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JAMA suggests removing children from their homes due to morbid obesity

Dominika Osmolska Psy.D.'s picture

Believe it or not, the Journal of the American Medical Association has just published an article in which a lawyer and a doctor endorse sanctions against parents whose children are morbidly obese and who are unable or unwilling to do anything about it. Yes, that means child welfare agencies would be able to intervene and place the children in temporary foster homes.

The paper is sure to raise eyebrows – and hackles.

Obesity is undoubtedly a major national health concern, and it is even more concerning in the pediatric population, which, historically, has never been plagued by the degree of obesity it is now burdened with. Obesity rates have increased dramatically over the last two decades, and now a whopping 32% of children ages 2-19 are overweight or obese. A full 12% of those are extremely, or morbidly, obese.

The statistics do point to a large problem in terms of these children’s future health. Many will undoubtedly be saddled with chronic and debilitating diseases that are more commonly seen in midlife or later. But does their condition warrant removal from the parents’ custody?

Children are removed from parental homes when they are abused or neglected. One form of neglect is malnourishment. Another, as defined by a handful of states, is “overnourishment.” California, Indiana, Iowa, New Mexico, New York, Pennsylvania and Texas have precedent to apply laws governing intervention in cases of malnourishment to "overnourishment" and severe obesity.

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The researchers cite a 2007 article in the journal American Society of Law, Medicine and Ethics, which explored the case of Brittany, a morbidly obese 9-year-old girl in Chemung County, N.Y. She was shuttled between her home and foster care for four years with her parents under orders to watch her diet and take her to the gym two to three times a week. When the parents failed to heed the order, the child was placed in the care of the state.

The case was extreme, and there is no denying that obesity among kids is going to be a large social problem in the years to come. But that does not mean that the state ought to be given a pass to undermine parental authority. The only basis for compelling medical treatment against a parent’s wishes is if a child is at imminent risk of death — meaning days or hours — and a proven cure exists for what threatens to kill them. Obesity is not a medical condition which presents its patient with imminent risk of death. Death might come earlier for these kids than their average-weight peers, but it will still be way down the line.

The truth is that obesity is not a direct contributor to death. It is the precipitating condition for a host of chronic diseases which may or may not affect the individual. There is also no known effective cure for obesity. Sure, exercise and a sensible diet help, but as so much research has shown in recent years, the propensity to overeat has very complex, biochemical and endocrine factors, many of which are genetically determined. It is not simply that parents are force-feeding their children junk food. It is also that some of these children may crave the junk food or may crave more than average.

And like it or not, children can and do make choices for themselves. While that cannot be said of a 2-year-old, it most definitely can be said of a 9-year-old. Our society at large provides children with an unprecedented array of choices, and perhaps an unprecedented means to exercise those choices. A 9-year-old American child is incomparably wealthy in comparison to a child living in, say, the Sudan. He has the means and the money to treat himself to convenience food, beckoning him at practically every corner. Surely not all the blame can be laid at parents’ feet. They are often fighting an overwhelming current speeding in the opposite direction to their intentions.

Would such children “treated” through the foster care system really stand a better chance to be healthy, happy and lean? Seriously, folks, the system is buckling under the strain of stretched resources as it is. And the outcomes for youth aged out of the system are, for the most part, dire and depressing. Nobody is made healthy and adjusted in the state foster system, barring a few exceptional stories of care and love. The most such a system does is removes the children from imminent, bodily and psychological trauma. Obesity just does not make the cut.

We live in a society absolutely saturated with food, most of it processed. The only way we can turn this tide around is literally to change our food culture. Surely this is not an impossible task. It was not so long ago that we lived in a different food culture, before the advent of mass advertising, marketing and runaway packaged foods market. The only way out of the current situation is to begin demonizing processed, convenience food, just as we have managed to demonize smoking, to some extent, and even drinking, to a lesser extent. This wouldn’t be some puritan project of sober, lean living. This is the project to save ourselves – and our planet.