Should parents lose custody of severely obese kids?
Published Wednesday, July 13, 2011 6:33PM EDT
A controversial new editorial is firing up the debate about what to do about kids who have become severely overweight, suggesting that some of them should be placed into foster care.
In an opinion piece in Wednesday's Journal of the American Medical Association, an obesity specialist and his co-author discuss the ethics and legal considerations of taking severely overweight children away from their parents.
The piece is written by Dr. David Ludwig, an obesity specialist at Children's Hospital Boston and Lindsey Murtagh, a lawyer and a researcher at Harvard's School of Public Health.
They say the children they're thinking about aren't those who are a little overweight. They're referring to those who are severely obese, who are on the brink of developing health problems, like type 2 diabetes or liver disease.
Some of these children might be taking in 1,000 calories a day or more above what they should, "suggesting profoundly dysfunctional eating and activity habits."
"In severe instances of childhood obesity, removal from the home may be justifiable from a legal standpoint because of imminent health risks and the parents' chronic failure to address medical problems," they write.
Parents have the right to raise their children as they choose, the authors says. But they point out that there are many instances in which the state will intervene to protect a child. In cases of child abuse or neglect or severe undernourishment, child welfare workers will often step in.
And yet, they note, only a handful of states have ever used child abuse laws to step in, in cases of "overnourishment" and severe obesity.
"State intervention may serve the best interests of many children with life-threatening obesity, comprising the only realistic way to control harmful behaviors," they write.
The authors acknowledge that foster care is often not ideal and doesn't guarantee that the kids will lose weight. And they concede that taking kids away from their families puts them at risk of emotional harm.
They also note that given that there are about 2 million children in the U.S. who are extremely obese, removing all of them from their homes is likely unfeasible. Still, they say taking the kids away from their caregivers may be more ethical than another alternative: subjecting the kids to obesity surgery.
"Ultimately, government can reduce the need for such interventions through investments in the social infrastructure and policies to improve diet and promote physical activity among children," they conclude.
Ludwig and Murtagh are not the first to propose state intervention in the cases of extremely overweight children.
In a commentary last year in the British medical journal BMJ, pediatrician Dr. Russell Viner and colleagues said obesity had been a factor in several child protection cases in Britain. They argued that child protection services should be considered if parents are neglectful or actively reject efforts to control an extremely obese child's weight.
A 2009 opinion article in Pediatrics made similar arguments. Its authors said temporary removal from the home would be warranted "when all reasonable alternative options have been exhausted."
That piece discussed a 200-kg (440 lb) 16-year-old girl who developed breathing problems from excess weight and nearly died at a University of Wisconsin hospital.
Doctors discussed whether to report her family for neglect. In the end they didn't, because her medical crisis "was a wake-up call" for her family. The girl went on to lose about 100 pounds.
Jerri Gray, a Greenville, S.C., single mother who lost custody of her 555-pound (250 kg) 14-year-old son two years ago, told The Associated Press that many people don't understand the challenges some families face trying to control their kids' weight.
"I was always working two jobs so we wouldn't end up living in ghettos," Gray said.
She said she often didn't have time to cook, so she would buy her son fast food. When she asked doctors for help for her son's big appetite, she was accused of neglect.
Her sister has custody of the boy, who is now 16. Gray said her sister has had the money to help him with a special diet and exercise, and the boy has lost more than 200 pounds.
"Even though good has come out of this as far as him losing weight, he told me just last week, 'Mommy, I want to be back with you so bad.' They've done damage by pulling us apart," Gray said.
With a report from the Associated Press