A Georgia hospital designed a campaign to tell hard truths about childhood obesity. Is it tough love or too harsh?
For Dr Mark Wulkan, surgeon-in-chief for Children's Healthcare of Atlanta, overweight children are a problem.
"Georgia is second in the nation on childhood obesity, and that's a top 10 list we want to get out of as fast as we can," he says.
As the largest paediatric healthcare provider in the state, he says: "We saw the problem as something that we should take some responsibility for, and something that we had to fix.
"We're seeing very young children in our clinic that had high blood pressure, type 2 diabetes, liver disease, kidney disease. The long-term health impact for our state, looking at the numbers, is tremendous."
The time for "warm and fuzzies", he says, was over. So instead, his hospital created an aggressive campaign, based in part off a previously successful anti-methamphetamine campaign.
This time the target wasn't drugs, but obesity.
Part of theStrong4Life campaignincluded giant billboards and bus shelter ads, with photos of grim-looking, overweight children and dire warnings about their future, such as "Chubby isn't cute if it leads to type two diabetes" and "Being fat takes the fun out of being a kid".
But while proponents saw a no-nonsense wake-up call, many people across the country saw obese children under attack, and worried the billboards played up dangerous stereotypes about health and size.
"When you're fat - I calculated this - you're subjected to 386,170 negative messages a year. When you're constantly stigmatised, you can internalise that," says Ragen Chastain, who runs the blog Dances With Fat.
That these messages were targeted to children especially upset her readers.
"Some people identified with the bullied fat kids that they once were. Some parents identified with their own kids and others realised that humiliation is no form of healthcare," she says.
"It got them to say this isn't right."
Ms Chastain says that while she supports healthy habits and movement for children of all sizes, singling out overweight young people feels dangerous and unfair.
So she decided to start raising funds to launch a counter-campaign, this one with positive messages for children of all sizes.
On the first day, theSupport All Kids Billboard projectraised $12,000 (£7,563). Collections still continue, and they are aiming to raise $20,000 (£12,606) with the help of a matching grant
Ms Chastain says they plan to run one large billboard, a few smaller billboards and several bus shelter ads in the Atlanta area.
She hopes the billboards will go up in March.
"We want kids to have tangible proof that they are respected and valued in the body they have now," she says.
Hers was just one of the online campaigns making noise.
Fat activist Marilyn Wann designed a template so that people could create their own version of the Strong4Life advertisement, featuring a more upbeat picture and inspirational message.
These photos were posted online, with messages like "I stand for happy and healthy children of all sizes" and "I stand for dignity, kindness and the delights of diversity". Many have beencollected on Tumblr.
Meanwhile, Shannon Russell, who runs the blogFierce, Freethinking Fattieslaunched a continued campaign against the ads. Every day, he posted on his blog about the billboards, while also writing letters to the hospital staff and commenting on their Facebook page.
As first reported by the BBC, Mr Russell also solicited letters of support from public officials, and received a response from a top official at the National Institutes of Health. In the letter, Alan Guttmacher, director of the Institute of Child Health and Human Development, agreed that the Strong4Life campaign "carries a great risk of increasing stigma" for overweight and obese children.
"I've been blogging about this every day since January 5th, and I'm exhausted," Russell said. "But I won't stop until the billboards come down."
While many of the billboards are already down, says a spokesperson for the hospital, some still remain in targeted areas of high childhood obesity.
For Dr Wulkan, tough love is the best way to fight what he sees as a public health crisis.
"The Strong4Life movement is about solutions.
"It's about saying the first steps in making any change is recognising you have a problem," he says, and notes that the ads were just one part of a comprehensive plan to tackle childhood obesity.
Ms Chastain says that labelling the way someone looks as a problem instead of focusing on behaviours isn't the solution to better health. "It's not an either-or. We can be for developing healthy habits in kids of all sizes without humiliating any kids at all," she says.
Throughout this entire controversy, both Children's Healthcare of Atlanta and those who oppose the campaign say they want the same thing: for kids to grow up happy and healthy.
But the fight over what's best remains contentious, with neither side looking to back down any time soon.