Custody debated in child obesity
Intervention needed in some cases, doctors say
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 advocates who say the government should be allowed to intervene in extreme cases.
It has happened a few times in the United States, and the opinion piece in today’s Journal of the American Medical Association says putting children temporarily in foster care is sometimes more ethical than obesity surgery.
Dr. David Ludwig, an obesity specialist at Harvard-affiliated Children’s Hospital Boston, said the point is not to blame parents but rather to act in children’s best interest and get them help their parents cannot 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 cannot 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 American 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 has not 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.
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,’’ which is when children are severely underweight.