Should parents lose custody of super obese kids?

[teko]

Lindsey Tanner, AP Medical Writer
showing 1 of 7 photos

7/12/11


CHICAGO — Should parents of extremely obese children lose custody for not controlling their kids' weight? A provocative commentary in one of the nation's most distinguished medical journals argues yes, and its authors are joining a quiet chorus of advocates who say the government should be allowed to intervene in extreme cases.

It has happened a few times in the U.S., and the opinion piece in Wednesday's Journal of the American Medical Association says putting children temporarily in foster care is in some cases more ethical than obesity surgery.

Dr. David Ludwig, an obesity specialist at Harvard-affiliated Children's Hospital Boston, said the point isn't to blame parents, but rather to act in children's best interest and get them help that for whatever reason their parents can't provide.

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 may require instruction on parenting," said Ludwig, who wrote the article with Lindsey Murtagh, a lawyer and a researcher at Harvard's School of Public Health.

"Despite the discomfort posed by state intervention, it may sometimes be necessary to protect a child," Murtagh said.

But University of Pennsylvania bioethicist Art Caplan said he worries that the debate risks putting too much blame on parents. Obese children are victims of advertising, marketing, peer pressure and bullying — things a parent can't control, he said.

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

Roughly 2 million U.S. children are extremely obese. Most are not in imminent danger, Ludwig said. But some have obesity-related conditions such as Type 2 diabetes, breathing difficulties and liver problems that could kill them by age 30. It is these kids for whom state intervention, including education, parent training, and temporary protective custody in the most extreme cases, should be considered, Ludwig said.

While some doctors promote weight-loss surgery for severely obese teens, Ludwig said it hasn't been used for very long in adolescents and can have serious, sometimes life-threatening complications.

"We don't know the long-term safety and effectiveness of these procedures done at an early age," he said.

Ludwig said he starting thinking about the issue after a 90-pound 3-year-old girl came to his obesity clinic several years ago. Her parents had physical disabilities, little money and difficulty controlling her weight. Last year, at age 12, she weighed 400 pounds and had developed diabetes, cholesterol problems, high blood pressure and sleep apnea.

"Out of medical concern, the state placed this girl in foster care, where she simply received three balanced meals a day and a snack or two and moderate physical activity," he said. After a year, she lost 130 pounds. Though she is still obese, her diabetes and apnea disappeared; she remains in foster care, he said.

In a commentary in the medical journal BMJ last year, London pediatrician Dr. Russell Viner and colleagues said obesity was 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 440-pound 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. But they didn't need to, because her medical crisis "was a wake-up call" for her family, and the girl ended up losing about 100 pounds, said co-author Dr. Norman Fost, a medical ethicist at the university's Madison campus.

State intervention in obesity "doesn't necessarily involve new legal requirements," Ludwig said. Health care providers are required to report children who are at immediate risk, and that can be for a variety of reasons, including neglect, abuse and what doctors call "failure to thrive." That's when children are severely underweight.

Jerri Gray, a Greenville, S.C., single mother who lost custody of her 555-pound 14-year-old son two years ago, said 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 has custody of the boy, now 16. The sister has the money to help him with a special diet and exercise, and the boy has lost more than 200 pounds, Gray said.

"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.

Stormy Bradley, an Atlanta mother whose overweight 14-year-old daughter is participating in a Georgia advocacy group's "Stop Childhood Obesity" campaign, said she sympathizes with families facing legal action because of their kids' weight.

Healthier food often costs more, and trying to monitor kids' weight can be difficult, especially when they reach their teens and shun parental control, Bradley said. But taking youngsters away from their parents "definitely seems too extreme," she said.

Dr. Lainie Ross, a medical ethicist at the University of Chicago, said: "There's a stigma with state intervention. We just have to do it with caution and humility and make sure we really can say that our interventions are going to do more good than harm."

[adgal]

They are taking steps here as well to cut out cafeteria junk food.  They have also removed the pop machines which is fantastic!  In all honesty, I don't mind my son having treats, but I like to be the one to make the decisions as to how often and how much.  So I don't expect the school system to take care of it for me, but more to support the decisions I make as his mother.  I cannot be with him in school obviously, so I am very happy that stuff is gone!  I do believe I will be going the brown bag route.

I also agree with Rglass'es comments earlier in this thread with regards to excercise.  Not sure if you in the US are facing this, but due to budget cuts physical education and extracurricaler activities are being slashed more then any other program.  So I think that more then ever we as parents have to ensure our children are getting the excercise they need.  We already go for daily walks and play outside whenever weather permits.  I think it is important to make sure they are getting that.  Obese or super skinny, they need physical activity to be healthy.  I have to say, I love all the attention and focus health is getting.  Families can do it together and make it enjoyable.  We just have to teach those that don't already, how.  Make it fun for kids and they will do it.

Something specialmom said has caught my attention.  She mentioned being a skinny kid.  I was too...am still pretty thin.  Thin does need mean healthy necessarily.  I am now, but certainly wasn't always careful about watching out for my health.  So what if a kid is skinny, but not healthy?  Do we remove them from their families too?  Where is the line drawn?  I still think there is a world of difference between obesity and neglect.  Perhaps sometimes they go hand in hand, but certainly not always.  Obesity on it's own is just not a good enough reason for me.  

[specialmom]

Treats made at home really don't have anything to do with nutrution as to why they aren't allowed in the majority of schools but rather the ever growing allergy situation.  

But WHO the heck said pizza was junk food????  

Just kidding.  Well, not really.  Even when I was on my super skinny girl diets, we were allowed to have a slice or two of cheese pizza.  And school lunches serve just a slice with a meal.  Deli sandwiches------------  a turkey sandwich is bad for you too?   Both on the menu at my state's schools.  Once a month they have hot dogs as a choice too.  I can live with a once a month hot dog choice.

Truth is, kids in elementary school get 15 to 20 minutes to eat.  My kids do much better with food in the stomach during their school day.  If the food is not appealing to them, they won't eat in that 15 to 20 minutes.  (My son's can stare down a food item they don't really like far beyond 20 minutes . . .)  I want them to eat------  and hope the school takes a stab and balancing kid fare with health.  That is the bottom line for me as a parent.  

[sweetpea03]

I don't know about Canada, or even other states from my own, but California has cut all junk food from schools. They only serve certain lunches and you can't bring in treats or any home made food for a party in the classroom. My mother is an elementary school teacher and there is an approved list for what foods you can give the children. I also remember back in high school when they made the switch and took away all of the options for lunch and would only sell the approved "healthy" lunch that looked horrible(typical cafeteria food look - I brought food from home). No more pizza, cookies, big deli sandwiches, etc. I hated seeing the deli sandwiches go. lol. Plus schools already require a minimum of 2 years of Physical Education in high school and are looking to add on a required 3rd year because so many teens and kids are heavy. I don't see it as the school's responsibility to get kids healthy, that is the parent's job. The parents need to be on them about eating well and exercising.

[adgal]

I think for me to be ok with removing a child over things like obesity, it would have to be part of overall neglect. And it has to be endangering type of neglect if that makes sense.  So not just what they feed them, but how they are cared for in general.  But to have it just because they are obese?  I still say nutritional counselling is the way to go.  I also do believe that the majority of parents would more then willingly attend.  And yep, gonna say it (I know this is a bone of contention for many, but it's how I feel) - I am absolutely for removing junk food from the menu in schools.  Even those that eat healthy at home will go for the junk food in many cases if it's offered. Personally, I don't want the schools providing that to my child without my permission. Get rid of the pop, hot dogs, pizza, etc.  To me that IS giving parents the choice when they are the ones with their children.  I do think that will help the situation. It's fine for kids to have junk food sometimes, but not for lunch everyday.

I still think that obesity should be looked at as a medical issue because it is a medical issue and we know that it causes all sorts of health problems.  So I still 100% believe the key here is education, not removal.  I just don't see that doing any good, and still think it will only serve to traumatize children.  You can't just take kids from their parents unless there is neglect and/or abuse.  I really think that those that have been through that, or work with children in that situation are the only ones that can truly understand how horrible it is for a kid.  It just can't be taken lightly...not ever.

[specialmom]

Oh good grief, what ever happened to free will?  Choice?  The ability to make mistakes in one's life?  We have public education until 12th grade----------  good eating is on the curriculum.  I'd agree to school's running educational programs for parents for free given by nutritionists to help them make better choices for their family.  But parent's would decide to attend that or not.

Feeding junk to kids is not a problem for just obese children.   So, is it okay for them to eat 10 ho ho's just because they are not obese?  Do we police ALL families to make sure they are eating as 'we' see fit?  Do we have forced exercise time--------- kids taken away if they can't pass a fitness test?  

While obesity is a problem, I hate to make it criminal.  Taking kids away is a big deal-------  and the foster system ain't no picnic.  

Should we remove kids from parents who smoke?  Drink alcohol and have it in the home?  Who bring kids into the world knowing they can not afford them and thus, set them up to live a life of poverty?  

Unless we are willing to give ALL parent's a litmus test prior to pregnancy as to their 'worthiness"----------  and force birth control to those who can't pass-----------  I think it is ridiculous to consider taking kids for what their parent's feed them.

[sweetpea03]

The problem with looking at intent is that all parents (supposedly) want what is best for their child, but then you have many who are doing more harm to their child than good. If you watch the video about the half ton teen(not sure which part of the series it stated this, may have to keep following the next link), the mother says she would do anything for her son and she wants him to be happy,never have to feel the sadness that she has, but she has also fed him into oblivion and put his life at risk. He could have easily died and many obese patients do right there on the OR table.

There are live-in 'clinics'(not sure what you call them) all over the US for obese patients to stay at and start to get to a healthy state. They go there to remove themselves from an unhealthy environment(their home life) and change their lifestyle. It's part of the 'social cognitive theory' to not only look at the individual, but also their environment(the individual, the environment, and the behavior are all intertwined). They have to be removed from a bad area in order to get healthy again. People learn a behavior through human interaction, observational learning. Typically the parents as well as the children are overweight or obese, so you either need to change the parents(environment) or take the child away from the bad environment in order to get them healthy.    

[adgal]

I would agree with you.  I just think that we have to think very carefully and explore other options before jumping to removal.  Far more harm then good can be done and it should always always be treated as a last resort.  But, abuse is abuse, and if a child's well being is in danger, action does need to be taken.  I guess I worry we are moving into that realm of requiring perfection from parents, and it's just not going to happen.  I do believe intent should be at the basis of many of these decisions if that makes any sense.

[sweetpea03]

Total family education would be great, but at what point do authorities step in to take action. Do they wait until the child/minor is morbidly obese or do they try to prevent it sooner by stepping in before it gets to that point? Like in the video I linked, the teen was half a ton and could have easily died while trying to lose weight. They waited wayy too long before getting help and having him lose weight. People of the teens weight typically die in the operating rooms because it just puts too much stress on people's bodies. In my opinion, it wouldn't need to get to the point of being morbidly obese to be considered abuse. Any parent that over feeds their child(ren) and does not make sure they are healthy are abusing their child(ren).

[adgal]

I think that morbid obesity should be treated like any other illness.  If a child had an illness that the parents refused to treat, the authorities need to step in.  But if it is just a matter of not understanding the dangers or how to treat it, then I would prefer to see total family education.  I think it's better for all involved.

El, I get what your saying, and good on your parents.  I wish every parent had that kind of common sense.  However, that not being the case, sometimes they need to be taught.  If they are willing to do what's needed to be done, then the family should stay together.  

R - you are right...much of this is about getting our kids away from the video games and back into physical activities..even if it's just running around in the backyard.   My nephews seem to spend way more time in front of video games and tv then playing and I worry for them.  

[R Glass]

That was rough. After watching that, in some cases the authorities should step in. He is 19 now and it is strictly up to him to lose weight. If he stays there with his mother, there will be no hope for him and he will die.

[sweetpea03]

Great point and a lot of people will blame genetics or health problems for obesity, when that is only part of the cause. Yes, some people have a naturally slower metabolism and a health problem, but that does not mean the child can be obese. A girl I used to watch has Type I diabetes, but she has always kept her weight under control. She eats well and exercises. I think all too many people use that as an excuse(health issues and money) and don't push their children to stay healthy. If the neighborhood isn't all that safe, then have the child run around the back yard and/or keep moving inside the house by playing physical games that require movement. It's also cheaper to make food at home than it is to buy fast food/take out, so I don't see that as an excuse either. I know when I was growing up, our parents always forced us to eat our vegetables, but that doesn't happen as often today. Many parents will just let the kids eat what they want so they don't have to argue with the children or discipline them. I see this happen all over the place, with the kids I baby sit/nanny and also at the local elementary schools and hospital that I volunteer at.

I am hesitant to think about taking a child away from the parents because that can be very traumatic, but at the same time the child does need to get away from that unhealthy environment in order to get healthy again. If you look at the documentary about the half ton teen, they take him away from his mother and then get him to lose weight. His mother just kept feeding him and feeding him until he could barely move. I do see that as a form of abuse, even though she does think in her own mind that she is showing him that she loves him.

http://www.youtube.com/watch?v=jzktJYFkEJ0
(ignore the random comments, couldn't find the original video)

[R Glass]

Another problem is exercise. We live in a totally different world than what we grew up in.
I was raised an Army Brat so we didn’t have the money to eat good wholesome nutritious meals. We lived outside Army Bases with many other Military families that were in the same financial situation. However, there were very few obese kids.
The reason was, we didn’t sit inside the house, snacking on junk food, playing video games (there hadn’t been invented yet anyway).
We were out playing baseball, football, riding our bicycles, or playing Army in the woods all day. Our parents never worried about us as long as we were home before dark. Fast forward to 2011. It is no longer safe for children to run free the way we could. I do fault the parents that are able but not making an effort to get their kids involved in programs like Little League Baseball, YMCA etc. I also understand for some it is Genetics but where were all these Kids with Genetic problems when I was a kid?

[el_em_en_oh]

Everyone is saying that "SOMETHING" should be done about obese children, and that parents aren't at fault, as they were never educated on the pro's & con's of fast food, nutrition, etc, etc.

I realize that there are exceptions to my "take the kids away, as it's a form of abuse" point of view (ie: Brice's little boy, cases where the kids just naturally 'large', etc), but WHO do you place the onus on, if not the parents?

Saying that "You can't blame the parents because they weren't educated and work 2 jobs" doesn't cut it, in my book. Sorry. It's no excuse. You make it part of your job, to feed your family healthily. Besides, it's cheaper to cook than it is to drive-thru. Everyone's complaining about how BROKE they are, yet they continue to drive-thru & takeout.

Again, MY parents weren't formally educated on nutrition. And MY parents worked day jobs, and had weekend gigs too, to earn extra money (from what I remember anyway)... and neither my sister, nor myself, are anywhere NEAR obese/fat.

I realize that my sister & I are just ONE example, but I honestly cannot remember growing up with a bunch of fat kids.

Now... I look at the 50-60+ boys in my Boy Scout Troop, and 75% of them are obese/fat. And WHY are they obese/fat? The majority of them come from single-parent families, and they get fast-food shoveled into their mouths every day because their mother or father can't/won't/doesn't take the time to cook a meal.

I'm sorry, but that's a form of abuse, in my humble opinion.

[sweetpea03]

I don't know if removing the child would be the best option, but something should be done about the child's weight. I know some others stated that there are a number of reasons for why a child can be obese, which is true, but a majority of cases are just from children overeating and parents letting them eat what they want(fast food, fattening snacks, etc). A lot of parents think that is how they show their child "love" by letting them do and eat what they want, but they need to realize they are hurting their child and need to step up and be a parent. Take control of what your child eats and does and make sure they are healthy. The parents need to be educated!

A boy I used to watch used to be able to eat what ever he wanted and his mother never pushed him to eat healthy. His mom would always give me money to buy him Wendy's for lunch or McDonalds. I don't think the kid had ever seen a fruit or vegetable and you wonder why he was overweight and had constant problems with constipation! And this isn't a rare case, this happens with a lot of families across the US. The parents need to be pushed to do the right thing and take care if their children by forcing them to eat right and exercise. I used to make the boy I watched eat apples and we'd sit at the dinner table until he finished. He'd whine and moan about it for a while, but he would always end up eating it. I also got him into going for walks around the neighborhood and karate, which got him to lose a lot of weight. He's now a much happier boy because he is more healthy and can do more without getting winded.

I myself have asthma along with allergies that can make it difficult for me to breathe at times, but I always played sports growing up. I was in soccer, basketball, track, and volleyball and loved it all. I just had to make sure to keep my inhaler around until I grew out of most of the asthma. I also had numerous surgeries and was on medication on and off for years, but I have never had a weight problem. I understand that for some people it can be hard, but for the majority of cases, it's just laziness and bad choices.  

[adgal]

I am a former foster kid and I work daily with families who have lost their children for a variety of reasons.  If a childs welfare is in danger, absolutely they should be removed - quickly and without hesitation.  But first attempts should be made to work with the family and every attempt should be made to keep them together.  I speak from experience here...taking a kid away from it's parents is incredibly traumatizing and leaves life long scars.  Yes, it's sometimes necessary, but it's not always the right answer.

Obesity is serious stuff.  The medical conditions associated with it are potentially life threatening.  But most parents just don't know any different, and that is the honest to God's truth.  No one ever taught them about nutrition and health and how to plan/cook healthy meals.  I would almost stake my life on the fact that if they educated these parents on what and how to do it, they would.  But to just remove their kids?  uh uh.  Not unless they are abusive or downright neglectful.  It sure shouldn't be the first line of action, I can tell you that.  Not for this issue.

[MrsPincince]

I agree. It would do absolutely nothing...

[brice1967]

Growing up, my father thought I was fat.  I had asthma and couldn't exercise like the rest of the kids.  (I was not fat on numerous doctors accounts)  My dad constantly beat me mentally over my weight.... every time I saw him he had something to say about my weight.  My dad went as far as to take me to his doctor to have me weighed and his doc told him the same thing..... "the boy has asthma, he gets exercise, he's fine..."

I'm simply saying that parents cannot be responsible for what kids are stuffing in their mouths when they aren't around.  

My son has a dear friend... this 17 year old girl is about 4'5" tall and weighs about 260lbs.  Not only does she have a few medical issues, she can and will eat anything.  Her parents have had her with therapists, have sent her to special camps, all to no avail.  They've tried to feed her healthy foods, but once she leaves the house, it's anything goes.  This girl knows she is unhealthy but she cannot control herself....

I grew up with a kid that lived in a Beaver Cleaver home setting.  Mom stayed home and dad worked.  Jerry was obese by the time he was 11-12 maybe.  He'd eat healthy at home, but once away from his house it was anything goes.....

My son is classified as morbidly obese. WE knew this was coming.  He has a medical condition revolving around a seizure disorder and the meds used to treat the disorder.  We were told that the meds would affect his metabolism sooner or later.  It did.... He's recently lost 5 lbs on a program he put himself on, but his deal is like the people I mentioned above. He will make unhealthy choices when were not around.  Part of me believes this is because we had to monitor a lot of what he ate because of the seizure disorder and the study project we okayed him to be added to.  When he has an opportunity, hell choose a candy bar over an apple.  He knows he shouldnt and me or his mother nagging at him does any good.  The good examples we've set often get over looked.... what would taking him away do???

[MrsPincince]

it's easier to just "order out"....

[MrsPincince]

@ El...I agree that some parents aren't doing right by their children with cooking. You never know what their situation is. My mom worked 2nd shift when I was younger and all through high school. She did always have dinner waiting for me (I think it's b/c she was a single mom and couldn't afford ordering food..lol Not funny but true) or she'd have it prepared so all I had to do was either nuke it or throw it in the oven. I'm just saying I think it's a lil drastic to remove the children because they are getting unhealthy nutrition. I mean if the child was obese enough for his/her Dr to inform the parents that there's an health issue, and the parents knowingly ignore the DR's advice then YES, that in my eyes is neglect. It's unfortunate b/c some parents are on top of what their children eat and they make sure that their children get a nutritional meal and some parents don't..

[el_em_en_oh]

I'll agree with you on that point... just because a child is fat/obese, don't mean that his/her parents are unfit. HOWEVER, the majority of the fat kids out there, were made that way by their parents lack of cooking healthy meals and simply swinging through the fast-food drive-thru on the way home.

Listen, both my parents worked while I was growing up, as did the parents of all my childhood friends. None of us was fat/obese. My Mom & Dad made sure we had home-cooked meals every day. Did that lead to us being healthy and NOT fat? ABSOLUTELY.

Are their some kids that are just fat, and will be fat no matter if they eat healthily or not? Yes, of course. But IN GENERAL (these days anyway), with the number of kids that are obese/fat, you HAVE TO look at the parents and how they're feeding their kids.

Fast-food does not a skinny child make.

That's my only point.

These kids aren't buying the fast-food for themselves. It's their parents, that aren't taking the time to cook healthy, home-made meals.

Thoughts?

[MrsPincince]

@ El....Just because a child is Fat/Obese doesn't mean the parents are unfit. I think taking them away would do more harm than good UNLESS it's a case of actual physical/sexual/emotional/verbal abuse, neglect, starvation, etc..I agree with Brice and his logic 100%.

[brice1967]

I'm not sure how an obese child proves a parents ability to parent.  The ability to feed, clothe, shelter, and otherwise care for and love a child is among the criteria being used to evaluate a parents ability....

So, there have been studies that show that taking children from their parents does often lead to psychological issues.... is that a risk we are willing to take?  Aren't there enough troubled people around without the system taking and producing more?

Now, if mom and dad are crack heads and all the kid gets to eat is Ding Dongs, Bread and butter, lives in complete pig sty, has to drink water from the toilet..... yeah, I think you do what you can for the childs welfare, but it isn't just the fact that the kid is fat....

[el_em_en_oh]

I'm going to have to disagree with everyone.

There are people out there that are unfit to raise children, have children, be around children, be remotely connected with children in any way, shape or form.

I come in contact with them ALL THE TIME, and they are truly worthless parents. For whatever reason, they are UNFIT parents.

I'd rather see their children taken away from them, rather than have to deal with the aftermath of their failed parenting when the child is morbidly obese, a serial-killer in the making, a bully, an addict/alcoholic, a criminal, a social misfit (ie: Columbine'esq), etc, etc.

Hell, there are stricter criteria to adopt a puppy from the SPCA than there are for having & raising children.

If a "parent" is identified as unfit, then I say remove the children and place with someone that IS fit.

*Now let's talk about who the judge is going to be, that decides who is a "fit" parent, and who is an "unfit" parent...

[specialmom]

Dumb idea.  Really dumb.  Perhaps early intervention for families identified at risk here with a home nurse visit to discuss food and resources to purchase healthy food.  

And really, I must say that even parents that do not feed their children well (and that includes a whole lot of skinny kids) have a right to do so.  Just like I have the right to eat a whole cheese cake in the middle of the night if I so desire.  

Regulating every thing including our population's food choices is heading toward the ridiculous.