Friday, July 15th, 2011
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.