This is not something new - in fact, there have been some isolated cases where social services or another government authority has stepped in and removed a morbidly obese child from a home in an effort to prevent further health risks from developing. The intent has been to "save the child" and not to indict the parents. Obviously the net result of such an action is to basically suggest that the parents are not engaged in good parenting and the child, because of that, is at serious risk from a health perspective. With the publication of this new Journal of the American Medical Association commentary, and the chorus of other health professionals supporting this expert's written essay, the issue of whether to remove an obese child from his home is now front and center.
It seems just last week we were arguing about whether bariatric surgery or the Lap Band is appropriate for obese teens. That discussion may now seem tame in comparison to removing a child from a home because a doctor or a government official believes that the child's weight is sufficiently threatening his health to warrant drastic action. Somehow we find it much easier as a society to expect authorities to step in when a child is being manhandled and physically hurt with beatings, or is painfully thin and starving or is being denied life-saving medical treatment because of religious convictions. Why do we cringe and fidget at the thought if an intervention because a child is being fed to death? Maybe we simply refuse to believe that too much food causes death -even though experts keep sounding the bell and unequivocally stating that obesity is associated with heart disease, diabetes, cancers, arthritis, strokes, hypertension, quality of life issues and even premature death. Just how large does a kid need to get weight-wise, for the average person to think that maybe their needs to be an intervention and removal of the child from their home until the family can be sufficiently convinced and educated to change the home habits? Why is it that when a child is being hit repeatedly or starved we don't think the child should remain while the family gets help and counseling? Is it because we believe the imminent harm is too great to chance it? Well can't a very obese child suddenly have a heart attack or stroke or die due to sleep apnea?
The current standard for removing a child from a home is when "all reasonable and alternative options have been exhausted." In a 2010 British Medical Journal a London pediatrician stated that "child protective services should be considered if parents are neglectful or actively reject efforts to control an extremely obese child's weight." He was specifically reflecting on a recent case where a 12 year old weighed 400 pounds and had developed diabetes, hypertension, cholesterol problems, high blood pressure and sleep apnea. She had first presented to the clinic at age 3 already weighing 90 lbs. and her parents were struggling with disabilities and were also very financially challenged. When the medical community removed her at age 12 and placed her in foster care, she lost 130 pounds in one year and the diabetes and sleep apnea disappeared. She is currently still in foster care. Are you OK with that case decision?
Here in the US over 2 million children are extremely obese. Whether you believe it of not - these children can die in their teens or very early adulthood from breathing issues, liver disease, diabetes complications or a heart attack or stroke. Certainly the best case scenario would be to have the parents eagerly embrace - even demand - help and for there to be adequate funds to support ongoing multi-disciplinary help. Health professionals who deal with these families often find great resistance from parents and in some cases the parents stop seeing the pediatricians who try to gently and helpfully intervene. In one case it took a 440 pound 16 year old to almost die from sudden breathing problems for her family to "wake up and accept help" (this was a case in 2009 in Wisconsin). Certainly it has to be acknowledged that in some cases, no help is readily available, even if the parents do want it.
So when a mother says she is working two jobs to keep her family off welfare and she has no time to cook or "watch her son " and her son grows to 550 pounds at age 14, does a doctor have the right to call authorities and demand the child's removal from the home? In this case, the child ended up with an aunt and successfully lost 200 pounds. Weight loss continues but the child misses his mom....terribly. Should authorities put the child back with mom and hope for the best? One expert summed it up best when she said that it is important to "intervene with caution and humility and make sure that you can say without any doubt that the intervention will do more good than harm."
What do you think??
Published On: July 14, 2011