I cannot count how many times a good, even a fantastic, idea has been completely ruined by throwing weight loss/fat stigma into the mix. I’ve rarely seen such a good (good here having the meaning of HORRIBLE) example as the Fruit and Vegetable Prescription Program.
Good idea: Help people afford fresh fruits and vegetables from local farmers markets. I believe that public health should be about giving people options for the foods that they would like to eat, I can get behind this idea.
Good idea all fucked up: Make this a program for fat kids who have to be weighed in and “educated” monthly.
What’s the problem?
First is the stereotypical assumption that fat kids don’t eat vegetables and thin kids do. I’m sure that there are plenty of thin kids whose parents could use help affording fruits and vegetables from local farmers markets and plenty of fat kids who eat their fruits and veggies. If vegetables are healthy, then they are healthy for all kids – not just the fat ones.
Subjecting fat kids to weekly weigh-ins is super problematic, as any fat kid who was subjected to weekly weigh-ins can attest. Also, it doesn’t work. Research from the University of Minnesota found that “None of the behaviors being used by adolescents (in 1999) for weight-control purposes predicted weight loss[in 2006]…Of greater concern were the negative outcomes associated with dieting and the use of unhealthful weight-control behaviors, including significant weight gain.”
There are studies that show that eating fruits and vegetables can have some health benefits for some people (there are people who live with illnesses that make eating fruits and vegetables problematic.) There are no studies that show that eating fruits and vegetables will make these kids thinner. The idea that it will creates sets up these fat kids up to be seen as failures, and possibly as a “waste of money/resources.”
One of the testimonials from an MD states “Families who took advantage of the program bought more fruits and veggies. Beyond this, the greatest success was in improving enrollment and attendance at monthly visits.” It takes a special kind of arrogance and a complete lack of understanding about the deep weight bias held by many doctors and healthcare professionals, to think that getting fat kids to the doctor to be weighted and lectured once a month is a great success.
The biggest problem is that they are guessing about this – they are experimenting on children. They have learned nothing from the so-called “healthy living” programs that were supposed to “combat childhood obesity” (because anytime you can put combat and childhood in the same sentence you know you’re on a great path), an ended up increasing disordered eating.
In short, the fact that the program is well-meaning does not overcome the fact that it is based in stereotypes, steeped in condescending paternalism, and could absolutely do more harm than good. Plenty of studies show that, while health is multi-dimensional and not entirely within our control, behaviors are a much better indicator of future health than body size. There are no studies where a majority of fat people become thin and stay that way long term, and there are no studies that show that those who maintain long-term weight loss are healthier.
The answer is simple – it’s time to take weight out of the health discussion. Make public health about making options available to the public, rather than making fat people’s bodies the public’s business. People don’t take care of things that they hate and that includes their bodies and shame is not good for our health, so public health interventions that create body hatred and stigmatize a body size are flawed from the outset, so let’s stop doing that and start doing something that makes sense.
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