Michelle Obama has earned accolades for making healthy living and eliminating childhood obesity a priority as first lady. But when it came down to personalizing the issue in relation to her daughters, the remarks touched a nerve with some, and praise from others.
"We went to our pediatrician all the time," Obama said. "I thought my kids were perfect -- they are and always will be -- but he [the doctor] warned that he was concerned that something was getting off balance."
"I didn't see the changes. And that's also part of the problem, or part of the challenge. It's often hard to see changes in your own kids when you're living with them day in and day out," she added. "But we often simply don't realize that those kids are our kids, and our kids could be in danger of becoming obese. We always think that only happens to someone else's kid -- and I was in that position."
Obama said the doctor suggested she first look at her daughters' body mass index (BMI). The minor changes she subsequently made in their daily habits, Obama said, made all the difference.
The first lady's comments have stirred up the Web and medical world, and have drawn both criticism and praise. Some say Obama should not have personalized the issue and brought up her daughters. Even if it is for the greater public good, critics say, it does not bode well for their self-image. Others say the first lady used that example only to connect to Americans who may find themselves in a similar position.
The first lady's office would not comment on the criticism.
Some charge that Obama's comments may be perceived as a focus on weight and dieting, which sends the wrong message to the public. The first lady should be discussing behavioral change, not weight loss, said Laura Collins Lyster-Mensh, an eating disorder activist and executive director of Families Empowered and Supporting Treatment of Disorder (F.E.A.S.T.).
"We've confused health and weight in a way that's very confusing for children and very confusing for parents," Lyster-Mensh said. "When we speak publicly about putting our children on a diet, we start to get into weight stigma and confusing the message to families."
The focus on obesity, Lyster-Mensh said, turns this into an issue of appearances, which does not bode well for children, especially girls.
"There is simply no reason to be pushing children into weight reduction diets and that's the message parents out there get," Lyster-Mensh said. "Dieting is a gateway drug to eating disorders for those with a biological predisposition to eating disorders."
President Obama is also guilty of talking about his daughters' weight. In an interview with Parents magazine in November 2008, the president said, "A couple of years ago -- you'd never know it by looking at her now -- Malia was getting a little chubby."
The president then spoke about what he and the first lady did to balance their daughters' diet, and the impact "was so significant that the next time we visited our pediatrician he was amazed."
Even then, critics panned the president for commenting on the weight of Sasha, who is now 8 years old.
Some say parents talking about their daughters' weight can have a harmful impact on young girls.
"One of the things I've noticed is that a lot of girls develop an eating disorder because they don't want criticism from their parents," said Jeanne Sager, a reporter who blogs on parenting Web site babble.com, and who, herself, suffered from an eating disorder.
"I don't think Mrs. Obama was trying to do anything harmful to her children," said Sager, but talking so openly about her daughters "makes it more or less open season" for criticism on their weight, whether they are overweight or skinny.
"Considering the disgusting things said about a teenaged Chelsea Clinton during her father's presidency -- when no one was actively discussing her body -- what does this sort of public attention do to a tween? And what greater good does it really serve for Mrs. Obama to be talking about her kids' struggle with weight?" Sager questioned in her blog.
Lyster-Mensh says the Obamas should continue to talk about healthy eating and behavior but cut out the focus on weight and especially refrain from talking about their daughters' weights.
"As a public figure, I think Mrs. Obama wanted people to be able to relate to her experiences and I'm sure she was unaware... that some of those messages could be taken in an unhealthy way," Lyster-Mensh said. "I am not a critic of the Obamas' approach to healthy behavior with their kids. I am concerned about weight-based language because it's demonstrably, scientifically not helpful."
Doctors say behavioral changes are key to guiding children to a healthy life.
"Weight is just a marker for behavior. Losing a particular amount of weight does not work well for kids," said Dr. Goutham Rao, clinical director of the Center for Pediatric Weight Management and Wellness at the Children's Hospital of Pittsburgh and author of "Child Obesity: A Parent's Guide to a Fit, Trim and Healthy Child. "
Despite the criticism against the Obamas for using their children as an example, supporters of the first lady's remarks say her intention was exactly to convey the message that critics have seized.
"The fact that she made this public, about her own... modest changes she made was exactly that -- That this is a public conversation about what we're all doing," said Dr. Judith Palfrey, president of the American Academy of Pediatrics, who was present at the event last week. "It's like a neighborhood conversation except that it's national, about how we live."
Palfrey shot down criticism that this kind of rhetoric sends the wrong message to the first daughters or that it breeds eating disorders.
"I just thought it was wonderful, a living example of all of us sharing with each other how we can live healthy lives," Palfrey said. "I didn't see it in any way doing anything except how we balance all the stresses in our lives."
Rao said giving a personal example helps convey the message better to others.
"I think it's completely appropriate she raised it and personalized it so that other mothers and fathers can relate to it," Rao said.
He added that the first lady raised an important issue by pointing out how her pediatrician went about informing her. Talking about the BMI "opens the door for discussion," Rao said.
Childhood obesity is a major issue facing the United States. It is a serious medical condition that impacts close to one-third of all children in the country. That means one in three children in the United States is overweight or obese. Blacks have a 51 percent higher prevalence of obesity, and Hispanics have a 21 percent higher obesity prevalence compared with whites, according to the Centers for Disease Control.
The first lady has made fighting childhood obesity one of her key priorities. She inaugurated the famous vegetable garden at the White House and has encouraged sports and other healthy activities among kids.
Experts say parents play a huge role in guiding their kids to a healthy lifestyle, which includes encouraging physical activity, eating healthy foods, and consuming less fast food.
"Lately, there has been indication that levels have leveled off, which is encouraging," Rao said. "We're starting to turn the corner."
Palfrey said it is important to convey the right message that it's not about weight but about living a balanced life.
"We're really talking about walking a wide space between too little and too much. I think that's the message that we want to get out that too much is not good and too little is not good," she said. "We want to avoid the two extremes."