Jacob C. Warren & K. Bryant Smalley

The doctors discuss the research for their text, Always the Fat Kid: The Truth About the Enduring Effects of Childhood Obesity.

Jacob C. Warren and K. Bryant Smalley are co-executive directors of the Rural Health Research Institute at Georgia Southern University. Smalley is a clinical psychologist whose research interests include rural mental health, rural health disparities, risk-taking behavior and gender roles. He also has clinical experience in university counseling centers. A behavioral epidemiologist, Warren's research includes HIV prevention and use of the Internet and emerging technologies in study recruitment and intervention delivery.

Both doctors have published numerous scientific articles on the impact of obesity on children and, in their text, Always the Fat Kid—described as a clarion call for parents—offer the message that being overweight in youth is not a disease, but the result of poor lifestyle choices.


Tavis: The crisis facing so many American kids, childhood obesity, has caught everyone’s attention of late, but just how best to combat the problem is less clear-cut. Wading into that controversy are researchers and healthcare experts Doctors Jacob Warren and K. Bryant Smalley.

Their new text is called “Always the Fat Kid: The Truth About the Enduring Effects of Childhood Obesity.” It pulls no punches when it comes to what needs to be done, and so I’m honored to have the doctors on this program. Good to have you both.

Dr. K. Bryant Smalley: Thank you for having us.

Tavis: Thank you for your work. When I first saw this text come across my desk, I knew we were going to talk about it on the show. But what got me was the title: “Always the Fat Kid.” I thought “fat” was politically incorrect.

Smalley: Yeah.

Dr. Jacob Warren: It is. That’s part of why we used it. (Laughter) We seem to have gotten into a culture of avoiding calling things what they are, and so a lot of people talk about this in terms of obesity and overweightness, which is technically correct, but the core issue is that our kids are too fat, and until we start calling things what they are, we think the conversation is just going to keep getting held up where it is.

Tavis: When we say “too fat,” what do we mean?

Smalley: Well, considering that we’re at a stage where a third of children currently are overweight, and that’s the stage where we feel that children – well, really as a nation we’ve reached a point where we’re at a critical point in our history, and that’s the stage, at this moment in time, given the fact that on one hand we have advances that are just extraordinary in our history in terms of medical advances.

The vaccinations that we have, the medical advances that we have with medications, with surgeries that can extend life, and then on the other hand we’re hearing news from researchers that this may be the first generation of children who actually will have a shorter life expectancy than their parents.

So with hearing those two things together and the juxtaposition of those, it really indicates that we’re at a crisis point.

Tavis: What’s driving that?

Warren: I think there’s a lot of factors with it. There’s things that we hear a lot about, so increase in portion sizes, increase in the availability of foods, decrease in physical activity.

But a lot of it comes down to other factors, such as aggressive marketing of unhealthy food items to children, which continues today, despite all the evidence that it is actually affecting the quality of the food that they eat. The availability of foods in certain areas, where sometimes you don’t have a choice; even if you want to buy those foods, you can’t. Until we address those issues, then it’s going to continue.

Tavis: But to your point, Dr. Warren, when Mayor Bloomberg, Michael Bloomberg in New York, went after the soft drink industry, the super-sized drink, he got a smackdown in New York.

Warren: Yeah, he did.

Tavis: So to your point about advertising and the fact that it works, so what? He tried to push back on it, he got smacked around.

Warren: I think there’s got to be a strategy of combining smart legislative action with actually targeting people to change their behaviors. Just approaching it from a legal standpoint isn’t going to have the full effect that it could.

There are legislations that need to happen. Changing the availability of food in schools, for instance. We shouldn’t be selling our children’s health in schools. But then also teaching people how to make those decisions in an affordable and healthy way.

Tavis: Yeah

Smalley: With that as well, just to add in, we very much believe that Mayor Bloomberg’s intent was good, because we really do need to take bold action when it comes to childhood obesity. But there are some issues with the regulation itself, the implementation of that regulation, and as Jacob mentioned, we definitely need to take other action in terms of the regulations and the legislation that we implement.

But also, this starts at home. This is an individual-based issue just as much as it is a state and federal issue. So this is one of those moments in time where truly, it takes a village to solve this type of the crisis that we’re in.

Tavis: The challenge, though – I was going to say problem; I don’t want to put it in that category. But the challenge certainly to getting parents to do that is real. This is one of those issues, unlike other health consequences that we have to navigate our way through, this is one of those issues where you see, physically, literally, visibly see the evidence

Smalley: Yes.

Tavis: You do not have to have 20/20, whatever is better than 20/20. You don’t need perfect vision to see –

Smalley: Absolutely.

Tavis: – that our kids are overweight, that they’re obese, that they’re fat, to use the language of the text that we’re talking about tonight. Yet with all that evidence that we visibly, visually see every day, the evidence doesn’t suggest to me that we’re making progress in getting parents to understand the problem.

Warren: And we’re not. There seems to be this perception that it’s not a big deal, that it’s just a little baby fat, that it’ll go away over time. But the evidence is definitely that it’s not, because 80 percent of overweight children will be overweight adults, and we’re reaching the point now where almost 75 percent of adults themselves are overweight.

So it’s an issue of how do we teach parents to teach behaviors to their children that they themselves are struggling with.

Tavis: So against that backdrop of negativity, why then spend the time (unintelligible) just writing “Always the Fat Kid?”

Smalley: Well, one of the things that we noticed, and we both have experienced – and kind of the journey that led to this was both personal and professional. We talk about in the book our own journeys of and experiencing being overweight as children, but we’re also university-based health researchers.

As we really started to delve even deeper into the research, what we noticed is that some themes started to emerge that were really consistent with our own experiences, but also we noticed that there were some severe gaps in the literature and some gaps in the discussion related to childhood obesity.

A lot of attention is focused on physical health, and it should be, and certainly physical health is extremely important. We spend a lot of time in the book talking about physical health. But also, part of what’s missed in the discussion are the psychological issues related to childhood obesity.

That children who are overweight – well, overweight children are far more likely to become bullied as children, which only compounds the issues. There are also social consequences. Even if a child loses the weight in their childhood, these consequences can last into adulthood. So all of that led us to say we need to have this discussion.

Tavis: This subtitle is called “Truth About the Enduring Effects of Childhood Obesity,” to the point you’re making now, Dr. Smalley. What are the truths that you think are not being told about what we’re doing to our kids?

Warren: I think one of them is that these effects are long-term. That it’s not something that will go away once they reach adulthood. Even if they have been able to lose weight, there are these effects that accumulate over time and are going to stay.

One of the other things that we like to talk about is that obesity, when it comes down to it, is not a disease. Obesity is a behavior. While that at first sounds a little depressing, it’s actually empowering, we feel, because that means you also have the choice to change the situation.

So yes, there are all these negative effects that we talked about, but it also at the same time provides the path of how to get out of the situation.

Tavis: Dr. Smalley, you mentioned earlier that this book is a result of both professional and personal journeys.

I wonder if I could ask each of you to tell me about your personal journey and what it was like being one of these kids back in the day.

Smalley: Well for me, I was a bit fortunate. I experienced being overweight as a kid, but I had a lot of motivation as a kid to overcome being overweight. I certainly experienced some of the negative consequences associated with being overweight, but around middle school time period I said I had enough.

I want to overcome this. So I would sit in front of the television, I would do sit-ups. I would go run in the afternoons after school. I noticed a big change in myself, and also how I felt internally.

Not just physically, but also how I felt internally. I know that Jacob’s story was a bit different, but there are some similarities in terms of the hangover effects that are there in relation to self-esteem, body-image-related things that may come up.

So there are certainly consequences of being an overweight kid, and I know your story was a bit different.

Warren: I was overweight my entire childhood, so it’s one of those that from birth to 20 I was overweight. Until I got to college, I didn’t start addressing it, so I was that bullied kid. I was the one on the school bus that everyone picked on. I had that whole experience.

Then when I got to my twenties I started addressing it, but I still noticed, even once I lost over 80 pounds, I still didn’t like to eat in front of people, I didn’t like to be photographed, all those issues that I would have thought would have evaporated.

But it really is that long-term effect of having grown up as a fat child. Even if I’m not overweight as an adult, I will always have been a fat child.

Tavis: Yeah. I wonder, to both of your points now, I wonder why it is – the thought just hit me – why it is that we don’t see more kid ambassadors for fighting obesity. I think of all the TV commercials now that just pop into my head that I see for all these weight-loss programs all the time that always feature adults.

I wonder how this conversation might change if somebody – our government or somebody – got behind a campaign that featured kids who we could see losing the weight in their childhood. Not when they’re 12 and 25, but when they’re 10 and 13 or when they’re 13 and 16.

I wonder whether or not, since we are a visual people, I wonder whether or not seeing that sort of campaign on television and magazines, that kind of campaign, everywhere you look, you see kids who are losing weight, and they’re the ones that are being featured in the campaigns. I wonder if that might not have an impact, why that hasn’t happened yet.

Smalley: I think that could be meaningful, because what children look for, certainly from their peers and their parents, are models. Models for how do I make this happen, how can I get through this. It is a challenging thing. We’ve experienced it. We’ve been there.

So certainly to overcome being overweight or obese as a child is a challenging thing, so being able to see those models certainly could be helpful.

Tavis: Just an idea. Maybe somebody will take it and run with it. (Laughter) The book by Doctors Warren and Smalley is called “Always the Fat Kid: The Truth About the Enduring Effects of Childhood Obesity.”

You don’t want your kid to be dealing with these issues for the rest of his or her life. You might want to get this book right about now. Good to have you both on the program. Thanks for your work.

Smalley: Thank you.

Warren: Thank you.

Smalley: Thank you very much.

Tavis: That’s our show for tonight. See you next time on PBS. Until then, good night from L.A., thanks for watching, and as always, keep the faith.

“Announcer:” For more information on today’s show, visit Tavis Smiley at PBS.org.

“Wade Hunt:” There’s a saying that Dr. King had, and he said, “There’s always a right time to do the right thing.” I just try to live my life every day by doing the right thing. We know that we’re only about halfway to completely eliminate hunger, and we have a lot of work to do. And Walmart committed $2 billion to fighting hunger in the U.S. As we work together, we can stamp hunger out.

“Announcer:” And by contributions to your PBS station from viewers like you. Thank you.

Last modified: June 30, 2013 at 9:39 pm