Jennifer Lovejoy, PhD, Vice President, Clinical Development & Support:
Recent headlines have raised yet another issue to add to the worry of American parents – the threat of having their child taken away by the state because they are obese.
In a July 13th editorial in the Journal of the American Medical Association (JAMA), Drs. Murtagh and Ludwig, a lawyer and physician respectively, argue that because childhood obesity has potentially severe medical consequences, it makes ethical sense to consider foster care for severely obese children to see if weight can be reduced behaviorally. The suggestion is that severe obesity is basically the flip side of starving, or deliberately under-nourishing, children, which is legally included under child abuse and neglect laws.
Unfortunately, while great for generating dramatic headlines, there are some significant problems with the idea that we can blame childhood obesity totally on the parents. Severe (or “morbid”) obesity in either children or adults is rarely caused by behavioral choices per se. There are a number of known genetic factors that cause early and excessive weight gain in children, and new genes that strongly predispose to obesity are being discovered all the time.
Furthermore, it has been demonstrated that “metabolic programming” occurs during pregnancy, such that children of moms who are obese during pregnancy are predisposed to becoming obese and engaging in less healthy behaviors. While experts strongly recommend that women who are planning to become pregnant reduce their weight to a healthier level before conceiving, this message is not widespread in the general culture and many women are totally unaware of the potential risks their excess weight may cause for their child. Blaming mothers after the fact for something that may have happened during pregnancy is about as useless (and unfair) as blaming mothers from the 1940s and 1950s who consumed alcohol or smoked during their pregnancies before it was known that these behaviors were harmful for the unborn child (and even today nobody threatens to take children away from moms who smoke even though we know how harmful second hand tobacco smoke is). Finally, we know that many causes of the childhood obesity epidemic are totally out of parents’ control: the reduction or removal of P.E. classes from schools, school vending machines selling high calorie snacks and sugary drinks, and few safe places for kids to play outside in many neighborhoods.
Frankly, it’s hard to view this latest debate as anything other than another sad example of weight bias and discrimination. We don’t blame parents whose children develop cancer or insulin-dependent (Type 1) diabetes even though there are known lifestyle and environmental factors that increase risk for these diseases. And yet, because of the pervasive stigma against obesity in our culture, it apparently seems acceptable to judge and blame parents of obese children, who probably have as little to do with their child’s disease as the parents of kids who develop other serious, chronic childhood diseases.
Obesity is a devastating disease deserving serious treatment whether it occurs in children or adults. While it’s a major problem that we have few treatment options between lifestyle counseling and weight loss surgery, that’s not an excuse for blaming the victim (or the victim’s parents). Obviously, no one condones true neglect of a child’s health, or denying children medical treatments that are available and can be life-saving. There are clearly cases of medical neglect where it is appropriate for governmental agencies to intervene to protect the well-being of the child. However, there is no basis for assuming that childhood obesity, in and of itself, constitutes one of these cases.