Obese Ohio Third Grader Placed in Foster Care

by Bettina Elias Siegel on November 28, 2011

The Plain Dealer‘s Cleveland.com site and other media outlets report today that a 200-pound eight-year-old has been removed from his Cleveland Heights, Ohio home and placed into foster care due to an alleged failure by his mother to follow doctor’s orders to address his obesity.

According to The Plain Dealer report, the child originally came to the attention of Cuyahoga county social workers after his mother sought medical attention for his sleep apnea, a weight-related condition.  He was monitored by the county for a year under “protective supervision,” during which time his mother agreed to enroll him in a weight reduction program at Rainbow Babies & Children’s Hospital.

While the child’s obesity no doubt places him at increased risk of obesity-related diseases down the road, he reportedly has no such conditions now and is, according to the public defender assigned to his case, “a normal elementary school student who was on the honor roll and participated in school activities.”

Earlier this year we discussed this very issue (“Should Parents Lose Custody of Morbidly Obese Children?“) after a highly controversial opinion piece by Dr. David Ludwig appeared in the Journal of the American Medical Association arguing that in cases of life-threatening childhood obesity, the state should intervene and place the child in foster care.  That Lunch Tray post generated a lot of reader response, and fellow blogger Brianne DeRosa of Red, Round or Green was inspired to write her own passionate argument against foster care in such cases, which I encourage you to read (“The News Item I Can’t Shake“).

As I wrote in my original post about the JAMA opinion piece

I can envision cases where the risk of death from obesity-related diseases might well be imminent, and in those very, very rare cases, I believe state intervention for overfeeding woud be as appropriate as for the starvation of a child.  But those cases would be the clear exception to the rule.  In the vast majority of cases, no doubt the trauma of separating parent and child would far exceed the possible benefits of foster care and, of course, it’s not even clear that foster care would be beneficial in all cases.

Reading the Plain Dealer account (and of course, I have no facts to draw on outside of those in media reports), this certainly does not seem to be a case in which a child’s life is in imminent danger.  Indeed, if the mother’s statements are true, it sounds as though she is struggling, as so many parents are, to address what is a multi-faceted and often devilishly intractable problem.

A court date is set for next month (on the child’s 9th birthday) to resolve the custody dispute.  I’ll share any information I learn here.

[Thanks to Dana Woldow of PEACHSF for the tip.]

 

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{ 23 comments… read them below or add one }

EdT. November 28, 2011 at 12:33 pm

I expect we will see a sharp increase in this type of story, as well as the introduction of (and the “sentencing” of obese individuals into) “fat-camps”, where they will be subjected to severe starvation and harsh exercise regimens, all in the name of “protecting the children” and “reducing health care costs”.

~EdT.

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Amanda @ Tales of an Amateur Mommy November 28, 2011 at 12:44 pm

I find this incredibly sad… now you are intertwining the complicated problem of childhood obesity with a system that means well but is complicated and flawed on it’s own.

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Milehimama November 28, 2011 at 1:24 pm

That is tragic. And short sighted- special diets for kids are incredibly difficult and yes, burdensome for parents. Now he’s going to be bounced around the foster care system, with people who don’t have a history with him and don’t have the same level of dedication or concern that a parent would have- and they are supposed to do better than his mother?

I can’t imagine the trauma of an 8 year old, taken from his mother, and also given and entirely new diet/way of eating (if that’s what they do).

The truly disturbing thing is that the HOSPITAL got CPS involved after the mother came seeking treatment for his breathing. How many parents are going to read that- and then NOT seek help, thinking they’ll get their kid’s weight down first? And since when do SOCIAL WORKERS get to decide what medical neglect is, without a fair trial for the parents? Shocking.

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EdT. November 28, 2011 at 1:37 pm

“How many parents are going to read that- and then NOT seek help…?”

I’m sure that laws will be passed to make this a felony (actually, it would probably be prosecutable as “medical neglect” and “injury to a child” even today.)

As I said: depressing. If I had the whole job of raising a child to do over again… I am not sure I would be willing to take it on.

~EdT.

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EdT. November 28, 2011 at 1:34 pm

On a less snarky note, I think the problem we are facing is that the child welfare/government bureaucrats are using the same faulty paradigm that many well-meaning folks perpetuate about obesity: the fact it can be reduced to a simple mathematical equation of (IF calories in > calories out THEN weight gain ELSE weight loss). The truth is that weight gain/loss is a far more complex matter, involving things like metabolic rates, the endocrine and other systems not found in internal combustion engines, and chemical reactions (which is how the “fuel” we consume is “burned”.)

Your average CPS worker is NOT a trained endocrinologist, and so is incapable of making these decisions based on sound science. Your average family court judge is equally ill-prepared to deal with these issues, and will likely go for the politically expedient solution (even though it is based on ignorance of a level not seen since “disease is caused by too much blood, so to cure disease you attach leeches to ‘bleed’ the patient, and if that doesn’t work you remove their skull to let the demons out” was in vogue.) Hence, my above comment (which is actually a very depressing thing to think of, maybe reflecting my recent visit to the Holocaust Museum Houston where I saw the result of similar pseudo-science mixed with good old-fashioned ignorance and bigotry.)

~EdT.

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Kate November 28, 2011 at 8:56 pm

Ed, I am curious about your comments about obesity being reduced to a simple mathematical equation. While I think there be many factors that contribute to obesity, it ultimately does come down to just that in most cases.

I had my BMR tested in a university medical center. It fell just of what my predicted BMR would be. As I understand it is very rare for individuals to fall significantly below the predicted BMR, despite the frequent talk about low metabolisms.

I’d agree with that a CPS worker is not an endocrinologist, but unless someone can provide substantial proof to the contrary, an eight year old doesn’t get to be 200 pounds without taking in more calories than he expends.

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Bri November 29, 2011 at 10:21 am

Kate, I don’t disagree with your basic premise that he probably was consuming more calories than he was expending; but there have been studies conducted recently that have shown that the traditional “calories-in, calories-out” model actually is not effective as a weight loss calculation for some children. Why, I don’t think anyone is clear — but there’s always the possibility that 1) children are wired, hormonally and metabolically, to hang onto food and fat cells in different ways than adults, to prepare them for rapid growth and puberty; 2) chemical and hormonal shifts from environmental sources may play a part in disturbing their bodies’ ability to deal with calories the way an adult’s body might; 3) some kids just have to grow the way they grow, and they’ll even out in the height-weight ratio when they reach adulthood. Clearly we can discount #3 as a full answer for a child this obese…but honestly, if weight loss were truly as simple as calories in, calories out, we as a nation would not be struggling so mightily with our waistlines.

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Kate November 29, 2011 at 11:01 am

I’d be curious to look at the studies you mentioned. I think there are variations from individual to individual as how easily one can maintain a healthy weight. I don’t believe an eight year weighs say almost three times as much as his peers though without significantly increased calorie intake.

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EdT. November 29, 2011 at 10:33 am

If weight control were a simple matter case of addition/subtraction, it would be simple (though probably illegal, and certainly immoral) to prove. Simply take an organism (an animal, or a child) and stop feeding it. You should be able to measure the calories expended, and from there calculate the amount of weight loss expected per day/week/until the organism dies.

In real life, it just isn’t that simple. In addition to metabolic rates (btw I have had a low metabolic rate my whole life, and so have to watch my thyroid levels – my mother had thyroid problems), there is a little thing called “survival mode” – our bodies are wonderfully designed to cope with both feast AND famine, and will take measures to ensure our survival when famine occurs. How does the body determine that it is time to activate those measures? By a sharp decrease in the amount of food consumed! A sibling of mine went into a special in-patient weight loss program, spending a total of 30 days in a hospital with 24×7 monitoring and carefully controlled diet/exercise regimens. The result? The first 15 days, he lost 17 lbs. The next 15 days… he GAINED 2!

Another contributor to “obesity” is water. Some of us are very good at holding on to the stuff, and many medications have as a side effect “water retention/swelling in the extremities”. Recently, I lost over 50 lbs – NONE of it “fat”. It turns out I have a fairly advanced case of lymphedema, and the weight was “squeezed” out of my legs over a 7 week period. I have been told I could probably drop another 50-75 lbs easily through additional treatment, but that would probably require an in-patient regimen, since the lymphatic fluid is actually accumulating in my upper legs and torso.

Currently, I am maintaining this weight, though I eat less than a quarter of the amount I used to (and almost all of that is “fresh”, as opposed to “processed”, food.) Last time I counted calories, I was getting about half of what I need to “maintain” my body weight: so, forgive me if I don’t drink the “it’s only about the calories” kool-aid.

Last (but by no means least): the simplistic “it’s only about the calories” paradigm leads to an equally faulty bit of thinking, that obesity is the result of a “lack of willpower”, and that fat people are that way because they are “weak-willed”. I can assure you that this is a wonderful thing to be reminded of, day after day after day, by your doctor, your family, your boss, your co-workers, random strangers you meet on the street/an airplane…

Even better? When the State decides you have committed a criminal act (child abuse/neglect) because of things that happen (eating additional food) during times when the child, BY LAW, is in the custody of others (the school they attend) – where, in many cases, the very thing they don’t need (unhealthy food) is being offered.

The simple fact is that obesity (whether child or adult) is not a simple thing. Each person’s circumstances are different, as is the road to successful weight loss (despite what those in the weight-loss industry, who make a gazillion dollars off of yo-yo and fad dietary mumbo-jumbo, will tell you.) It is this over-simplification of a very complex issue that I rant and rail against.

We are already well into the “You can not continue to live among us, as obese people” phase. I want to stop this insanity, before it moves to the “You can not continue to live among us” phase.

~EdT.

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Kate November 29, 2011 at 11:14 am

I’m not saying it is only about the calories…but for someone like me, I do need to track what I eat daily….I really don’t have an intuitive sense of what the right amount of food for weight control is. My husband, and his sister on the other hand know very little about nutrition and at times both have been below their ideal body weight range. Sometimes he simply does not think about eating…not a problem I have ever had.

I wasn’t at all trying to make this an issue about willpower.

I don’t believe the kid should be placed in foster care. but I do believe in the case of this little boy the old saying applies…when you hear hoofbeats, think horses, not zebras…..meaning the likely cause of his obesity is ingesting more calories than he needs.

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Bri November 29, 2011 at 11:39 am

I’m sorry, Kate, but I respectfully must disagree with you. I think you’re over-simplifying. As I said in my previous response to you, of COURSE he has likely been taking in more calories than he needs. But think about HOW MANY calories he would have had to be eating, every day, for his whole life, to have reached such a shocking weight. I’m no nutritional scientist, but it would have to be A LOT.
The question is not whether he may or may not have been overeating. The question(s) are:
1) Can that possibly be the ONLY contributor to his obesity; and can it be proven so? Can we really be so confident that it’s diet, and diet alone, and SQUARELY on the shoulders of his mother, that we can justify taking him away from her? I think not.
2) Is it only his parents who have the responsibility of feeding him? Again, I think not. No child in this world, unless homeschooled and never out of the parents’ sight, eats only what his/her parents provide and approve of.
3) Given the recent research on the powerfully addictive nature of foods, and children’s particular susceptibility to these addictive properties, is it even just or scientifically correct to treat such an extreme case of obesity in a child as a behavioral or parenting flaw — punishable by removal from the home? We don’t tend to take away teens with eating disorders, or with alcohol and drug addictions — we tend to offer them treatment and work with their families to set up nurturing home environments, and if things sadly fail, we don’t blame the parents. How is it different in this case? Do we really think his mother has been strapping him down and force-feeding him Twinkies?
Sorry, I don’t buy the theory that a child with a concerned mother manages to simply eat himself to 200 lbs., despite attempted medical interventions. Nor that it’s all Mom’s fault. I suspect that eating is only ONE factor here, and that there are many complexities at work.

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Kate November 29, 2011 at 12:11 pm

Bri…I don’t advocate for taking the child away from his mother….I don’t think that I ever advocated for that. I don’t think I ever said there was a parenting flaw here. However, as a daughter of an alcoholic, and one who has struggled with food issues herself…I’d have to wonder if the weight is representative of some other pain in this child’s life.

I’m not at all disputing that things like food addiction exist, at all. I’m not at all disputing that there are a host of factors that make it easier/harder for one person vs. another to maintain a healthy weight. If a person is a food addict though, that makes it that much harder to have an inuitive sense of what to eat.

I’d agree that there be many complex issues that cause the child to overeat.

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EdT. November 29, 2011 at 12:48 pm

I also track what I eat – but calories isn’t the most important of the data points (or even high on the list.) For me, it is carbs, sugars, and sodium, followed by a scanning of the ingredients in the list (looking for things I can’t pronounce, as well as “corn sugar” in all its various permutations.) These are the things I find have the most effect on my overall health.

~EdT.

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Kate November 29, 2011 at 1:14 pm

Ed, I also track my carbs…and try to avoid high sodium foods.

I’ve tried lower carb eating plans where one didn’t track calories, but these have never worked for me in the long term. I know they work well for many people though.

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June November 28, 2011 at 2:34 pm

This is the saddest story. Being taken away from one’s parents, especially a kid who is doing so well in all other aspects of his life, and obviously has caring parents, is awful. I’m guessing he is going to be pretty damaged by this decision. And, I’m also guessing that his medical condition isn’t going to be improved in the long run by this, at all.

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Bettina Elias Siegel November 28, 2011 at 9:34 pm

Jumping in late again, as usual these days. Sorry for that.

All I can say is that I find this whole story terribly painful to read about, and I agree with Milehimama that this story could deter parents of obese children from seeking medical care, the exact opposite of the desired result. I also agree with June that the trauma of being separated from one’s parents is only likely to exacerbate the situation.

And as for the exchange between Ed T. and Kate on the mechanisms of weight gain, I’m no expert and probably shouldn’t even opine. I will say that I used to subscribe only to the “simple math” view, and I still believe the majority of people seeking to lose excess weight could lose at least a significant portion of it via calorie reduction and increased exercise. That said, there have been some fascinating hints coming out of recent research that all sorts of heretofore unsuspected environmental influences could be playing a role in the recent rise in obesity, like BPA exposure and the overuse of antibiotics.

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EdT. November 29, 2011 at 10:49 am

There is another issue that isn’t mentioned in this story: being put in the foster care system isn’t just traumatic, in some cases it can put the child at risk for other types of abuse. Remember that Coach Sandusky was a foster parent (and had been “vetted”, more than once, by the child welfare folks in PA.) Few states have the staff to properly supervise all the foster parents. And, since if a child has a complaint sustained about a foster parent, it is a black mark on the child welfare agency/worker, there is a big incentive on the part of the state to discount/ignore any complaints the child might raise.

Also: I am not expert in nutrition/weight loss, though over the past several decades I have learned a lot, and have gained a lot of experience in these matters. What surprises me is just how ignorant most medical professionals are in this area – which I discovered when I first visited an endocrinologist. I do wonder how “connected” the medical profession is with agri-business (one linkage is the FDA), and also with other industries (such as weight loss) where their advice might be affected.

As I mentioned elsewhere, my big beef (pun slightly intended) is with the simplistic “calories in – calories out” method of “weight control”, because calories are an imperfect measure for humans (since, with the exception of those unfortunates who suffer from Spontaneous Human Combustion, our bodies consume “fuel” via chemical, not combustion, reactions), but mainly because it leads to other overly-simplistic lines of thinking, which, combined with the normal human tendency toward self-righteousness, result in situations like the one in Ohio.

~EdT.

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Kate November 28, 2011 at 11:39 pm

I looked up the information about BPA and saw that it was linked to insulin resistance. Do I believe something like BPA could contribute to a chain of events that could lead to obesity…sure. I don’t think it happens, though without the accompanying calorie intake.

I probably was insulin resistant for 20+ years before getting a diagnosis of diabetes, and I do believe persons with insulin resistance do struggle more with weight management. I think for a person with insulin resistance it might require more vigilance to adhere to a certain way of eating and calorie tracking to maintain your weight.

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Milehimama November 29, 2011 at 2:19 pm

I think that while calories in/calories out can be used as a simplistic way to describe how people become obese, there is more to the story especially in the case of young children.

In my experience, most children more or less self regulate their appetite. If a kid isn’t hungry, you can’t make him eat. Ask any mother who, concerned that her kid is living on air and graham cracker crumbs, begs/pleads/cajoles/bribes kids to eat something- anything!

While certainly a child will eat more “junk” food than carrots for a snack, for example, this kind of morbid obesity in a 3rd grader would seem to indicate an underlying problem- WHY is he compelled to eat so many more calories than he expends?

Have ALL of the underlying causes been addressed? Genetic testing? Metabolic resistance? Environmental factors? None of those will be “cured” by taking away the kids mother.

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Kate November 29, 2011 at 2:39 pm

I totally agree there is a “WHY” there.

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Milehimama November 29, 2011 at 2:22 pm

Wanted to add- my above comment about seeing ELSE is going on, the underlying cause comes from my perspective as a mother who sought treatment for my 6 year old, concerned he had an eating disorder. It turned out it wasn’t an eating disorder, but it was neurobiological in origin and no amount of diet foods could cure that. When those underlying issues were addressed, then the food issues resolved themselves.

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Bri November 29, 2011 at 4:01 pm

I’m reading Milehimama’s comment and nodding in agreement. Because sometimes there’s something else going on…and sometimes you may not ever know what it is. Those who have read the post from my blog that Bettina graciously linked to above will recognize that I’m the parent of an overweight child – and he’s not a child who noticeably overeats, he’s not a child who eats junk, he’s not a child who loafs in front of the TV all day. He’s active in horseback riding and kung fu, he goes to a preschool program where they play outside for at least an hour a day, etc. He often skips snacks of his own accord, and on Thanksgiving, he only ate a few bites of his favorite pumpkin pie before declaring himself full. But even though at age five he’s wearing 5/6 clothing and looks pretty “normal” to the eye, his BMI is a problem.
We don’t know why. We might never know why. But even though I suspect he’ll end up just fine — his dad and I both did, after inexplicably heavy childhoods — we experience a lot of scrutiny for his perceived weight problem. How terrifying to hear these stories and know that it’s always going to be deemed the parents’ “fault” unless current science can explain a kid’s weight.

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Bettina Elias Siegel November 30, 2011 at 10:26 am

I’ve been reading with interest this whole exchange and thank you all for your thoughts and comments. Bri’s story about her son does raise questions about the mechanisms underlying weight gain, especially in children.

I grow ever more humbled as I write TLT — on this and many, many other topics I used to think I knew a lot about.

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