Debate: Should the State Take Severely Obese Children From Their Families?

By Veronique Greenwood | July 14, 2011 4:10 pm

justice

What’s the News: Childhood obesity rates have escalated dramatically in recent years, in concert with nationwide explosion that has 34% of American adults falling into that category.

Now, scientists writing in the July 13 issue of the Journal of American Medical Association argue that much as feeding kids too little is considered child neglect, so should be feeding them too much. And if the former is grounds for removing them from their families, then the former may be as well.

As you can imagine, in the last 24 hours, numerous commentators have responded, and the ensuing debate touches on the causes of obesity and the difficulty of treating such a pervasive, devastating problem.

The Tinder:

  • 17% of kids 2-19 are obese, according to the CDC. That’s triple the rate in 1980.
  • Ethnicity and socio-economic level are tied to risk of obesity: Low-income, black or Hispanic children have especially high rates.
  • Childhood obesity can affect kids for the rest of their lives—in addition to having trouble breathing, high blood pressure, depression, and liver disease as kids, they may develop type 2 diabetes and are more likely to be severely obese adults, which comes with its own cluster of related ills, including heart disease and some cancers.
  • Each state has its own set of criteria for determining when the Department of Social Services should remove a child from his or her parents; generally, the rule of thumb is that either the child must be in immediate danger, or no other less disruptive option exists that would adequately protect the child. There’s a socio-economic side to this too: if a child from a low-income family winds up at a hospital, studies have shown, their parents are more likely to charged with neglect than wealthy parents are in the same situation.

The Spark:

  • In a two-page commentary, the scientists make the case that severe childhood obesity—being in the 99th percentile in terms of weight, and usually eating over 1000 calories more per day than recommended—can be considered the result of neglect and an immediate danger to a child.
  • They point out that several states, including California, Indiana, Iowa, New Mexico, New York, Pennsylvania, and Texas, have already set precedent for applying child welfare laws in cases of severe obesity.
  • Child protective services should certainly try to address the problem with parental counseling and training and other intermediate measures, they write. But if that doesn’t work, and bariatric surgery, which is quite a serious and invasive procedure in adults and whose long-term effects on kids seem dangerous, is the next option, then the state should step in.
  • Of course, there are certain cases where severe obesity is the cause of rare genetic diseases. But in these cases, they write, treating the disease usually requires major lifestyle modifications that the children’s families generally do not undertake. Thus, state intervention might still be required.

The Debate:

The suggestion set off alarm bells in many people, and responses in Scientific American, MSN, and Slate give a good sampling:

Defining childhood obesity as abuse would place a tremendous burden on parents—and an unfair one. Considering the marketing and low cost of sweetened cereals, high-fat fast-food meals and other treats aimed squarely at kids, others also bear responsibility for our childhood obesity epidemic. Even the U.S. government could be blamed, considering that the Department of Agriculture promotes the consumption of U.S. foods.

  • Bioethicist Arthur Caplan at MSN writes that the risks of obesity, as severe as they are, are not immediate enough for the state to step in, and it’s unclear that a foster family would have any greater success in getting a kid to lose weight:

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. The number of kids involved — an estimated 2 million children with body-mass index above the 99th percentile — would quickly swamp already overwhelmed social service departments. 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.

  • KJ Dell Antonia at Slate has a more nuanced take on the subject; commentators like Caplan gloss over the fact that this would only happen if parents had already failed to make changes, and so miss the point that what’s needed is a strategy of case-by-case attention that acknowledges the complexity of the obesity crisis:

Morbid obesity has already become a factor in considering whether a child should be placed into foster care. It’s not really the obesity itself that underlies the removal of a child from a parent’s custody, but the parent’s documented refusal or inability to intervene or to follow dietary or exercise guidelines imposed by state or medical agencies involved in the child’s care. Murtagh and Ludwig [the authors] appear to be suggesting that states use that power more often and wield it as a threat more effectively, not that obese children be removed from their parent’s custody from the moment they come to the state’s attention…

Childhood obesity is a larger problem with extreme individual implications. Broad social programs, like those advocated by Caplan, are great, but getting the nation to “go on a diet together” isn’t enough to target specific at-risk children…Let’s put all the fat kids in health care. Real health care, not “we can’t afford any visit with any local physician and the nearest doctor who takes the state child health insurance is an hour away and has a three-month-long waiting list and so we end up in the emergency room” health care. And then, once health care and help and dietary advice and practical exercise alternatives are available, consider foster care on an individual basis in only the most extreme cases.

The Consensus:

Everyone agrees that childhood obesity is a serious problem, and that parents, as well as food marketers, genetics, and even the US government, have a role in its genesis. But while some advocate for more national exercise programs and others for better health care, there’s no one-size-fits all answer.

Image credit: Mike Cogh / flickr

CATEGORIZED UNDER: Health & Medicine, Top Posts
  • Steve

    This is a a very irritating article and conclusion. Frame the debate to attack parents. Nice.

    Why, of all possible reactions to obesity, would they choose to upset families by removal of children from arguably happy families? Did no one consider the impact this would have on the kids’ mental health?

    You want a one-size fits all answer? Raise the minimum wage to where everyone can afford decent food and health care.

    Think that will hurt employment? Then stop shipping jobs out of the country. Tax the hourly rate of every job shipped out of the country – we could pay off the debt quickly.

    OK. I am getting off my soapbox now.

  • http://www.uxbooth.com Kristina

    Steve, do you really think that raising the minimum wage will make people eat healthier? I think that’s a loose correlation, far from cause and effect. Just because people have a few hundred dollars extra per month doesn’t mean their tastes will change. I’m all for raising minimum wage, but to think that will put a dent in the obesity issue is unrealistic.

  • Wendy

    IMHO, that’s not a bad idea *as a last resort*. But they’re not there yet. In fact, I suggest the government is partially to blame for their country’s obesity problem. If they really want to help, maybe they should instead do something about:

    -The countless food advertisements children are exposed to every day,
    -The disgusting, cheap, chemical abominations masquerading as “food” available for consumption,
    -The fact that proper food is too expensive for poor Americans to afford (and there are a lot of poor Americans!)
    -The fast food and soft drink advertisements in public schools (WTF is THAT about?!? Fund your own goddamn schools, USA!)
    -The lack of proper diet/nutrition/health information given to the public. EDUCATE!! Treat the cause, not the symptoms.

    Take care of all of the above first, *then* maybe you can justify more extreme measures. But like a parent, don’t neglect to raise your child properly, and then punish it when it misbehaves.

  • Dave

    Yeah, Hitler thought he knew what was right for people too………You “intellectuals” act like the world is some sort of classroom experiment and couldn’t care less about the affect your intrusions have on people’s lives. When you’re experiments go horribly wrong, all you can do is apologize after the fact but the damage has been done. Show a little restraint and compassion.

  • Joe

    Ok so when taking them away from the parents does not work, what’s next? Throw them into the incinerator?? This is some Nazi ass crap and should not even be debated in a free society…

  • Mike

    Ahh, only 4 comments before Hitler made an appearance. Are we sending parents to death row? Gassing people by the millions? Next time, try Stalin, he was arguably responsible for many more deaths. Or, you could add to the conversation instead of looking down your nose at “you intellectuals” and their incessant meddling in people’s lives. It’s a problem, people are looking for ways to address it. Have anything of value to say? Then say it. Thanks!

  • Kim

    If the government subsidies in the Farm Bill went to small sustainable farms instead of huge corporate farms that grow corn to make high fructose corn syrup then the cost of eating healthy fruits and vegetables would be affordable for these low income people. When you can buy an entire happy meal for less than it cost to buy a little bit of broccoli it’s not hard to understand why these kids keep getting fatter and fatter.

  • Zac

    The contradictions within these comments is what frustrates me the most. “We shouldn’t be debating this in free society”, well that contradiction is quite overt. Wendy’s comments asking the government to control advertisement and food production sounds more Socialist than the first comment I quoted. There is a word for when government controls the advertisement, see “Propaganda”. As long as what is being stated is factual, then it is fine (see Free Enterprise).
    “You intellectuals…” [sic, see Dave], well it’s you non-intellectuals who still have majority vote and swing left and right quicker than Foucault’s pendulum (and complain after you get your way).
    The responsibility of obesity lies completely in the parents. Blaming the government for why you don’t understand how sitting for 15 minutes through drive through getting a deep fried chicken sandwich, sandwiched by even more fried chicken, when there is unending amounts of information on this very internet you are on (see Google) that will warn you: Eating high fat/caloric foods and lack of daily exercise/movement of any kind may be harmful to yourself, your ego, and your children’s health, is ridiculous. Solution I see, healthcare should cost more for overweight individuals (excepting obesity by medications or other non-choice matters). Cheese burger costs a $1 for me since I’ll burn it off in one workout and $25 for him ($24 for the doctor consultation, hospital visits, insulin injections and the off chance of by-pass surgery, $1 for burger).

  • deathby2

    In my personal experience of being an ex-obese child and adult, the religious xtian fundy household I grew up in was a greater threat to my mental health. I have healed myself of obesity but the mental rape that I recieved has had lasting damage.

  • John Lerch

    How about taking kids away who smoke with their parents–now there’s an overt child abuse. In fact smoking in the presence of your children is overt child abuse–in fact smoking in the presence of anyone else (even other non-smoking (at the moment) smokers) is assault. And writing polemics about their so-called right to smoke is incitement to riot.
    Back to this topic. The notion that eating healthy is expensive is sick and STUPID!!!!! All the processing and advertising that goes into unhealthy foods make it far more expensive than produce, dairy and fresh meat.

  • Doug

    How about removing any and all federal and state subsidies for fast food companies and immediately applying them to healthier crops like fruits, vegetables?

  • Richard Engkraf

    This discussion would not even be happening in any country where the citizens actually understood the meaning of the word freedom. In america the word freedom has come to mean “not communist”, not actual freedom. The united states has 10x more laws than any other civilization has ever come up with, each one being something that you are not allowed to do. Would someone please explain how that equates with freedom? George Orwell was right! We are living in a police state. What’s next, taking away the children of atheists so that they can be indoctrinated into whatever sect of christianity the current lawmakers support? Get a clue people, we are electing our officials from the wrong pool if this is what they come up with!!!

  • Fargin

    “The responsibility of obesity lies completely in the parents.”

    I can concede this point, if you will concede that “Fixing obesity lies completely with the parents and doesn’t involve the state”

    Rarely are these causes of such societal problems caused by one group.

    We’ve had poor and uneducated people since we’ve had civilization. Do you think we’ve decided to all let ourselves and children go to spite you?

  • Rachel

    I agree that healthier food is more expensive. I would consider myself a low income American and I do have trouble affording healthier food. It is much cheaper to just buy ramen noodles, boxes of mac and cheese, and $5 large pizzas that last a few meals. I am more serious about my nutrition than a lot of others though. I try my best to mostly buy healthier “proper” food. I have to sacrifice other things so that I can spend money on healthier more expensive food and thankfully I don’t have children to worry about with this. I have discovered that it is usually cheaper to eat vegetarian meals because good meat is expensive.
    My point is that yes, I agree that proper food is more expensive and I have experienced this problem first hand.

  • Robert E

    @Steve — an introductory economics course will show you that raising the minimum wage is pointless. Any positive effects disappear in six months or less as the economy adjusts.

  • debra cole

    I live in a upper-middle class neighborhood. I do not see many overweight children. I think one reason is parents see our area as mostly safe Children are out riding bikes and just running around being children. But, not like when I was a child when it was constant morning till night. These children do play in organized sports and you see them going to gymnastics ect.
    I think children in lower economic neighborhoods don’t have these options. Even if mom could bring herself to let them play out doors the bike would probably be gone after one day.
    Of course eating habits are the number one reason but what do you reach for as a comfort food carbs thats what I reach for, as do most of my friends – the difference? We have the resources to hit the gym the next day.
    Grew up in foster care until 9 and yes I was skinny but it was not because I was served lots of fresh fruits and veggies.It was beans potatoes and corn bread and damned glad to get it.

  • crystal

    for 1 i am a mother of 4 and low income (not by choice)and have to make the choice of cheap or healthy and alot of time cheap wins because i want them to get full and not go Hungary if i get healthy there is not enough to feed everyone. and on another note am aunt of a child that is over weight and it was caused by him having to take setorieds almost his life for breathing problems.and he was taken form his mother by state for another reason and he has alot of problems with being taken from his mother.so the state wants to take over weight kids from their parents put them on a diet that don’t work all the time and give them mental problems by telling them they cant go home because they are ”fat” and have to loss weight and them when they grow up they are still over weight and in a mental institution for the rest of their life now how is that fair to the kids or families they a destroying and not to mention the money the government has to pay out for these kids they take from there homes and put the US more in diat

  • http://yahoo.com HealthGuru

    This is absurb! there is no need to take away the children from the families because of the children being severly obese. When I was younger I was on the brink of being obese, but my mom and uncle helped me to change all the excess weight. Now I am working on getting a six pack. The point is the american diet is S.A.D (Standard American Diet). Read the book Nutrition And Physical Degeneration By Weston A. Price, this book will explain everything about how the foods that we eat affect use to are very core. Someone needs to speak the truth about nutrition! Doctors are not helping anybody, if I listened to my doctor I would be obese with Type 2 diabetes.

  • Meihua

    It seems much more likely to me that obesity is increasing because our evolutionary responses haven’t yet adapted to our modern lifestyles. Our bodies still expect us to live shorter, harsher lives. No amount of finger-pointing or angry rhetoric will change it. It’s a phase we human beings will either have to get through or we won’t and our species will die out.

  • tracy

    growing up in the 60s there were fewer unhealthy options but still plenty of things for kids to pester their parents about. but just as in hunter -gatherer societies where I doubt if parents negotiated much with their kids on what was edible or dangerous or not, my parents simply closed their ears to most of our whining & looking back, I’m glad they did.
    I am witness to parents, friends of mine, who let their kids eat their way through the most unbelievable junk on a regular basis. I keep quiet but don’t understand what they’re lacking that my mom apparently had –the will to make sure what went into our bodies was mostly good for us.

  • plutosdad

    Unless we know a parent is force feeding their kids I don’t see how we can justify interfering at any level. The causes of obesity are widespread and there are so many variables, and there are too many caregivers each dropping the ball in some way (ever yell at the school administration on tv during Jamie Oliver’s Food Revolution?).

    Some people want to reduce it to calories in calories out but this is simple lack of knowledge of nutrition. Children may not be overeating but eating the wrong kind of foods, may be not exercising enough, may be more insulin insensitive, etc. Who knows. A parent can follow all the advice she is given and still the child stays fat. Especially considering there is so much conflicting advice out there, I’d rather trust my own research than some usda chart and person with less scientific background than me going through a flipchart checking off if I did this or that.

    Child services coming in, even if the children are not taken away, will only add to the stress in a child’s life. Unless a clear benefit can be shown, it is not worth it. Certainly parents may need help and training. But we can do that on a more general level, not having government agents come to the home and rate your child rearing.

    The original articles also ignore the fact that some countries have worse obesity problems than others. I am one of those that also blames the USDA, blames our laws that favor corn and huge feedlot operations resulting in animals with less omega3s and more omega6s, there are tons of changes that need to happen in society and in some ways the government makes getting healthy food harder not easier.

    So yes there is a real problem. But parents need help, not “help” in the form of more police-like agents coming over and giving advice, and if your child isn’t thinner by next year look out.

  • Bob Snyder

    @19… that’s a very convenient cop-out. While you are correct, the timescale for evolutionary forces to correct the problem is longer than you or I plan on being around. For a more pragmatic approach, we need to think of something that will help fix this problem in our lifetimes. And taking kids away from their parents is probably the worst idea and would only serve to exacerbate the problem, as many comments have noted.

  • brian

    wow what a crock of s***.

    Some doctor tried to call my son obese, because all the look at is age & weight. Of course my son is heavier than the average kid, he’s in the 99%tile for height. He’s a bean pole, no fat on him.

    So until the CDC can get their facts straight, we should avoid draconian police states taking away kids.

  • http://www.mylastdietever.com Wayne

    Having been fat at school, and classified as morbidly obese now, I cannot fathom the notion of removing a child from their home because they are obese. I ate healthy meals almost everyday at home as a child, but it was the other rubbish that I put into my body during the day that led to my obesity. I do not and cannot blame anyone but myself for the state my body is in. I now am on a diet to lose weight as I came to the realization that obesity is detrimental to my health.

    As with everything, it comes down to education. Do parents have all of the information at their disposal to see that their child being obese is not good in the long term; and if they do, are they actually using this information? Is it a case of that parents have such busy lives that as long as the child is happy, they don’t care what their child is eating when they are not around.

    Obesity is something that parents can help eliminate in their children if the wish is to do so; just by saying NO, and ensuring that the diet in the home is conducive to healthy living.

    It is always easy to say “remove obese kids from their parents” if:

    1. You don’t have kids or
    2. If your kids are already grown up and not living with you any longer.

    Instead of trying to legislate what we can and cannot do in our own homes, make information available for everyone to make the right decisions.

  • kevin

    Having been raising 4 kids for 16 years I can weigh in how I feel about this. Giving the government this much control over things is just stupid. Want to see things go awry just let the government get a hold of it. On the other hand how do you make folks understand raising kids means controlling all aspects of their lives and guiding them to be all they can be? I am lucky to have four kids that look much as I and my siblings looked growing up as kids, Skinny by todays standards. We don’t cut them back on food I never gripe about what they eat or when, only if they get something and then do not eat it. My oldest will be 16 in Jan is 6′ 3″ tall and weighs about 205 and his ribs show my 14 year old is 6 ft. tall and weighs about 190 and looks thin compared to his friends, Both these boys eat like crazy. But they work like mad and play like mad and we don’t let them lay around playing games all day on the T.V. and the puter. They eat some pretty Junky food too! In short Lack of activity I feel has caused this.
    I myself have experimented with the good diet as I at this stage in my life I am over weight and that I attribute to Lack of activity. I was normal in BMI even below for a while all my life till age 34 I got crippled up and very much less mobile then the pounds crept on. To loose has been hard but I have been on the Medi fast diet and it is working slowly. But had I been able to stay active as I want it would not be necessary at all. You are what you eat…….. unless you burn it all up.

  • Ava

    This is utter BS. I don’t even feel like I need to write a long angry rant about how stupid this is.

  • http://DiscoverMagazine Templar 7

    You know, in medievil times infertility was a curse. Now they just go out, get degrees in social work , and run orphanages and Planned Parenthood.

    Only the Strong Survive.

  • Avatar

    My neighbors have great jobs with excellent incomes yet their two children are in the morbidly obese category. We think this is terrible. Even my kids feel bad for them. They are a boy going into 4th and a girl going into 6th grade. The parents are educated yet when the kids come for the school bus in the mornings they have the worst stuff for breakfast. The son has chocolate milk and cheese danish, the sister who complains that the brother polished off the danish has a handful of corn chips. Sometimes it’s even candy. I remember the mother telling me back in February she was going to work on the kids weight this summer. (Why wait?) Well it’s summer and they are bigger than ever. It’s a shame. They are nice kids but at this rate they aren’t going to be able to walk soon. I think the threat of losing their kids might get these parents motivated to do the right things. All the mom has to do is stop buying junk and have the kids drink water instead of sweetened drinks. It would slim them down a lot.

  • debra cole

    When we talk about removing the kids from their homes what exactly do we mean. Will they be placed in foster care where they have maybe a 50/50 chance of getting adult supervision that is educated and cares? How about a quasi orphanage run more like a fat camp they were all the rage in the 70′s but the kids I knew who went either did not lose much weight or had put it all back on before Christmas break. I hate to see obese children, ,well let me just face it I hate to see obese people at all not because of the way they look but because they usually don’t feel good physically or mentally. However in very, very ancient days a grossly fat wife was a status symbol for her husband sorry research did not mention if he actually touched her or not. Sorry too tacky. How in the world can we decide who is fat enough to need a new home shall we take grades into consideration? My mom would have swapped me in on a fat genius in a heart beat. I think happy children who are growing in such a way they will contribute to a productive society may be the best we can hope for with other peoples children. I’m not for fostering been there no love makes you reach for what ever comfort you can get usually food

  • smgsmith

    there are so many factors contributing to obesity and such a scale of possible body types (eg. i look thinner than my weight , but one of my daughters looks heavier than her weight although we are a similar height); how would obesity be measured?

    how fat is “too fat’? is fatness a subjective condition wherein an anorexic social worker decides 5 lbs over starving is too fat? will a fat worker decide a child looks gaunt and underfed when they are actually average? (actually happened to a member of my family)

    will cps workers be trained in nutrition and normal pediatric growth values – when they are not even trained in child development or child care now? it sounds like these untrained child protective services workers will be having the say and that is very dangerous to a family.

    cps workers do not have to prove anything to take a child from a family, they merely have to make an accusation. and accusations by cps cannot be contested or spoken against in family court.

    this idea scares me!

  • Marian

    I know a kid who is obese and I was trying to help him to eat healthier foods. His Mother would get mad and say where did you hear that if he asked for fresh vegis or to try one of the recipes I gave him. He’d ask for healthy food and she’d come home with pizza and baffallo wings. He struggled and argued with her. His mother just wouldn’t help him eat healthier. She still doesn’t and she hates me for getting involved. She also let him quit school at 14, I don’t know how they got away with it. How did the state not get involved with that situation.. But the kid wasn’t in school for 2 years when I met him in an online game. She was never home and always gone, I felt sorry for him and would talk to him on skype. Their house was condemned because the animals peed all over the place and they had to move. She gives him other peoples prescriptions for ear infections and his skin condition. He’s almost 400 lbs and is very depressed. I’m not sure what I could have done to help. But I really tried to help him get on a good diet and at least do home schooling. She needs help to learn to feed him good healthy meals and to get him an education. She has health insurance so there’s no excuse for not bringing him to the doctors and giving him other peoples prescriptions. I’m afraid some day he might get very ill from taking something she’s given him.

    Anyway, I’m just frustrated with the situation. I don’t understand how she would want him not to eat healthy. The father isn’t in the picture much. So he doesn’t seem to get involved with raising his son. I feel very sorry for the kid. He begged me not to report her because I was seriously looking into it. He says he never wants to leave his mom. I just want her to get help and for him to get help to be a prosperous adult.

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