In an opinion piece in the Journal of the American Medical Association, a couple of doctors suggested that kids who were extremely obese with health problems should in some cases be subject to intermediate interventions by child protective services and, in extreme cases put in temporary protective custody. This is one of those things that causes a knee jerk reaction from both sides so I want to try to cover this as calmly and rationally as possible.
I first saw this article about it on Yahoo (thanks to readers Karen, Barbara, Jennifer and anyone else I’m forgetting for bringing it to my attention!) I was concerned that I wasn’t getting the full story from Yahoo so I went to the horse’s mouth at JAMA and paid $30 to read the piece (the things I do for you guys!). In this case I’m really glad that I read it.
It’s not nearly as bad as I expected. The author’s main focus seems to be suggesting intervention by the state as a better solution than the dangerous bariatric surgeries that are currently being recommended. They are also in favor of trying everything possible prior to removal from the home:
Child protective services typically provide intermediate options such as in-home social supports, parenting training, counseling, and financial assistance, that may address underlying problems without resorting to removal. These less burdensome forms of legal intervention may be sufficient and therefore preferable in many cases. In some instances, support services may be insufficient to prevent severe harm, leaving foster care or bariatric surgery as the only alternatives. Although removal of the child from the home can cause families great emotional pain, this option lacks the physical risks of bariatric surgery. Moreover, family reunification can occur when conditions warrant, whereas the most common bariatric procedure (Roux-en-Y anastomosis [gastric bypass]) is generally irreversible.
That actually sounds reasonably logical and I am happy to see a doctor speak out against weight loss surgery, but that’s not to say that I don’t have concerns. I absolutely do:
It’s tricky to use body size as a diagnosis:
- What about families where there are more than one child who eat the same diet but only one meets the definition of “extreme obesity”? Do they do interventions with all the children?
- What about parents who raise kids who eat lots of fast food and are sedentary but don’t become fat? Do those kids not get attention for their health issues?
We don’t actually know that much about childhood obesity:
Despite the fact that everyone and their overbearing mother thinks that they know exactly why we have a childhood obesity crisis, the truth is that nobody is sure. There is even some argument as to whether a crisis even exists. We don’t know if there are things in the environment that trigger some kids to gain a lot of weight, we don’t know if it’s that we have a fast food culture etc. Nothing is proven here so no matter how vehemently someone says that they know, they don’t. That makes it hard to find fault and place blame.
We don’t have a proven solution:
- Every weight loss method tested shows a less than 5% success rate over a five year period. This is particularly bothersome in situations where children are placed in foster care, lose the weight and then return to their family with a 95% chance that they’ll regain the weight and their parents will be labeled as repeat offenders.
- If they go to foster care and do not lose weight or gain weight, are the foster parents then at risk for being accused of neglect? What happens next?
- The system already deals with “failure to thrive” cases in which parents are suspected of starving their children. Even those cases are problematic because sometimes there is a health issue with the child (celiac’s disease for example or food allergies) that are causing the issue.
- Unless the parents are force-feeding these kids, there are issues determining causality and fault.
- Where are we going with this? Who is next?
- What about smokers who raise kids? Secondhand smoke contains more than 250 chemicals known to be toxic or carcinogenic (cancer-causing), including formaldehyde, benzene, vinyl chloride, arsenic, ammonia, and hydrogen cyanide. Children who are exposed to secondhand smoke are inhaling many of the same cancer-causing substances and poisons as smokers. Do we remove the ones who develop asthma? The ones with elevated blood pressure? Those born pre-term or with low birthweight?
- What about parents who choose not to vaccinate. If the kids get diseases after the parents refuse to vaccinate them, should they be removed?
This is a tricky and knotty issue. It deals with everything from parental rights to kid’s autonomy. Children who are under-nourished have long been subject to the type of interventions that are mentioned above despite many similar issues. I honestly don’t know the solution for these individual cases and it’s possible that, just like in under-nourishment situations, in some cases intervention probably is warranted but I certainly don’t want to have to decide which ones.
More importantly, CPS intervention and Gastric Bypass are not the only two options. What I think we really need to get out of this is how important it is for people to have information and access to the building blocks of health. Information about healthy eating and movement in combination with access to affordable foods and safe, affordable movement options that kids enjoy, affordable accessible preventative health care (not just reactive sick care). PE in every school and options that encourage a lifetime love of movement, rather than a lifetime of bitterness about PE. Dodgeball should go the way of the dinosaur. What if schools could offer more than just sports: dance, walking/hiking, Kinect style video games that incorporate movement etc? And not just during a PE hour but before and after school and during lunch and free periods, even on weekends? What if they offered busses and share-a-ride systems to the local YMCA or to the schools after-hours PE program? Wondering where you’ll get the money?
We’ve talked about this before but every year we give the diet industry $58 Billion dollars. Can you imagine what we could do if we could take that money out of their back pocket and use it to create access to food and movement for people in under-served areas? If we could get Michelle Obama to be for healthy kids instead of against obese ones? If we stopped body shaming and bullying fat kids allowing them to have the mental health that can only exist when they don’t live in a constant state of stigmatization would they be more likely to make healthy choices? I think so.
As usual I think our focus on weight is wasting time, money and effort and pushing us in the exact wrong direction. I would wager my life savings that if we would focus on health, spend our time thinking of ways to create access to health, invest our money creating access to health, we would actually have more health.