State should remove obese children from parents, doctor says

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A commentary in today's Journal of the American Medical Association argues that in extreme cases, state intervention is needed to save the lives of severly obese children.

The essay says that temporarily removing children from the custody of their parents and placing them in foster care is more ethical than surgery as a strategy for fighting life-threatening complications arising from obesity.

"Ubiquitous junk food marketing, lack of opportunities for physically active recreation, and other aspects of modern society promote unhealthful lifestyles in children. Inadequate or unskilled parental supervision can leave children vulnerable" to these obesity-causing influences, write the coauthors, Dr. David Ludwig and Lindsey Murtaugh.

Ludwig, an obesity specialist at Harvard-affiliated Childrens Hospital Boston, says that state intervention "ideally will support not just the child but the whole family, with the goal of reuniting child and family as soon as possible." That intervention could also take the form of measures that stop short of separation and would likely include education and training for the birth parents in all cases.

"Despite the discomfort posed by state intervention, it may sometimes be necessary to protect a child," said Murtagh, a lawyer and researcher at the Harvard School of Public Health.

University of Pennsylvania bioethicist Art Caplan isn't so sure. He said that framing the debate this way places too much blame on the parents when children are subject to a barrage of cultural forces, including advertising, marketing, peer pressure and bullying, that are beyond parental control.

"If you're going to change a child's weight, you're going to have to change all of them," Caplan said.

Jerri Gray, a Greenville, S.C., single mother who lost custody of her 555-pound 14-year-old son two years ago, would agree with him. She said that authorities don't understand the challenges families may face in 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. She said she asked doctors for help for her son's big appetite but was accused of neglect. Her sister, who can afford the cost of the boy's special diet, now has custody.

Cost and availability of healthier food is also an obstacle standing in the way of poorer parents who want to help their children lose weight. Healthier foods often cost more than fast food and junk food, and the small food stores that dominate low-income neighborhoods usually do not carry a large selection of produce and fresh foods. Improving access to healthier food is one of the goals First Lady Michelle Obama has for her "Let's Move" initiative, which is aimed at combating obesity across the board.

Roughly two million American children are obese. While most are not in imminent danger, Ludwig said some have developed conditions, such as Type 2 diabetes and sleep apnea, that could kill them by age 30 if left untreated.

A strategy that emphasizes state intervention would not require changes in existing law. Medical professionals are already required to report to authorities children who they see as at risk due to a wide number of conditions, and severe obesity combined with parental unwillingness or lack of interest in their child's weight can constitute grounds for removal for neglect or abuse. There have already been several instances like Gray's where state child protective services have taken children from their parents and placed them in foster care.

This is also not the first time medical experts have argued for state intervention as a strategy for fighting childhood obesity. A 2009 article in the journal Pediatrics and a 2010 commentary in the British journal BMJ also advocated removal of obese children from parental custody when conditions warrant.

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Source: Associated Press

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