Happy Martin Luther King Day, Nation! In the spirit of speaking up for what you believe in and speaking out on injustice, I have a little rant to share today:
My town of New York City really likes to get involved in the health of its citizens. From banning smoking in nearly all public places (most recently in public parks) to requiring restaurant chains with more than seven locations to display calorie counts, it seems like every time I turn on the news, NYC is enacting, banning or monitoring something.
The Department of Health (DOH) has done quite a bit in terms of diabetes, too, including launching an A1c Registry to keep tabs on how the PWDs in the city are doing with their glucose management. The program launched in 2006, though I’m not sure how helpful it’s actually been. I know at least one fellow NYC blogger, Scott Strumello, is none too happy about all the Big Brother activity on things the DOH doesn’t really have a right or need to monitor.
For the most part, I haven’t minded the new rules and awareness campaigns. But when I spotted this new public service announcement (PSA) from the DOH linking sugary sodas to diabetes amputations, I’ll admit, it pushed me a little too far… Take a look:
Ugh. Really?!
And the NYC DOH isn’t the only one receiving criticism for their no-holds-barred ads on the obesity epidemic. Earlier this month, Children’s Healthcare of Atlanta started circulating these PSAs on childhood obesity, all part of the new campaign, Strong4Life, launched because Georgia has the second highest rate of childhood obesity in the country.
Ouch! I was once an overweight little girl and right now, she’s crying a little inside… I think these PSAs are targeted toward their parents, but still. Children can read, folks. They know what you’re saying about them and you’re not helping. Why do you think diets are on the rise in young girls? Journalist Kellee Terrell, in an article on the Georgia campaign, writes, “These ads don’t really empower or promote healthier lifestyles, just more guilt.”
Yes, and we need less guilt and more empowerment.
Honestly, I think you would be hard-pressed to find an overweight person who doesn’t realize why they might be overweight. That’s the easy part. The hard part is doing something about it. There are financial restraints many low-income families would have to overcome. There are safety issues that many of these families contend with, such as living in a neighborhood where it’s unsafe to exercise, like the Projects in NYC. There are budget shortages that have eliminated many health programs critical to families. Healthy food and athletics are expensive, and often not readily available.
Not only that, but science is showing bit by bit just how difficult it is to lose weight for people who do not have these resources. It is far easier to prevent being overweight than to lose weight, but once someone is overweight — whether they have a diagnosis of type 2 diabetes, pre-diabetes, or no diagnosis at all — it’s incredibly challenging to simply reverse the course.
So fat-shaming anyone, adults or children, isn’t helpful. Because there are thousands of people who have recently made the commitment to lose weight and who may find it very difficult to see any results, even if they do nothing but shop at Whole Foods and go the gym regularly.
Now, obviously I’m not a proponent of excessive consumption of fast food, sodas and junk food that has clearly caused an increase in obesity in America. Exercise and healthier food help in more ways than just weight control. That much is obvious. What I do have a problem with is using scare tactics — or in the case of the DOH’s 2009 campaign, gross scare tactics — to achieve this goal. I also have a problem with the huge jump to conclusions between drinking sodas, type 2 diabetes and amputations.
Dr. Thomas Farley, NYC’s health commissioner, argues, “We are warning people about the risks of super-size portions so they can make more informed choices about what they eat. Consuming too many calories can lead to weight gain, which greatly increases the risk of type 2 diabetes. If New Yorkers cut their portions, they can cut their risk of these health problems.”
That’s like going from A to N in the alphabet and then jumping directly to W. There is a lot more to type 2 diabetes than just drinking too many sodas, and the DOH’s oversimplification of the situation does nothing but perpetuate myths and misconceptions about how people get diabetes, and how it can affect a person living with the disease. How might someone feel if they had just been diagnosed with type 2 diabetes and were now seeing these patient-blaming ads warning that amputations are in their future? It’s likely to make anyone feel depressed, hopeless and defeated. That doesn’t sound terribly healthy to me! How does this empower people?
Now, I’m not saying that there aren’t kernels of truth in these ads. Obesity is clearly on the rise and fast food clearly isn’t healthy for anybody. But given the complexities surrounding diabetes and living a healthy lifestyle, I think it’s almost a cop-out to just circulate some advertisements for a few weeks saying, “Don’t do this! It’ll kill you!” Does the DOH actually think that’s going to save lives? Preventing diabetes is more complicated than just saying “Don’t drink sodas” or “Take the stairs” (or “Just say no”). Couldn’t this money be used toward programs aimed at more beneficial, long-lasting results?
In an article in the Atlanta Journal-Constitution, Karen Hilyard, a health communication researcher at the University of Georgia, says, “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.”
I’m left wondering what the NYC DOH and Children’s Health of Atlanta are hoping to accomplish and what kind of metrics they’re using to judge how successful they are. This isn’t the first time the NYC DOH has used these scare tactics, so what measure of success convinced them to do it again? I suppose they think if they say “Being fat is bad” enough times, there will be less fat people. Right?! I don’t get it either.
When will we see these organizations stop with the lip-service and actually provide tangible resources so we can see real improvement in the health of our country? And more importantly: what will that look like?
Just some “food” for thought…
Thanks for posting this. I get really upset when I see campaigns like this. I did my Master’s in Public Health and something we learned on practically day one was that scare or shame tactics (like the campaigns you highlighted) don’t work. Research has shown that again and again. It makes me wonder whose idea these campaigns were? Well-trained public health practitioners, especially those with training in behavior change, should know better than to waste money on these kinds of campaigns.
What do they accomplish? They make non-diabetics and practitioners feel noble and righteous. They perpetuate the superstition that if one lives one’s life “absolutely perfectly” and judges others harshly that nothing bad will ever happen. It works for all kinds of problems: obesity, diabetes, cancer, rape, murder, objects falling from the sky, lightning….
…ugh, the enormous guilt placed upon T2′s. As a T1, at least I am not blamed for being diabetic! There are plenty of T2′s in my family, and I feel for them, simply because of the mean-spiritedness exemplified by things like this ad. Don’t get me started!
I wrote about this campaign on the Huffington post a year ago when it first showed up. The city says this is education. We know it’s scare tactics and bound to fail http://www.huffingtonpost.com/riva-greenberg/nyc-public-service-announ_b_821658.html
Sorry ladies and gentlemen, I must interject with some fair balance here. I am a diabetes educator and although I have great compassion for those with diabetes, what is it going to take for individuals with T2 to realize that this is a self-inflicted disease. Yes, some T2 have a genetic flaw that has led to increased beta cell burnout or insulin resistance. However, they did not gain 80 pounds overnight. It is a gradual increase that at some point was controllable. Is it difficult for someone who is 300 lbs to lose weight? Absolutely. Would it have been easier for them to begin trying to lose weight at 225 instead of waiting until 300? Absolutely. We need to stop making excuses and start doing. What should be done is create a poster of two individuals: one non-smoking in shape individual and one obese indvidual. Then beside each individual list how much money each person requires in healthcare spending every year. Want to make healthcare more affordable? Drop the weight and live a healthier life. Cmon people! Quit making excuses!
Regardless of whether or not this is a “self-inflicted disease” (which is still debatable and you, as a CDE, should know better than to say for certain that it is), these posters do nothing to provide the education, support and resources that those at risk need. Posters that ridicule and / or point out the obvious don’t help. Saying, “Hey, don’t drink soda and everything will be fine” is a lie and a disservice to the kind of awareness that at-risk folks actually deserve.
If you read the New York Times (or clicked on the link which I provided) you will see the scientists have actually proven that once the body gains the weight, biology will do everything in its power to prevent you from losing weight. It’s a slow and tedious process that goes way beyond “living a healthy life” and takes far more time, commitment and education than most people are able to give it. Is it possible to lose weight? Yes, it is. Will it simply come off by forgoing soda and exercising 30 minutes a day? Probably not! There is far more that goes into losing weight than people are willing to admit, and diabetes educators and government officials shaming people because they “got” their diabetes — or making threatening statements — backfires, causing people to be defensive and hopeless, leading to even higher obesity rates because these people don’t see how they could possibly do all that they need to do given their resources.
Sorry Allison, I don’t see where in the two adverts provided where it says losing weight is as simple as just exercising for 30 minutes and forgoing soda. But doing these things not only proves you are attempting to control the variables you can control, but they are also two of the easiest things you can start doing to start your long and challenging journey.
By not calling out these 100% verifiable facts (forgoing soda and exercising are two of the easier ways to reduce your risk for developing T2 diabetes and effective ways to battle obesity) WE are the ones doing the disservice to the at-risk population.
Tend to agree with John. This campaign is no doubt blunt and very shocking – but isn’t that the point of advertising? To get everyone’s attention? To what end has our coddling of society gotten us to? Skyrocketing T2 and explosions in generally unhealthy lifestyles. I am not naive – I know these are multifaceted problems – but can we all agree what we have done in the past, has, by in large, failed? How can we effectively provide the “education, support and resources” to deal with T2 and general poor health of this country if we can’t even admit our current methods don’t deal with the problem? You can disagree that this the most effective way of dealing with the problem, but I would hope these methods wouldn’t get dismissed out of hand immediately (judging from the relatively small sample size of this website’s comment section).
Well said by all. I recently had a friend send me a picture of an ad at KFC that says “complete your meal with a mega jug, and KFC will donate $1 to JDRF” and the friend then commented “that’s just sad – fight type 1 [diabetes] by getting type 2 [diabetes]“. It is ads like the ones talked about in this post that bolster the misinformation about both types of diabetes and perpetuate stigmas. And, as aptly noted, the ads don’t actually change health behaviours. Surely a mega jug of soda isn’t a great idea for anyone, (but no matter who you are or what disease(s) you have, you should be eating healthy), but soda doesn’t cause diabetes and not drinking soda won’t stop the onset of diabetes. But according to the PSA above, sodas do cause type 2 and apparently that means certain amputation.
I am constantly infuriated by the lack of understanding surrounding type 1 and type 2 that not only seeps into the public discourse but can in fact influence health care providers and public health advocates. I have had doctors tell me, even though I have type 1, that I should just eat better. So how can we help anyone get healthy if we continue to misinform the public? Obesity is an issue. Obesity is a factor for type 2. But it is NOT THE ONLY FACTOR and in continuing to harp on that one factor, we lose sight of what’s really important, which is to help people live healthily regardless of which disease(s) they have or may have.
We can’t help anyone by shaming them or scaring them. We need to take the time to educate them. Which means proverbially, not skipping from A to N to W but reciting the whole alphabet.
Good job, Allison! I particularly liked the fact that you took issue with the not-so-well educated “diabetes educator” about the fact that the cause of T2 has NOT been definitively established (and it’s not just one disease, to boot!). If it were just obesity, then every fat person would have T2, and the fact is that the majority of them DON’T, and never will. And then there is the issue of “thin” or normal-weight T2s who have been proven not to be T1 or LADA by antibody testing. T2 is a VERY complicated disease, and simple-minded thinking will not solve the problem. Every year, more and more evidence comes out linking T2 to lots more problems than simple obesity, and it’s too bad that the public and media and most PCPs are totally unaware and worse, uninterested in that.
Wait, John, you have “great compassion for those with diabetes?” Um, hmm, can’t say it comes through in your post – wait, I’m going to read it again. Er, nope, still can’t find it… wait, I’ll try again….
Thanks, Allison, great post! These ads are horrible and do no one any good, in my opinion. Blame and shame is hardly productive. I don’t pretend to know what the answer is, but these ads surely are not it.