Who's really to blame for child obesity?

Posted: August 10, 2011

Should morbidly obese children be taken from their parents and put into foster care?

That was the central question in a commentary piece last month by obesity expert David S. Ludwig of Children's Hospital Boston and lawyer Lindsey Murtagh of the Harvard School of Public Health, who explored this drastic solution at a time when the rates of obesity in U.S. children over the last 30 years have tripled.

"In severe instances of childhood obesity, removal from the home may be justifiable from a legal standpoint because of imminent health risks and parents' chronic failure to address medical problems," wrote Murtagh and Ludwig.

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.

Reporting laws in a handful of states, including Pennsylvania, could make this happen. They require that doctors contact child services if they think chronic parental neglect has resulted in morbidly obese complications - like failing to comply with doctors' orders for weight-related diabetes and sleep apnea.

But placing blame solely on parents would be shortsighted, according to Daniel Taylor, a pediatrician at St. Christopher's Hospital for Children in Philadelphia and the founder of the Children's Advocacy Project, known as Cap4Kids.

"It gets tiring, blaming the individual," Taylor said.

Decades of societal neglect are actually to blame for our obesogenic generation, he said, citing the areas of food-industry regulation, investments in safe outdoor play, and portion-control regulation as elements that have been ignored.

Just getting states to pass a law seems unlikely. In June, Mayor Nutter fought for sugary-soda tax legislation that, for the second time, went nowhere.

Despite their counterarguments, experts, doctors, and parents share the same frustration over an epidemic that is threatening to shorten the lives of a generation. No one wants to remove children from their families or resort to another controversial option: weight-loss surgery for teens. But no one really knows what else to do.

Alternatives already exist. The Healthy Weight Program at the Children's Hospital of Philadelphia is one of several in the city that aims to engage children and their families by providing clinical care and behavioral modification.

Tony Sparber, who owns a weight-loss camp in the Poconos, says that parents can be more proactive in helping their child lose weight and eat right, but that "a child also needs to come to the realization on his or her own terms that they want to become healthier and lose weight."

Taylor says that, no matter the intervention, the only children who lose weight come from families who are motivated and committed.

"I don't know what that light is that clicks [on], but once in a while, they'll say, 'I did what you told me.' "

Contact staff writer Juliana Schatz at 215-854-4193, jschatz@philly.com, or @hooliana on Twitter.

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