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An Atlanta hospital has taken blunt advertising right to the gut, using stark television commercials featuring obese Georgia children with a simple question.
"Mom," one boy says. "Why am I fat?"
Five child actors star in the commercials, which feature frowning kids, creaking chairs and heavy breathing. Slogans like "Being fat takes the fun out of being a kid" and "Stop sugarcoating it, Georgia," run across the screen.
Georgia's 21.3 percent childhood obesity rate, the second-highest in the country, inspired Children's Healthcare of Atlanta to design a statewide billboard, radio and television campaign.
"Nothing else worked," according to Dr. Mark Wulkan, the hospital's surgeon-in-chief who has seen heart disease, diabetes and hypertension in teenagers.
"This isn't about making kids skinny for the prom. This is all about health," Wulkan said. "Kids aren't telling me they're going to jump off a bridge because they saw these ads."
But some public health experts believe the ad campaign encourages self-loathing in children whose problems often stem from factors they're powerless to stop - heritage, parental attitudes and a lack of education among them.
"It can send us more customers, and that's not what we want," said Lynn Grefe, president and CEO of the National Eating Disorders Association. "The ads are a lazy, thoughtless effort. These kids are not buying their own food, and they're not choosing to be overweight."
Patty Gregory, a spokeswoman at Children's Healthcare, said the ad campaign started with focus groups and a casting call. The child actors, all Georgia residents at the time, were "fully informed about how it was going to be depicted," she said.
One of the children, an articulate Sandy Springs, Ga., sixth-grader named Chloe McSwain, is portrayed as "Maritza." At the beginning of a black-and-white 30-second spot, she stares right into the camera.
"My doctor says I have something called hypertension," she says. "I'm really scared."
In white block letters, "SOME DISEASES AREN'T JUST FOR ADULTS ANYMORE," flashes across a black screen.
In real life, Chloe, 11, actually doesn't have hypertension, according to her mother.
"That was the commercial," Tiffany McSwain said. "She doesn't have any major health issues, and I'm grateful for that. That's something we're trying to prevent at this stage."
Chloe is home-schooled, but she does musical theater, summer camps and performing arts classes. Her face, body and weight issues are plastered all over Atlanta, but the people she knows, good friends and otherwise, haven't taunted her, she said.
"I have confidence in my friends, and my friends are really supportive," she said. "They're excited that I'm in a commercial and on billboards."
As part of the campaign, Children's Healthcare started a clinical program for overweight children that combines nutritionists, exercise physiologists and doctors into a planning committee geared toward improving an individual's health and weight. All five child actors have been invited into the program.
Chloe had her first appointment in the program - part of her compensation for the commercial - last week. She said a nutritionist guided her toward setting goals, showed her proper portion sizes and suggested "riding my scooter, jumping rope, running and playing in parks."
Asked if she hates when nosy reporters want to talk about her weight, Chloe said no.
"I'm definitely OK with discussing this because I know it's going to help kids with their weight," she said. "I'm really proud to be part of this campaign."
The ad campaign is the latest obesity attention grabber in a country that continues to struggle with its waistline. New York City banned trans fats in restaurant fare, San Francisco outlawed Happy Meals and Ohio placed a 200-pound third-grader in foster care after determining his mother wasn't doing enough to control his weight.
Children's Healthcare officials believe their campaign will require five years and $50 million to yank Georgia out of the top 10 states in childhood obesity rankings. (Tennessee languishes four spots behind the Peach State at No. 6, according to a 2010 report by Trust in America's Health.)
Awareness - the ad campaign - represents only the first part of the hospital's anti-obesity campaign since parents "often don't see the problem," according to Wulkan. In that way, the hospital has been successful, getting articles in the Washington Post and The New York Times, along with national television news coverage.
Before hitting metro Atlanta, the hospital conducted focus groups and market research in Columbus and Macon. The results were good. In Atlanta the hospital's new market research shows that 80 percent "agree with" the approach and 11 percent "do not like the campaign's message."
"It's not negative advertising," Wulkan said. "It's shock value, and it's getting people's attention."
But when they elaborate next steps, hospital officials play into a line their opponents use - ultimately, real change must happen at home, not in a TV commercial. Parents must enforce eating more fruits and vegetables, playing outside and limiting what Wulkan called "screen time" to an hour a day.
Grefe, the head of the national eating disorders group, said the hospital should "take a deep breath" and stop "tearing these kids apart." She said weight and health are two separate issues, adding that putting on pounds is part of puberty, especially for girls.
"The better approach is to take a deep breath and start educating about health and nutrition," she said. "This is overboard."