Custody of Morbidly Obese Children

Between the relentless media coverage of the obesity epidemic in America, and the First Lady’s pet project of ending it in children, you’re probably aware that there are more morbidly obese people—including kids—than ever before.

Now authorities and health experts are talking about whether overfeeding kids is as harmful to them as starving them. And by “overfeeding” we don’t just mean letting them have dessert every night plus the occasional pizza. We’re talking about kids so extremely obese, their health and even their lives are at risk.

According to a recent commentary by Harvard researchers in the Journal of the American Medical Association, state authorities should step in so that the kids can lose some of the weight while the parents learn how to feed them properly. Opponents claim that the child protective system is barely working for the most abused children, and that obesity is not a good enough reason to break up a family. Who’s right?

Serious health problems

Commentary author Dr. David Ludwig, obesity specialist at Harvard-affiliated Children’s Hospital Boston, is in favor of state intervention for morbidly obese kids, not to punish the parents, but to get them and their children help. He says that around 2 million children in the U.S. are extremely obese; some of these kids suffer from type 2 diabetes, liver problems, and breathing difficulties that could significantly shorten their lives.

Experts such as Dr. Ludwig, Padiatrics Magazine, and the British Medical Journal insist that morbidly obese children are every bit as much at risk as those who suffer from neglect, malnourishment, or physical and emotional abuse. Children do not have the knowledge and control to take charge of their own nutrition and their health and lives are at real risk if their parents can’t or won’t impose healthier eating and exercise habits.

The complexity of childhood obesity

Part of the problem, though, is that obesity in children is not entirely a matter of eating too much junk and playing video games. It’s a complex phenomenon that has roots in food production, poverty, the economy, marketing, peer pressure, and even environmental toxins.

When an adult punches his kid, it’s pretty straightforward abuse. But when a parent is working two jobs and isn’t home after school, can’t afford healthy, unprocessed food, and is too busy making ends meet to ferry the kids to sports practices and games, it’s a fuzzier line. Childhood obesity is a bigger problem than bad parenting, and removing a kid from his home won’t necessarily address all the underlying issues.

The catch-22 of weight loss programs, school lunches, and health insurance

The irony is that obesity is linked to poverty, and government-sponsored weight loss and lunch programs can actually add to the problem. Parents of very obese children have reported difficulties finding weight loss programs for their kids because the kids were over the maximum weight allowed—even in programs specifically designed for morbidly obese kids.

School lunches, which are notoriously processed and high in fat, sugar, and calories, are subsidized for a disproportionate number of kids who are obese—again, tying the problem back to poverty.

Many obese kids also have medical problems that exacerbate their weight gain, but their parents are without adequate health insurance to diagnose and treat such problems. If the parent can’t be there to watch what the child is eating and doing every minute of the day, is it fair to suspend their parental rights?

Denial, helplessness, or ignorance?

Another question is whether extremely obese children are coming from homes where the parents are helplessly falling between the cracks, are ignorant as to the damage to their children and need educating, or are in denial and in need of a wake-up call. The answer is all three, but who would actually benefit from state intervention?

Ethicist Arthur Caplan says that removing a child from the home because of obesity is misguided. “The problem with this proposal is that it puts the onus solely on the parents. This is not a problem just with individuals, this is a societal issue.”

Changing the laws?

The authors of the Harvard study insist that severe obesity is dangerous enough to justify state intervention, and that existing custody laws allow for it. However, most states only allow intervention if a child is “likely to suffer imminent seriously physical harm, injury, or death.”  Extreme obesity is more of a longer-term risk than immediate danger. Dr. Ludwig suggests that documentation of a child’s weight-related health issues and the parent’s “chronic failure to address the problem” should be enough to justify removal. He may be right, but at this point, the law is unclear.

Dr. David Katz, founder of the Yale Prevention Center, cautions that there isn’t yet enough evidence that extremely obese children would do any better in foster care and that cost and benefit tradeoffs need to be understood more clearly before state intervention is deemed appropriate.