shelters, there is no such opportunity to negotiate the nature or quantity of calories consumed in a single meal. Same goes for the children who receive free lunches in the public schools. Moreover, it neglects those who live in urban food deserts, where grocery stores are scarce and food purchases are made at bodegas and convenience stores. It assumes that people live in safe places, where children can go out of doors, or women can safely lace up their shoes and head out for a run.

Mostly, though, I'm not sure that the kind of pejorative language and imagery surrounding these campaigns is effective. While the confrontational tactics employed in the ads does its share to stir up dialogue, it might do little to inspire...and it certainly doesn't supply alternatives or provide the tools and resources people might need to better manage their health.

All that aside, I do believe in the power of parents. I believe they should absolutely exercise discretion in the feeding of their children, and I personally know many women who for reasons of laziness and personal food preferences rely on fast foods and processed convenience foods to feed their families. While one can argue that the ubiquity of marketing messages and junk foods makes it harder for parents to say "no," or to prepare and present quality foods, it is the job of mothers and fathers to preserve the health and safety of their kids. A pantry full of Hoe Cakes does seem negligent when your child is already overweight. I've seen more than a few sippy cups filled with cola, toddlers cut teeth on chicken nuggets and mothers stash grocery carts full of sweetened juice beverages and chips. I'm just not sure that shaming these parents will change their behavior. The answer is, as always, far more complex. It's a careful cocktail of agency, ownership, information and, yes, regulatory reform.

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