I came across an interesting piece in the LA Times that has really gotten me thinking. The question at the center of the piece is whether morbid obesity ever constitutes child abuse and if there are circumstances where obese children should be removed from their parents’ custody.

Family Photo -- Clearly Fat and Abused

The debate rose to new levels following the publication of a prominent commentary in the Journal of the American Medical Association by Dr. David Ludwig and Lindsey Murtagh. The two argued that when children are near death as a result of morbid obesity, the state must consider intervening on their behalf. While the practice is certainly uncommon, it has at times occurred both in the U.S. and abroad. Their reasoning rests on the severity of the diseases which accompany morbid obesity. In many cases these conditions will follow children into adulthood. In the most extreme cases, these diseases can even prove fatal before children reach 18. Accordingly, supporters see state intervention as necessary to prevent the death of a child. Those against the practice argue that it is an overreach of governmental authority and the benefits of removal have yet to be proven.

The LA Times presented both sides of the argument, with Dr. Norman Fast arguing for government intervention and David Orentlicher arguing against the practice.

PRO – Norman Fast

Dr. Fast argues that childhood obesity is a condition of child abuse worthy of government action because “[f]or a small number of morbidly obese children, state intervention could be lifesaving.” However, he recommends strict standards for intervention. First, it must be extremely likely that serious harm is imminent. Second, there must be a good chance that the intervention will benefit the child. Finally, government intervention must be a last resort.

It is clear that Dr. Fast is concerned about children: “there is a small percent of severely obese children who are going to die soon if there’s no state intervention.” In his mind, that is where the government must play a role; the state does not intervene simply to correct obesity. Instead, the government must play an active role when a child’s life is at stake. “The goal of state action is not to fix obesity–it’s to prevent death in cases that are the worst of the worst.”

To Dr. Fast, morbid obesity lies at the far end of the spectrum of malnutrition; it is a condition of overnutrition. He makes the point that children are routinely removed from homes for “nutritional neglect” and undernutrition. In his mind, the government should treat all forms of malnutrition–both under- and overnutrition–with the same methods.

Here's the Real Abuse

CON – David Orentlicher

Central to Mr. Orentlicher’s argument is the reality that we do not have any data to support the efficacy of state intervention in cases of child obesity. We simply don’t know whether removing morbidly obese kids from their homes actually works.

Moreover, there are some additional problems with government intervention. First, it places all the blame for childhood obesity on the parents, neglecting other causes such as genetics, environment, and poverty. Second, it neglects to make any attempt at working with the family in a less invasive manner.

Childhood obesity does not fit the typical mold of abuse, according to Orentlicher: “We are not talking about an abuse situation where the child could be killed at any moment.” Instead, obesity is a long-term medical problem. It does not have the urgency that typically comes with abusive situations.

Orentlicher recognizes that proponents want to reserve this practice only for the most extreme cases. However, in his opinion, “when we try to implement these kinds of policies and limit them to only the appropriate cases, it just doesn’t work out.” Ultimately, decisions are made in arbitrary ways, and children may be removed from homes in unfair ways. Additionally, he warns that the government might be “too quick to intervene.”

Basically, Orentlicher argues that we are “weighing an almost certain harm against a speculative benefit.” We can’t do that when there are children in the mix.

MY TAKE

The biggest problem I have with state intervention is that it presumes that the government has a fix for childhood obesity, that the state can “cure” these morbidly obese children. Childhood obesity is just as complex, if not more so, as adult obesity; there is no shortage of factors playing a role. Yes, the home environment is one of those factors, but it is certainly not the only variable at play, and it may not even be the most important. Assuming that childhood obesity will be resolved by removing the child from the home drastically oversimplifies the reality.

Part of that reality is that we currently have no effective treatment for childhood obesity. The state doesn’t hold some secret cure for these kids. What is it going to provide to ensure that their health improves? We’ve seen time and time again that diet and exercise alone are no match for morbid obesity. What does the government propose to do differently?

On a personal level, I was a morbidly obese teenager. Was it child abuse? Definitely not. As a family, we tried everything possible to get me to lose weight and, short of that, to keep me as healthy as possible regardless of my weight. This finally culminated in my gastric bypass at age twenty-one. You can’t tell a family’s home life simply by a child’s weight; obesity is far more complex than that. And obesity is not strictly environmental. Rarely is a child obese only because of her parents’ actions.

In the extreme case where a child is near death due to obesity and the home has become an unsafe environment, yes, removal should be considered, but that should be the exception, not the policy.

What do you think? Does fat equal abused? Are there circumstances where obese children should be removed from their parents’ homes?