If a child in suburban Toronto was grossly malnourished and failing to thrive, would we hesitate, even an instant, in our demands that Children’s Aid step in and save his life?
So why would we not do the same for a child who is sickeningly over-nourished and suffering from the life-threatening health problems that are caused by extreme obesity?
Yet when Dr. David Ludwig, an obesity expert at Children’s Hospital in Boston, wrote last week in the Journal of the American Medical Association that parents of some extremely obese children should lose custody in some cases, there was an outcry.
“We don’t need the nanny state ripping children from the loving arms of their parents,” went a common refrain. “Having a big appetite is not a crime,” went another. “Let them eat cake,” said the historically-inclined dissenters.
Any story about obesity is guaranteed to generate a lot of jerking knees but, to be fair, in this case some of the anger was based on misunderstanding. In cyberspace, reading beyond the headline is not required to form an opinion. Besides, many media reports misrepresented Dr. Ludwig’s views.
“Fat children should be taken into foster care,” The Daily Mail trumpeted. “A Call for Parents to Lose Custody of Obese Kids,” said ABC News. Time magazine’s article began by saying that “one way to manage the nation’s childhood obesity crisis might be to take the most severely overweight kids away from their parents.”
Dr. Ludwig said nothing of the sort. In his article, titled State Intervention in Life-Threatening Childhood Obesity, the key words are “life-threatening.”
The pediatrician did not issue a rallying cry for the creation of the Twinkie police nor did he advocate taking a battering ram to the front door of every home with an Xbox console. He said that taking children into care should be considered when all else has failed.
Dr. Ludwig also stressed that taking children out of a poisonous environment – temporarily, not permanently – is far more ethical than performing bariatric surgery, an approach that is increasingly being promoted for severely obese children but that has little evidence to back it up.
It has to be stressed too that intervention should be considered only in extreme cases, where children are, weight-wise, in the 99th percentile of their age group.
Dr. Ludwig related the story of a girl who weighed 90 pounds at age three and, by age 12, she weighed more than 400 pounds and was suffering from life-threatening diabetes and apnea. She was placed in foster care and lost 130 lbs. in a matter of months and, while still obese, her health conditions were no longer imminently life-threatening.
Another case that has attracted a lot of media attention is that of Alex Draper, a 14-year-old South Carolina boy who tipped the scales at 555 lbs. before child-protection services intervened.
His mother, Jerri Gray, lost custody of the boy (foster care placed him with an aunt) and she was charged with child neglect. In the subsequent year, Alex lost more than 200 lbs.
Note that Dr. Ludwig did not advocate criminal prosecution of parents. On the contrary, he said that families of severely obese children need as much help as (if not more than) the children themselves. More often than not, the parents of these children suffer mental-health problems and severe socio-economic challenges; at best, their parenting skills – the ability to cook, for example – are greatly wanting.
The tragedy in the South Carolina case is that state troopers were sent to the home instead of a nutritionist and psychologist.
In Canada, much of the reaction to Dr. Ludwig’s proposal has assumed – wrongly – that this heavy-handed approach was being advocated.
