But, they added, "the decision to pursue this option must be guided by carefully defined criteria . . . with less-intrusive methods used whenever possible."
Despite those clear conditions, the editorial, which ran in the Journal of the American Medical Association, provoked frenzied comments from parents, physicians, and children's-services advocates. "Don't blame me for my fat kid," wrote one parent on the Wall Street Journal blog. "I think the solution is to prohibit McDonald's from including toys in Happy Meals."
Bill Lawhorn, a supervisor of Court Appointed Special Advocates in Philadelphia, says that, in more than 30 years with the child-welfare system, he has never seen a case of removal based solely on obesity and that to do so would be a logistical challenge.
"Child welfare is hard-pressed to respond to adjudicate matters of abuse and neglect, let alone dietary concerns and lifestyle, or following through on healthy choices," Lawhorn said.
Imminent risk - where children are really in lethal situations - is the only reason children can be removed from parental custody. Obesity does not meet that requirement, according to Arthur Caplan, a bioethicist from the University of Pennsylvania. The risk of death is real, but it is "way down the road for kids," wrote Caplan in his MSNBC.com rebuttal.
Ludwig does not want to wait that long, reiterating that this is about morbidly obese children. "We're talking about whether a child will live into adulthood," Ludwig said. Rather than let youngsters face the chance of developing type 2 diabetes, which he notes usually becomes permanent within several years if no weight is lost, the state can help educate families.
Foster care, he said, should be used only when in-home efforts, such as parental training, have been exhausted.
