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News that the nation’s obesity problem could balloon to more than 40 percent of the population in the next two decades has brought doubt to many of the recent efforts to impart healthier eating and exercise habits, particularly on children, and has led to some harsher tactics, like a recent ad campaign launched in Georgia.

Called “Stop Sugarcoating,” the campaign is targeting the state’s obese children—the second highest rate of childhood obesity in the U.S.—with ads that many are finding controversial.

Using billboards and television commercials, Children’s Healthcare of Atlanta began running the divisive ads last year, showing just what obese children actually look like. And the outrage has resulted from eerie black and white imagery of overweight children with bold warnings that read: “It’s hard to be a little girl when you’re not” and “Fat prevention begins at home. And the buffet line.”

Critics of the ads call them insensitive and worry that they could be counterproductive, causing more stress on families struggling with obesity.

A similar campaign that  began running in New York City earlier this year also received criticism for its use of amputees to show the effects of diabetes—an obesity related illness—and how the common portion sizes of many fast and junk food items have dramatically increased over the last forty years.

The Centers for Disease Control estimate that more than one-third of adult Americans are currently obese and that nearly 20 percent of children ages 2-19 are also clinically obese. Obesity related illnesses include type 2 diabetes, heart disease and hypertension.

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Image: Children’s Healthcare of Atlanta