Two readers sent me links to this news story, which has gotten a lot of media play: David Ludwig, an obesity doctor at Children’s Hospital Boston, and Lindsey Murtagh, a researcher at Harvard’s School of Public Health, have published an opinion piece in the most resent issue of 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.
Not surprisingly, the editorial has set off a fierce debate, raising the spectre of a Nanny State snatching chubby children from the arms of their loving parents. But from what I can glean from the Internet (the original piece is behind a pay wall), the authors are far more measured in their beliefs than media reports might lead you to believe. Here they’re quoted as saying:
State intervention would clearly not be desirable or practical, and probably not be legally justifiable, for most of the approximately 2 million children in the United States with a BMI at or beyond the 99th percentile.
Giving two examples of situations where they believe foster care was warranted, the authors cite a
12-year-old girl who weighed 400 pounds and whose parents had physical disabilities. After a year in foster care, she lost 130 pounds and her Type 2 diabetes disappeared. In another case, a 555-pound teen placed in the home of his mother’s sister lost 200 pounds in two years.
In such extreme cases, the authors believe:
State intervention may serve the best interests of many children with life-threatening obesity, comprising the only realistic way to control harmful behaviors . . . . In severe instances of childhood obesity, removal from the home may be justifiable, from a legal standpoint because of imminent health risks and the parents’ chronic failure to address medical problems.
In an opposing op-ed written for MSNBC, Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, disagrees:
Our laws give enormous authority to parents and rightly so. The only basis for compelling medical treatment against a parent’s wishes are if a child is at imminent risk of death — meaning days or hours — and a proven cure exists for what threatens to kill them. Obesity does not pass these requirements.
The risk of death from obesity is real, but it is way down the road for kids. There is no proven cure for obesity. The ability to treat a child with diet or a lifestyle change who does not want to be “treated” by strangers is a long shot at best. . . . . And, no matter what you do with overweight children, sooner or later they are going back home where their often overweight parents will still be.
Personally, 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. As Dr. David Katz of the Yale Prevention Center said in this news story (which offered a paraphrased quote):
. . . without having evidence that foster care would benefit a morbidly obese child more than his original caregivers and without knowing cost and benefit tradeoffs when the state takes children from their parents, it’s too early to say whether this is an appropriate response.
So, what do you make of all this? Let me know in a comment.
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