The Boy Scouts of America (BSA) raised eyebrows this summer when the group announced that the quadrennial Boy Scout Jamboree, which wrapped up last week in West Virginia, would ban children whose body mass index (BMI) was over 40 and require children whose BMI was above 32 to submit medical information to be included in the event.
While the BSA deserves credit for its commitment to the heath and well-being of children, and for its efforts to address the difficult issue of childhood obesity, the decision risks perpetuating a stigma which could in fact make the problem worse.
Childhood obesity is a complex and varied disorder with respect to causes, physical and emotional consequences, and treatment.
Yet many people view childhood obesity in a singular, negative way.
There is perhaps no group that is the subject of more stigma than obese children. This plays out in the form of teasing, ridicule for their appearance, blame for their condition, and an assumption that they are lazy or lack willpower.
All this, despite evidence of powerful genetic, biological and environmental forces that maintain childhood obesity. And beyond the physical, obese children can also be seen as mentally unsound even though obese children can demonstrate considerable resilience and the American Psychiatric Association does not consider obesity a mental health disorder.
Stigma can lead to intense body image dissatisfaction and low self-esteem among obese children. This can be perpetuated by peers as well as adults, including teachers and health care practitioners. Rather than motivating children to lose weight in a healthy manner, stigma often leads to unhealthy practices that accentuate the problem.
For example, obese children and adolescents are more likely to engage in unhealthy dietary practices such as overly restrictive eating, which paradoxically can result in binge eating.
Further, childhood experiences often form the foundations for adult life. Ridicule about childhood weight can lead to poor physical and mental health in adults.
In fact, people with eating disorders frequently report childhood teasing and social exclusion as the basis for their poor self-esteem and body image as an adult.
Further, the stress associated with stigma of obesity can result in weight gain and cardiovascular issues. The stigma of obesity thus contributes to further public health consequences.
The BSA's decision to formally and publicly exclude obese children from the Jamboree runs the risk of feeding into the stigma of obesity on all fronts.
First, by having rigid exclusion criteria they are erroneously saying that all obese children are the same in terms of health and fitness.
Second, the exclusionary policy alienates children and their families from an exercise-based activity, which could actually improve their health.
Finally, the BSA policy models exclusionary behavior towards obese children – if the adults can do it, why not kids?
The statement by BSA officials that children who cannot lose weight in time of the event have "self-selected" out of the event is if anything a testimony to this perception of exclusion and the potential damage done by this decision.
So what can be done? Certainly the Boy Scouts of America in setting its policy did not intend to perpetuate a stigma. To address the public health impact of obesity, it is essential that reducing stigma be a core element of its approach for future events.
First, the BSA should publicly condemn the teasing or exclusion of obese children and reverse it's decision to exclude obese children.
Second, the BSA should develop safety measures that codify its interest and concern for the health and well-being of all children at its events, including required medical personnel.
Third, the BSA should publicly embrace a wide range of approaches to manage obesity, including those that target behaviors rather than weight loss per se.
Finally, there must be specific outreach to advocacy groups that specialize in reducing stigma.
Leaving stigma unaddressed unfortunately signals that the BSA passively accepts it.
Attempting to manage childhood obesity is a noble goal, but we must not overlook the real impact of general public perceptions on the problem.
If we want a healthier society, we have to consider not just the physical implications, but the very real social and psychological aspects of obesity as well.