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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Bri says
What do I think? I read this yesterday, and spent lots of time trying to research it, and I feel viscerally ill. I cannot shake that feeling. I was going to blog about it myself last night, but I found it was too emotional. Couldn’t write a word.
I may try again to articulate myself on my own site, but to sum it up: 1) INTERVENING for the sake of these children could be done in a very different way from REMOVING them. Tearing families apart because of a child’s weight, when there are SO many complex factors that may contribute to it, is shocking to me and may cause long-term psychological implications that we can’t even fathom. What about designing a whole new paradigm? I don’t know what it would include — live-in dietary aides? Supervised mealtimes? Daily dietician visits? Family relocation to a facility that works 24-7 with them to retool their lifestyle and their way of being together? I don’t know. But none of those solutions are as drastic as taking kids away.
2) Our foster care system is shaky at best. Case workers are overloaded. We hear all the time about children who are severely abused and neglected, who die because they “slip through the cracks” of an overburdened system. Now let’s complicate things and put more strain on the system by adding to it kids who are too big. That makes no sense to me. Too much drain on resources.
3) Sure, now it’s the small fraction of kids who’d be recommended for this program; but what’s to say the guidelines/parameters don’t change at some point? What’s to say that 10 or 20 years down the road, our country’s still way too heavy, and somebody says “Great…we’ve got to take away MORE kids to fight this?” Who’s deciding? Where are they going to draw the line?
4) It’s size-ist. Yes, there are horrible health implications. Nobody denies that. But at a certain point, it just becomes punishing people for being large or for having children who are large. No matter what your justification is, that’s not okay. It’s no more okay than it was fifty years ago when babies with Down Syndrome were taken from their families and put into institutions.
5) Weight is not the only measure of parenting. What about skinny kids who are fed unhealthy crap and may have lurking disease? What about kids who are normal weight but are failing school, doing drugs, engaging in risky behaviors, spending too much time in front of violent video games, etc., etc.? Nobody takes those kids away from their parents. Nobody says that their problems are such a reflection of their parenting that they can’t live at home anymore. Come on.
6) My kid is only a few pounds overweight, despite my desperate attempts to resolve the issue, and I already don’t want to take him to the doctor. I do, because I have to, but I’m so emotionally worn out from being shamed and treated like a bad parent because of his size. When your child is overweight, you don’t get credit for how smart they are. You don’t get credit for how kind they are. You don’t get to talk pleasantly about their developmental milestones, their wonderful gifts, their many successes. You don’t even get to point out that your kid hasn’t been sick all year, is active and happy, and shows no signs of the supposed wretched illness the extra weight is supposed to cause. The only thing doctors want to talk about, when your kid is even a pound above that magic line, is WHAT’S WRONG WITH THEM AND WHAT’S WRONG WITH YOU. I already get treated like a second-class citizen in the health care system. I can’t imagine how much worse it could be, with every mounting pound, with every doctor’s visit, if the threat of some nebulous future that might include TAKING MY CHILD AWAY no matter what I’m trying to do to help him, hanging over my head.
I’m sorry to rant and ramble. But I’m nearly in tears. This is so, so wrong.
Bettina Elias Siegel says
Bri:
Fist, I feel really honored that you shared your perspective here.
As with so many of your thoughtful comments on TLT, I found myself brought up short, forced to reexamine some of my assumptions and prejudices. For example, I was about to jump all over your statement that this proposal is size-ist, thinking that it is purely a matter of a child’s health and well being. But then I got to your point 5 and was forced to agree that there are many other ways in which a parent could endanger a child’s health, short of abuse, where no one would dream of removing the child from his or her home. And most of all I was quite moved by your last point, discussing your own experiences with an overweight child and the way in which you feel you and your child are viewed differently — and negatively — through no fault of your own.
I suspect you’ll disagree, but the lawyer in me can still envision the “blue book” hypothetical in which a child’s weight is so extreme and his/her health so clearly and imminently endangered that, if the parents have repeatedly failed to heed medical advice — removal from the home might be warranted. But the key would be “imminently” — if a child’s health problems are of a more chronic nature, than I agree with you that removal would never be the right thing to do.
Bri says
I don’t know if I so much disagree with you about the very odd, very extreme, outside case, Bettina. That’s kind of the point, though, isn’t it — that there’s a lot of gray area here, and it’s sort of dangerous to embark on such a slippery slope without a lot of qualifiers? The thing is, it’s what is NOT being said that is the biggest disturbance in this whole mess. What’s NOT being said — or at least, not reported — is that there have to be about a dozen other, less traumatizing, more family-oriented, NEW solutions implemented first. I think before you can even talk about whether or not a family is “repeatedly failing” to heed advice, you have to talk about how you can intensively and consistently intervene with that family to even make success possible. Just saying “your kid is too fat, and you need to do xyz diet and exercise programs” clearly doesn’t cut it anymore. We have to think creatively to figure out what might come in between the first signs of obesity and the extreme medical emergency.
And believe me…I do see that. I personally knew a child who died of massive cardiac arrest at age 6. She was medically fragile due to many special needs, and was also morbidly obese (as was the rest of her family). By age 6, she was so heavy she could barely move around on her own. Doctors tried. Early intervention tried. But when you’re just talking, talking, talking at a family whose language skills, resources, etc., etc. are limited, their ability to successful grab hold of the information, use it, and positively impact their daughter’s life and health is tragically at about nil. I still think of that child and what a tragedy her death was — how preventible it was. But I’ve always thought of it not as “Why didn’t they take her away?”…rather, “Why didn’t they help that family before it was too late?” I think that her case is a perfect example of “How do you define imminent?” Until the day she passed, nobody thought a 6-year-old kid was going to die of a heart attack. I’m sure her medical caregivers all thought her condition was more along the “grave chronic illness” spectrum, not the “imminent danger of death” spectrum. That’s the hardest thing about this. Some morbidly obese people live much longer, with many fewer health complications, than others. Some people die of obesity-related causes when they are still in the “overweight” range, while others get up to 600+ pounds and survive. How can we tell?
EdT. says
Bettina – I also was ready to challenge the contention that this is “size-ist”. But then, I too stopped to think, and to be honest Bri has a point. It seems that society has had to cast about for a new “they’re raising MY health care costs” pariah now that smoking is on the decline, and somehow it set its sights on obesity. (It should be noted that some tried to re-target the LGBT community in this regard, but that this hasn’t been as successful – at least not directly.) I would add, however, that children – especially the taking of children into public places where some folks don’t think they should be taken – is on the increase, and in many cases is being accompanied by the same cries of “these are BAD PARENTS BECAUSE THEY WON’T HIDE THEIR KIDS AT HOME WHERE WE DON’T HAVE TO BE EXPOSED TO THEM.”, combined with disparaging remarks about “ALL PARENTS BEING UNWILLING TO USE OLD-SCHOOL DISCIPLINE ON THEIR UNRULY LITTLE OFFSPRING” (even though I suspect they would faint dead away if they saw an angry parent giving a small child a good “old-school” butt-whipping in public.) So, I wonder if it isn’t more a matter of “it takes a village” being taken to extremes, or possibly a reaction (totally foreseen, IMNSHO) to the thought of “universal health care” where fixing the consequences of someone else’s mistakes will be paid for out of my pocket (so to speak), combined with a good healthy dose of ignorance.
Oh my, I need to navigate away from this page… I am getting all worked up (not that I wasn’t already, as in “ever since I first read about this topic”), and I need to get my blood pressure back under control.
‘Later!
~EdT.
Bettina Elias Siegel says
EdT – interesting idea, that obesity is the new scapegoat in the health care debates. Like smoking, obesity DOES actually drive up health care costs significantly, but of course that’s not an excuse to stigmatize or shame individual people — we have to figure out the interventions to get at the root of the problem. But I’m glad the post got you worked up! Nothing is more fun to read than EdT when he’s on a roll! 🙂
EdT. says
What I really think needs to be done is to identify the root causes of this “epidemic” – then figure out how to address those. And, I don’t think this is rocket science, as we have plenty of studies that point the way to the root causes. Our manipulation of the food supply at a biological level, in order to increase yields and feed an ever-expanding (pun intended) population; the use of preservatives in food, in order to extend its shelf-life t0 Eternity; the addition of HFCS/”Corn Sugar” to dang near EVERYTHING we eat, as a replacement for “bad fat”; the near elimination of physical activity (outside of regimented exercise programs) from childrens’ schedules, due to the needs of high-stakes testing and the fear of sleazy, raincoat-wearing pervs who wait behind every tree to snatch the little ones up; an lifestyle which encourages eating as fast as possible, resulting in the consumption of more food than is either necessary or desireable; and I could go on and on and on. Many of these things have been written about, in this and other nutrition-related blogs and journals.
The problem I see is that many of these issues are being addressed by advocates, which tend to spin them with an eye toward bolstering the position they are advocating. Unfortunately, we evolved in order to be able to survive in a natural order that is very different than the one we have created, and as the commercial (for a processed food product, ironically) said, “It’s not nice to fool Mother Nature.”
(I really do need to put these thoughts down in a blog post of my own.)
~EdT.
Mel says
Bri – you’ve said everything I feel. Every single point you made brings tears to my eyes. I can’t put into words how SCARY this scenario c0uld be . . . can’t people see that? Can you imagine the implications based upon a premise that can have the yardstick moved based upon the “lastest” study? Being a parent, I cannot believe that ANYONE would choose to give this power to any entity. Open this door an inch, and God have mercy on us.
MultitaskMamma says
There are different ways of looking at this… as a mom, it would terrify me to think that there was another legal way that the government could steal my children from me… often times, bringing in these new custody laws just allows more room for misuse of them. The legalities around it freak me out… MY CHILDREN… MINE… not the government’s… Big Brother already scares me enough!
I’m not from the US, though, so, my opinions are only based on what I know from my country’s stances and from my outsiders opinion of the US government.
The other day, my two year old, who was supposedly playing with my 4 year old in his room, ran out the front door while I was in my room folding laundry. It might have taken me longer to realize she had left, had the dog not gotten out when she left the door wide open… and my son ran into my room all freaked out about the dog getting out. My daughter had never opened any of the doors in our house, so, why would I expect her to be able to open the front door and go outside?
I was absolutely HORRIFIED when it hit me that she was outside running around by herself!!! I have never ‘lost’ a child for even a few seconds. I am always careful when out with the kids and at home, that they are safe. We had just moved to a new town and I didn’t know anyone, so, I was scared to ask around when I went outside to look for her. I didn’t want to give the wrong impression and have child services called.
I ran up and down the street looking frantically for my tiny two year old girl. Then I went behind our house and looked in the back alley… just in time to see her walking back home down the middle of the back alley, wearing only her diaper and her brother’s shoes that we way to big for her. She had a big smile on her face and a bunch of dandelions in her hand.
Those few minutes of not knowing where she was were the worst moments of my entire life… ever ever ever… terrifying. I know that she probably looked so bad, too, naked with just a diaper… walking alone down a back alley.. wearing shoes a million sizes too big for her… dirt all over her because she had probably been playing in the gravel of the back alley (she loves dirt)… I am fortunate that no one spotted her and called Social Services! I could have lost my children or at, very least, gone under supervision for that!!!
I shared that story with only a few of my close friends.. and all of them told me stories of when their kids scared them in similar ways… and one person even told me about his sister almost losing her children over a similar scenario.
That story probably has nothing to do with Obesity… that’s a whole other issue.. I’m just saying that, I would absolutely hate for “legalities” to have any more reason to take my kids from me. I’m a good parent, but everyone makes mistakes, everyone can sometimes look bad to the Social Services… shit happens.
HOWEVER.. I think that if your kid is FAT.. like disgustingly, morbidly obese… baring some sort of medical reason… there is something seriously wrong there. Does the kid have some sort of issue in their life that they are covering up with food. Are the parents using FOOD like a DRUG in their home? There is SOMETHING going on that is NOT healthy… and YES, I think that it should be treated the same way as it would if your child were being starved or beaten or exposed to drugs or whatever… because it is a very similar thing… just because America is known for being obese and loving their food, doesn’t mean that over-eating, having health issues from being morbidly obese, and not feeding your children a proper diet should be overlooked by Social Services.
Perhaps the children should not be removed from their homes.. there are enough children in “the system” as it is.. and it seems like a good number of foster homes are not helping children in any way, shape, or form in America… however, I think there needs to be mediation! 400lbs for a child is UNACCEPTABLE…. absolutely! HECK, a school-age CHILD over 150lbs is absolutely unacceptable! My son is almost 5 and 45lbs and we think HE is a big guy.. he’s taller and big bulkier than your average kid… he looks like he’ll grow up to be a football player. Barring medical issues and inborn tendencies… kids should not be fat. Absolutely not.
The parents NEED to be held accountable. They need to be educated. They need to be watched. They need to be supported. In circumstances where you can see that the whole family has BAD eating habits and are all disgustingly overweight, perhaps a dietitian should be called in… perhaps eating habits, brochures, grocery lists, recipes, exercise schedules… perhaps people checking in every other week to see the progress.. perhaps mandatory doctor visits & weigh ins every month. Taking the kids from their parents should be absolutely LAST option.
Bettina Elias Siegel says
MultitaskMama – I think a lot of readers share your feeling that the removal of a child from his/her home has to be the absolute last resort and like your experience with your daughter disappearing (scary!), there’s a legitimate fear that the government will make the wrong call. It sounds like you do support intervention, though, and I think a lot of people agree. One thing I’d chide you on a little is the use of the word “disgusting” to describe morbidly obese kids — not because I want to be a scold, but just to point out what reader Bri was saying about the size-ist streak that may be running through this whole idea. (Also see the link left on this post by Dana Woldow about the guy who wants to shame fat people!) Thanks for commenting here!
Kim says
Thank you, Bettina! I wrote my comment below before I saw this one from you.
Kim says
MultitaskMama, please stop using the term “disgustingly overweight.” It’s terribly mean and hurtful.
Dana Woldow says
Hard to say which idea is more horrifying – the taking away of obese kids from their parents, or this guy’s idea.
http://tinyurl.com/6aqd747
MultitaskMamma says
I wonder how our grocery stores would look if companies who made really bad-for-you food had to put yucky labels on their stuff just like the cigarette companies… Or if places like McDonalds had to put nasty labels and warnings on their wrappers for their Big Macs and Fries and whatnot. That would be interesting!
The difference between smoking and over-eating is that smoking harms others, while over-eating really just harms yourself… unless you are passing the over-eating habit to your children, which is sort of what this whole blog post is about.
I definitely think it would be interesting if foods with high sugar/fat/salt content HAD to have warning labels on them…
EdT. says
The warning label *I* would like to see:
“Consuming this food in a public venue may result in self-righteous a**holes engaging in the making of snide, insulting, rude, and ignorant comments about you, your parents, your will power, and other things they know nothing about.
While it may *seem* highly desirable to respond to such effrontery by jack-slapping the fools into the middle of next week, please remember that assault is a criminal act, and that the temporary stress relief you will obtain by doing so isn’t worth spending time in a jail cell.”
~EdT.
Bettina Elias Siegel says
I just like the phrase “jack-slapping.” It reminds me of Dick Cheney’s infamous and colorful “frog march.” LOL.
Bettina Elias Siegel says
MutlitaskMamma: given the power of the food lobby in our country, I would say, don’t hold your breath! 🙂
MultitaskMamma says
I definitely never said I WANTED it to happen… said it was an interesting thought.. thank you
Kim says
The brain surgeon who wrote that article seems to think that smokers have suffered bias and bigotry more than overweight people. What planet does he live on?
EdT. says
Dana – I made the mistake of clicking on that link, and reading the article. I also don’t know which is more horrifying, but I know the very idea of this being declared not only socially acceptable, but even a desirable behavior, is just… oh Christ I can’t even say what I am thinking right now!
To those who would push such a program, I would consider hiring flash mobs to swarm them at random intervals in public, and point out one of their “failings” by pointing at them and shouting (in unison) “YOU’RE SO %WHATEVER%! EWWWWW!”
As one who has been subjected to public shaming and ridicule on account of his weight, I can say that is it simultaneously one of the most depressing – and one of the most *enraging* – things one can experience.
I certainly hope I never have the misfortune to meet Mr. Alex Beam in person, for I am not certain I could control myself.
~EdT.
Bettina Elias Siegel says
Yeah, he sounds like a real prince, doesn’t he?
Bettina Elias Siegel says
OMG! Horrible. But what puzzles me is that this person doesn’t think overweight people already suffer from stigma in our society. Maybe they’re not called out on government public health billboards, but studies show that they’re discriminated against, paid less in the workplace, viewed as less intelligent, etc. etc.
Jamie says
Here I come with my social worker perspective. I think the whole idea is ludicrous. But I’m here to talk about the fine points of foster care.
First off, Bri, thank you for sharing sure pure, heartfelt passion.
I find myself repeating the following story whenever anyone starts throwing “foster care” into the mix. As a white, middle-upper class, educated woman who finds herself with a social circle of the same, I’m often appalled at what most people think about our state care. Those 2 examples of kids losing weight are wonderful. Miraculous, even. However, the bulk of foster care sucks, to put it simply. People tend to envision these wonderful homes where children can be taken from awful circumstances and go on to lead fulfilling lives. This can and does happen but there’s a flip side as well. I often hear this, “those kids should be taken from that mother.”
I was part of team that removed 3 children from their mother for gross neglect. Not overt abuse but pretty horrible neglect. The kids were placed with a foster mom. This woman left them in the care of her boyfriend one night. The 2 year old had some sort of tantrum and the boyfriend put her in a large pot of boiling water. She had 3rd degree burns over 70% of her body.
I don’t think I need to state anymore about the fallout from this tragedy. I feel it bears repeating because some children go from the frying pan to the fire. The system is extremely taxed and needs massive re-hauling. And yes, many children need to be removed from their current situation. I would venture to say that obesity is not one of them.
Of course, there are special circumstances but what I can’t stand about this article is once again, it’s putting an idea into the mainstream that logistically will never happen. And now we’ve got more people talking about “those people”.
Sorry. I know this was not addressing the actual topic. But I seethe when foster care starts coming into the picture. It ain’t all roses.
EdT. says
Jamie – I think you bring out a very good point, one that needs saying (or even “shouting from the mountaintops”.) Too many people talk as if foster care (or, just as bad, the “orphanage”) is some sort of Utopian paradise for children who have less-than-ideal parents. This simply isn’t so! While there are times when removing a child is necessary, it is an extreme solution, and does not guarantee a successful outcome.
I remember, back in the days when I was a pre-teen, that my parents had a major fight (of the verbal variety) – one of the very few they had during in all the years I lived with them. It got bad enough that words were said (in anger) about us kids leaving the house. While those words were taken back, the absolute terror they inspired in a child still in elementary school can never, ever be un-lived. I cannot imagine *any* child being subjected to removal from the home, who would not experience the same terror at the thought of being separated from those they are dependent on (even if part of them is expressing relief at being liberated from a really bad situation.)
~EdT.
Bettina Elias Siegel says
Oh, Jamie. Horrible. And I think that’s possibly the most important point here. Even if you felt foster care was warranted (a highly controversial proposition), where are these idyllic foster homes where the family is going to know what interventions to use to treat what can be a highly complex, intractable problem?