Monday, November 28th, 2011
Today there is a reported case of an obese third grader being placed in foster care. The rationale for this is that when a parent(s) ignores or doesn’t properly follow medical recommendations – and their child continues to suffer from extreme obesity – then the appropriate agency can petition a court and cite “medical neglect” as a rationale for temporary placement in foster care.
I discussed this issue this summer in response to a thoughtful and provocative editorial published in the Journal of the American Medical Association. But now that we have a current news story in front of us, it seems appropriate to continue the debate.
To start, let’s be clear about one thing – a third grade boy who weighs over 200 pounds and is suffering from sleep apnea requires immediate intervention (we’re not talking about a kid who is a little heavy for his age). The health risks – both immediate and longer-term – are too great to be ignored. Let’s add to this that fundamental changes in the child’s caretaking are necessary (we’re not talking about occasionally eating too much junk food and not getting quite enough exercise) – especially since they have not happened despite medical advice. And even if there is a medical basis (including rare but powerful genetic conditions) underlying the obesity, major lifestyle alterations will need to be made with respect to diet and activity. So the issue is how best to deliver an intervention that will be successful.
I continue to understand the frustrations of practitioners who are trying to (quite literally) save a child’s life, and watch as their suggestions are not followed. But I still disagree with the idea of taking the child away from the mother, especially since the goal is to return the child at a later time. Simply put, I think administering in-home intervention that will help teach the mom and her son how to break the extreme habits that have been formed would serve as the best platform for long-term change. As someone who is currently conducting research on family-centered interventions, I know first-hand that this is easier said than done. But to me there is much more potential for improving this family’s life – and this boy’s health – by keeping them together and devoting all the potential resources to deliver in-home care to get this family to make the changes they need to make. Sometimes families need help, and by bringing medical intervention to them in their home environment, perhaps we can make more progress in the fight against childhood obesity.
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