What's the News: Childhood obesity rates have escalated dramatically in recent years, in concert with nationwide explosion that has 34% of American adults falling into that category. Now, scientists writing in the July 13 issue of the Journal of American Medical Associationargue that much as feeding kids too little is considered child neglect, so should be feeding them too much. And if the former is grounds for removing them from their families, then the former may be as well. As you can imagine, in the last 24 hours, numerous commentators have responded, and the ensuing debate touches on the causes of obesity and the difficulty of treating such a pervasive, devastating problem. The Tinder:
17% of kids 2-19 are obese, according to the CDC. That's triple the rate in 1980.
Ethnicity and socio-economic level are tied to risk of obesity: Low-income, black or Hispanic children have especially high rates.
Childhood obesity can affect kids for the rest of their lives---in addition to having trouble breathing, high blood pressure, depression, and liver disease as kids, they may develop type 2 diabetes and are more likely to be severely obese adults, which comes with its own cluster of related ills, including heart disease and some cancers.
Each state has its own set of criteria for determining when the Department of Social Services should remove a child from his or her parents; generally, the rule of thumb is that either the child must be in immediate danger, or no other less disruptive option exists that would adequately protect the child. There's a socio-economic side to this too: if a child from a low-income family winds up at a hospital, studies have shown, their parents are more likely to charged with neglect than wealthy parents are in the same situation.
The Spark:
In a two-page commentary, the scientists make the case that severe childhood obesity---being in the 99th percentile in terms of weight, and usually eating over 1000 calories more per day than recommended---can be considered the result of neglect and an immediate danger to a child.
They point out that several states, including California, Indiana, Iowa, New Mexico, New York, Pennsylvania, and Texas, have already set precedent for applying child welfare laws in cases of severe obesity.
Child protective services should certainly try to address the problem with parental counseling and training and other intermediate measures, they write. But if that doesn't work, and bariatric surgery, which is quite a serious and invasive procedure in adults and whose long-term effects on kids seem dangerous, is the next option, then the state should step in.
Of course, there are certain cases where severe obesity is the cause of rare genetic diseases. But in these cases, they write, treating the disease usually requires major lifestyle modifications that the children's families generally do not undertake. Thus, state intervention might still be required.
The Debate: The suggestion set off alarm bells in many people, and responses in Scientific American, MSN, and Slate give a good sampling:
Phil Yam at Scientific American writes the suggestion is misguided, as it places most of the blame on parents:
Defining childhood obesity as abuse would place a tremendous burden on parents—and an unfair one. Considering the marketing and low cost of sweetened cereals, high-fat fast-food meals and other treats aimed squarely at kids, others also bear responsibility for our childhood obesity epidemic. Even the U.S. government could be blamed, considering that the Department of Agriculture promotes the consumption of U.S. foods.
Bioethicist Arthur Caplan at MSN writes that the risks of obesity, as severe as they are, are not immediate enough for the state to step in, and it's unclear that a foster family would have any greater success in getting a kid to lose weight:
Our laws give enormous authority to parents and rightly so. The only basis for compelling medical treatment against a parent’s wishes are if a child is at imminent risk of death — meaning days or hours — and a proven cure exists for what threatens to kill them. Obesity does not pass these requirements. The risk of death from obesity is real, but it is way down the road for kids. There is no proven cure for obesity. The ability to treat a child with diet or a lifestyle change who does not want to be "treated" by strangers is a long shot at best. The number of kids involved — an estimated 2 million children with body-mass index above the 99th percentile — would quickly swamp already overwhelmed social service departments. And, no matter what you do with overweight children, sooner or later they are going back home where their often overweight parents will still be.
KJ Dell Antonia at Slate has a more nuanced take on the subject; commentators like Caplan gloss over the fact that this would only happen if parents had already failed to make changes, and so miss the point that what's needed is a strategy of case-by-case attention that acknowledges the complexity of the obesity crisis:
Morbid obesity has already become a factor in considering whether a child should be placed into foster care. It's not really the obesity itself that underlies the removal of a child from a parent's custody, but the parent's documented refusal or inability to intervene or to follow dietary or exercise guidelines imposed by state or medical agencies involved in the child's care. Murtagh and Ludwig [the authors] appear to be suggesting that states use that power more often and wield it as a threat more effectively, not that obese children be removed from their parent's custody from the moment they come to the state's attention... Childhood obesity is a larger problem with extreme individual implications. Broad social programs, like those advocated by Caplan, are great, but getting the nation to "go on a diet together" isn't enough to target specific at-risk children...Let's put all the fat kids in health care. Real health care, not "we can't afford any visit with any local physician and the nearest doctor who takes the state child health insurance is an hour away and has a three-month-long waiting list and so we end up in the emergency room" health care. And then, once health care and help and dietary advice and practical exercise alternatives are available, consider foster care on an individual basis in only the most extreme cases.
The Consensus: Everyone agrees that childhood obesity is a serious problem, and that parents, as well as food marketers, genetics, and even the US government, have a role in its genesis. But while some advocate for more national exercise programs and others for better health care, there's no one-size-fits all answer.
Image credit: Mike Cogh / flickr
