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?
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