Does Severe Childhood Obesity Warrant Separation From Parents?

If a child is severely obese, and facing immediate health risks (such as onset of Type 2 diabetes), should this be considered a form of child abuse or neglect? Should the child be placed in foster care to promote substantial weight loss?

As many of you know, an essay published earlier this week in the Journal of the American Medical Association (JAMA) suggested that, in some rare cases, the answer is yes. (Do keep in mind that the paper was an opinion expressed by researchers and not a formal statement by any professional organization or JAMA).

I say no. But before I share why I came to this conclusion (it took me 3 days to figure out exactly what I think about this complex issue), let’s consider the many important points raised in this paper.

First, I appreciate how the authors articulated the responsibility that parents have these days to understand the very real risks for obesity for youth in a culture that the Centers for Disease Control and Prevention has labeled “obesogenic.” These include: too much unhealthy food, not enough sleep, and not enough exercise. It’s a challenge for all of us parents to keep up with the many factors (obvious and subtle) that continue to push kids into unhealthy lifestyles.

Second, I firmly agree with the authors that educating parents about lifestyle choices is imperative, especially if kids are edging towards very real health issues that are related to weight. As they point out, it is possible to intervene and try to prevent problems before they happen in youth — immediate weight reduction could prevent onset of Type 2 diabetes in severely obese youth.

Third, I also respect how the authors suggested that only a very few clinical cases (the most severe and extreme) would warrant consideration of separation from parents. And I get the frustration that health care providers experience when they see a child heading towards potentially irreversible diseases, yet observe no changes happening with respect to parenting.

All that said, I still think that are emphasis should be placed on developing interventions to help families lead more healthy lives (especially since our culture is full of risk factors that impact parents as well as their children), and to find methods to help parents help kids achieve immediate lifestyle changes when necessary. Although the clinical perspective may lead some to want to impose temporary interventions to protect children, the broader public health mission is to put more resources into ways to educate both parents and their children as a unit to support each other’s transition to healthier lifestyles. Let’s try to keep families together and help them develop into healthier families.

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  1. by TLS

    On July 18, 2011 at 11:57 am

    As a teacher, I feel very strongly about this issue. I often see severely obese children who come to school telling me they ate doughnuts for breakfast,or whose parents bring them McDonald’s for lunch every day. We educate the children on healthy eating habits as early as first grade, which can be helpful, but parents need education as well. I agree that when the child is facing serious health issues and the parents are not doing anything to change the child’s eating habits that it borders on abuse and that intervention services and education need to be given to the parents. Someone needs to speak up for obese children, who in my eyes, are victims.

  2. by Michelle

    On July 18, 2011 at 11:58 am

    If the child is chubby, no. If the child is obese…and so are the parents…maybe. Because obviously the parents do not care about themselves,or their child. Or are not smart enough to not feed their child the CRAP they eat. I am not skinny, but my son is. It is just a conscience decision to make sure we play and eat right. Kids deserve the best, not what their parents will settle for. Or say I don’t have the time to cook good food…BOLOGNA!! We all can MAKE the time. If it is a priority.

  3. by Mrs. Treasure

    On July 18, 2011 at 1:02 pm

    I see obesity as a preventable disease. My sister-in-law died for her obesity, quite literally. My mother is dying from obesity. My entire mother’s family is dying of obesity. Of 13 children, only two of them do not top 300 pounds.

    I resent the idea that these parents don’t “know” how to properly feed their child. Every single human being who grew up in America can tell you the four basic food groups, and that McDonald’s for lunch every day is not good for you. So why are we still making this excuse?

    Obesity is a disease and if parents don’t treat it, they are neglecting their child’s health. Lazy, compromise parenting is no excuse for killing your child with food because it’s easier than saying no. Yes, if a parent cannot help their child be healthier, and the child is going to die from the obesity, the child needs to be with someone who sees how important it is to not die from your own fat.

  4. by Lindsey

    On July 18, 2011 at 1:34 pm

    Okay, I agree that it is a very serious issue that needs to be addressed. However, I don’t think taking a child away from their parent is the answer. Are we going to start taking away every child of a parent who smokes, too? That is just as likely to kill a person later in life as obesity. But our society can’t handle the children already in foster care for much more serious and immediate issues like abuse, neglect, and physical safety concerns. I think education is the key. It is frustrating to see people not raising a child the way I would do it but there will always be people who don’t live up to the standards someone else believes in. That does not mean we have the right to remove a child from parents who may be good and loving people otherwise (despite their obesity/smoking/etc.)

  5. by Marsha

    On July 18, 2011 at 2:02 pm

    I gave my opinion on this when the blog first came out, and i still stand by it. I can understand a little chubby. My kids were for a while, but then grew into their chubbiness. But for kids who look like little Micheline tire men, that to me is just disgusting. Yes, I think children should be taken away for this reason, but only after first the problem is identified by the pediatrician. That attempts by the pediatrician have been made to help the parents establish a proper diet, and finally, I think a court order with subsequent evaluations should occur before the option of removal from the home should be used. Also, a full battery of testing should be completed to rule out any possible medical issues, ie thyroid problems and such, as those are out of any person’s control and maintaining a proper weight at that point is difficult. And finally, i think that gastric bypass should be made an option, but only on a case by case basis, and that there be strict guidelines to warrant that surgery. A bypass is no good if the parents still continue to feed their kids garbage.

  6. by Chris

    On July 18, 2011 at 2:06 pm

    If you start taking kids away due to obesity, who will care for them? The government? The government can barely pay its bills the way it is!
    How about let’s take children away from families who are on welfare because they can’t care for their children without government subsidy! Let’s take children away from parents who smoke, not only are the children exposed to second hand smoke, they are more like to become tobacco users themselves.
    While we are at it, let’s take children away from parents who simply do not know how to parent – Then we will take children away from parents who use drugs, abuse alcohol, and/or gamble.

    WHEN WILL IT END?

    Our society is in the shape it is in because people refuse to take personal responsibility for their actions, and the actions that effect other. The Federal Government cannot, and should not be a gatekeeper – that isn’t the job of government.

    When people once again take personal responsibility for their actions and don’t rely on the government to sustain them, the government will work once again. The government isn’t God.

  7. by secondlook

    On July 18, 2011 at 2:32 pm

    As a person who has dealt with CPS in my own extended family…My Brother is Scitzophrenic and could not raise his kids. There is another side to this story. I was fit to raise my nephew b/c he was a partically hard case that CPS did not want to deal with. However, his sister who was sweet, pretty, and thin, was their choice to remove from my ex sister-in-law’s home. Please be aware my niece was sexually assaulted twice before she ran away from her foster care home. Instead of bringing this case to the public eye, her caseworker was forced into early retirement w/full benefits intact and dear niece was shifted to a group home, 300 miles away, and could not have any contact with us at all. The home was off a long dirt road in a remote area behind a junkyard for old cars… It looked to be a small version of south-fork for teen girls. It even had the group home’s mother’s name on an arch-way entrance to the luxurious home complete with swimming-pool, exercise room, and tennis courts. Funded solely by your tax dollars. The group mom and her twenty year old son ran the home. He was lounging by the pool with some of the girls when we arrived. The tanned, thin, teen-girls were required to compete in beauty pageants, Thus they had to maintain a certain weight.They also shared rooms, bunk-beds, four to a room. (Which we could not do.DFACS requires family members,that raise the kids to provide a room for each child.) They did all cleaning and cooking. This particular home catered to a certain race, which was made clear to me upon meeting the group mom…That was suppose to make me feel better.. LOL, I informed her I was not prejudice… She did not know my niece and nephew are mixed race. Much to their surprise, I made the trip with my nephew,(her brother), and my three year old daughter to visit her ever third weekend. But, only after I took DFACS to court and won visitation for her brother. We were only allowed one hour of visitation, supervised by group mom, after a 4 hour ride… The restrictions were placed solely in an effort to keep her quiet about what happened to her. She sent me an email from school library pouring out the details of her trama. The school immediately called group-mom and she was sent to boot camp for being disobedient. a.k.a. spilling the beans on them. Two years later she was placed in another foster home an hour away from us..but only after going to court a second time. We did bring suit against DFACS/CPS and won as well as imprisonment of her previous foster dad… but only after she was booted out, a.k.a. aged-out of the system at eighteen years old,even though she was in her senior year of high school.. Amazing how she came home to my family who was so unfit, a.k.a. not wealthy enough…. CPS/DFACS SWEPT HER CASE UNDER THE RUG.. IT WAS NEVER IN THE NEWS OF ANY SORT. Also, this DFACS DEPT WAS REPRESENTED BY THE LARGEST LAW-FIRM IN THIS WEALTHY COUNTY… So I had to practically search the ends of the state to find an attorney willing to challenge the crooked Judges that were in bed with that law-firm..Please Protect your Daughters, Big or Thin from these people..Their innocence is worth far more than weight issues. CPS is not who it is cracked up to be……….
    Also, please be aware of this article, brought to my attention by my attorney.. Under the Fostering Connections to Success and Increasing Adoptions Act of 2008(P.L. 110-351), the adoption incentives were revamped to provide stronger incentives for states to redouble their efforts to find children – particularly older children and children with special needs – loving adoptive homes. In
    addition, the law introduced the concept of an adoption rate, which is derived from comparing current year adoptions to the number of children in care at the end of the previous year. States receive additional money if they exceed their
    highest foster child adoption rate for previous years back to 2002. The Adoption Incentive program gives states $4,000 for every foster child adopted above their 2007 baseline, plus a payment of $8,000 for every foster child age nine and
    older and $4,000 for every other special needs child adopted above the respective baselines. In addition, states receive $1,000 for every foster child adopted over and above the level of the state`s highest foster child adoption rate for previous years.

  8. by Dana

    On July 18, 2011 at 2:33 pm

    As a professional that works with children in the foster care system…the thought of putting a child in a foster home that is not in imminent danger is RIDICULOUS. I am thankful to work with a private agency that licenses amazing foster homes…but there are many out there who subpar… there are STUDIES and STUDIES done on the outcome of kids ACTUALLY abused and neglected that show MANY of them do BETTER in the long term when they are NOT placed in foster care, then when they are placed in the system. Now, like I said, I license foster homes so of course I see the need for them…but it is ridiculous to increase our kids risks of MANY other things by taking them from their parents for this reason. Educate and intervene…but do a little research.

  9. by balimuse33

    On July 18, 2011 at 4:17 pm

    Removing the child/children from the home should be the last resort!! I feel the pediatrician should recommend that the parent take some kind of nutrition/support class to help the child loose weight and monitor the child to make sure that he/she is on a right track. if the parent refuse then dcfs should step in and help out by providing them services, if the parent still refuse then remove the chil/children and placed them with family not foster care.(My opinion) about foster care is that its only a paycheck for the care giver,and majority of them dont give a crap about the kids !! foster care wont take the time to help these kids loose weight because they have other kids to attend !!! (only my opinion)

  10. by Jennifer Margulis

    On August 3, 2011 at 11:26 pm

    Just read another interesting blog about the same subject that I thought you might appreciate Richard: http://www.blogher.com/taking-obese-children-their-parents?from=comments