Should parents lose custody of super obese kids?

[teko]

Lindsey Tanner, AP Medical Writer
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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]

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?