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."

[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"....