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Is Severe Obesity in Kids a Sign of Child Abuse?

Is Severe Obesity in Kids a Sign of Child Abuse?

Are parents of an extremely — morbidly — obese child committing child abuse?

A Journal of the American Medical Association op-ed by Lindsey Murtagh, JD, MPH, of the Harvard School of Public Health and David S. Ludwig, MD, PhD, of the Children’s Hospital of Boston, considers whether the state in the form of Child Protective Services should intervene when a child is so severely obese that he or she is at risk of developing a life-threatening condition such as type 2 diabetes.

That is, according to the op-ed’s authors, having a severely obese child is a sign of parental neglect. At a time when, the authors write, “ubiquitous junk food marketing, lack of opportunities for physically active recreation, and other aspects of modern society promote unhealthful lifestyles in children,” overnourishment and severe obesity need to be thought of as endangering children’s lives just as “improper feeding practices, causing undernourishment and failure to thrive have long been addressed through the child abuse and neglect framework.”

Murtagh’s and Ludwig’s suggestion sounds and is, they acknowledge, drastic and should be applied only when obesity is life-threatening. It’s a last resort after “intermediate options such as in-home social supports, parenting training, counseling, and financial assistance” have been tried. They also discuss gastric bypass surgery — while noting the risk of health complications — as an option to removing a child and placing her or him in foster care when “support services may be insufficient to prevent severe harm.” As they write,

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. Indeed, it may be unethical to subject such children to an invasive and irreversible procedure without first considering foster care. Nevertheless, state intervention would clearly not be desirable or practical, and probably not be legally justifiable, for most of the approximately 2 million children in the United States with a BMI at or beyond the 99th percentile.9 Moreover, the quality of foster care varies greatly; removal from the home does not guarantee improved physical health, and substantial psychosocial morbidity may ensue. Thus, the decision to pursue this option must be guided by carefully defined criteria such as those proposed by Varness et al, with less intrusive methods used whenever possible.

What stands out in Murtagh’s and Ludwig’s argument is their equation of overnourishment — causing a child to become severely obese — as tantamount to child abuse and malnourishing a child. GOOD magazine points out that

Whether you agree with it or not, kids have already started being taken from their homes for being too overweight. Ludwig says the idea for state intervention in obesity cases came to him when he met a 90-pound 3-year-old whose parents were poor, disabled, and unable to control her weight. By the time she was 12, she weighed 400 pounds and had developed diabetes, at which point the Massachusetts Department of Protective and Family Services intervened and removed her from her home. Within a year of government care, she’d lost 130 pounds and her diabetes was gone. She’s still obese, says Ludwig, but she’s getting better all the time, which is why she remains in government care.

There’s already enough of an outcry about First Lady Michelle Obama’s efforts to stop the epidemic of obesity among children. Having state agencies step in and remove a child is certainly a much more intrusive act into people’s private lives. What we do need to keep pushing (though it’s an uphill battle) is education of parents and children about healthy eating practices and exercise; is making sure that healthy food options are available — though, of course, there’s no guarantee that just because there’s fresh fruits and vegetables that people will buy them.

Currently only a few states (California, Indiana, Iowa, New Mexico, New York, Pennsylvania, and Texas) have, say Murtagh and Ludwig, “legal precedent for applying this framework to overnourishment and severe obesity”: What if more states also chose to apply this framework? Could there be a day when overnourishment — when not getting a child to eat healthily (always a challenge for any parent) — is as much a crime as malnourishment?

Related Care2 Coverage

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96 comments

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5:57AM PST on Feb 7, 2014

Thank you

11:48PM PST on Jan 16, 2014

eating right takes a bit more time and effort but more than worth it

9:03AM PST on Jan 16, 2014

Noted. Thanks for the information. I will keep all of these things in mind and also the comments made when I am advocating for the children who have ADHD and/or Autism (or a combination of both) - (especially those who have severe 'meltdowns', sometimes on a daily basis) who do not want to exercise and who have all kinds of issues that make it virtually impossible for the child/siblings/parents to have a 'normal' life. Not to mention, those on prescription medications that throw their hormones into a whole other light. Daily (good) habits and maintenance may be key, however, there are extenuating circumstances in which using words like 'neglect' and 'child abuse' are very harsh terms - particularly to the parents who are or have been making great efforts to meet the challenges of special needs children.

5:12AM PST on Jan 16, 2014

Poor diet and lack of exercise are not the only cause of obesity. Some obesity is from hormones out of whack, is in poly-cystic ovary syndrome and under-active thyroid. Also, poverty is not entirely the parents' fault and some obesity is due to people filling up on cheap starch because it is cheap and they can't afford better. First check for any possible medical problem that might be causing obesity. School breakfast and lunch and a school take out supper could go a long way toward curing obesity due to poor diet due to poverty. So also check for poverty and make sure to get the child signed up for school breakfast and lunch if eligible.

10:28PM PST on Jan 15, 2014

Yes, it is child abuse. Abuse can be caused by ignorance or neglect... It'd be hard for kids to be placed in foster homes, but maybe they should be required to follow a certain diet plan and exercise program...

10:52AM PST on Jan 14, 2014

I've seen children given orange soda pop in their bottles. And I have seen those kids sucking on those bottles at about 1 1/2 years old instead of being fed a real meal. Unfortunately their mothers were either teens or what I can only call borderline retarded. And no one is taking time to educate our kids on nutrition and we are cutting back on their exercise opportunities. There is a difference between walking and running all over the neighborhood or town and standing around waiting for your turn in an organized after school sports team. I know some kids in their early 20s who never got to go anywhere unless they were driven in the car.Not even the three blocks to school.

4:58AM PST on Jan 14, 2014

Making children fat is as vicious and violent a crime as throwing acid in their faces to disfigure bodies that were once beautiful and natural. I put it in the same category as sexual abuse because being fat destroys a part of the soul. It is inexcusable. Did you ever notice how McDonald's and Burger King use playgrounds and toys to lure children in the same way Errol Bradley used a playground to lure children in so that he could use them for his selfish interests the same way big corporations use children for their selfish unearned profits? At least Errol Bradley's victims did not suffer their bodies to become public trophies on display for the world to see; they could hide their trauma and maybe have a chance to heal somewhat, but obese children can never do this.
Let is end the excessive tolerance of one class of child molesters: the commercial food producers and the unfit parents who buy this crap and feed it to their children even "in moderation"; let us turn a deaf ear when they claim that they are in ant significant way different from those who touch inappropriately their children because "everybody does it so it must be normal," and stop this crime.

3:17AM PST on Jan 14, 2014

I think we all have a part to play in this. I think junk food should be banned or sold under restricted conditions like alcohol or any other drug is and both parents plus child should be sent to food boot camp. Its most important that its both parents as the dad lazing round on the sofa stuffing his face with nachos and watching TV is just as much an influence on his children as the mother For too long fathers have been left out of any debate on parental responsibility and its all about their 'rights'.

11:39PM PDT on Sep 11, 2012

YES!!! I don't understand how someone could let their child become very overweight or obese. If someone is starving their child it is considered cruelty and neglect yet if someone over feeds their child and lets them sit around and not exercise it is not considered cruelty and neglect!? Either way you are killing your child!

10:50AM PDT on May 1, 2012

It is abuse and neglect. My heart goes out to the children of parents that just don't want to be bothered. I see them every day. Mothers, Fathers that will not cook for the family, because fast food is easier. Or will not take children outside to play because there is no air conditioning. There should be some way to make parents do the right thing. Doctors, Hospitals and Schools should be required to report all over weight children that they treat and Teach, parents should have to go to parenting classes, and if they are on any kind of assistance programs their assistance should be in jeopardy. Some parents should not be allowed to have children. I know this sounds drastic but some parents can,t even be bothered to get out of bed and get their children off to school. Their should be punishment for them.

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