CHICAGO — Should parents of extremely obese children lose custody for not controlling their kids' weight? A provocative commentary in one of the nation's most distinguished medical journals argues yes. Its authors join a quiet chorus of advocates who say government should be allowed to intervene in extreme cases.
It has happened a few times in the U.S., and the opinion piece in Wednesday's Journal of the American Medical Association says putting children temporarily in foster care is in some cases more ethical than obesity surgery.
Dr. David Ludwig, an obesity specialist at Harvard-affiliated Children's Hospital Boston, said the point isn't to blame parents, but rather to act in children's best interest and get them help that for whatever reason their parents can't provide.
State intervention "ideally will support not just the child but the whole family, with the goal of reuniting child and family as soon as possible. That may require instruction on parenting," said Ludwig, who wrote the article with Lindsey Murtagh, a lawyer and a researcher at Harvard's School of Public Health. "Despite the discomfort posed by state intervention, it may sometimes be necessary to protect a child."
But University of Pennsylvania bioethicist Art Caplan said he worries that the debate risks putting too much blame on parents. Obese children are victims of advertising, marketing, peer pressure and bullying - things a parent can't control, he said.
Roughly 2 million U.S. children are extremely obese. Most are not in imminent danger, Ludwig said. But some have obesity-related conditions such as Type 2 diabetes, breathing difficulties and liver problems that could kill them by age 30. It is these kids for whom state intervention, including education, parent training, and temporary protective custody in the most extreme cases, should be considered, Ludwig said.
Ludwig said he started thinking about the issue after a 90-pound 3-year-old girl came to his obesity clinic several years ago. Her parents had physical disabilities, little money and difficulty controlling her weight. Last year, at age 12, she weighed 400 pounds and had developed diabetes, cholesterol problems, high blood pressure and sleep apnea.
"Out of medical concern, the state placed this girl in foster care, where she simply received three balanced meals a day and a snack or two and moderate physical activity," he said. After a year, she lost 130 pounds. Though she is still obese, her diabetes and apnea disappeared, he said.
Jerri Gray, a Greenville, S.C., single mother who lost custody of her 555-pound 14-year-old son two years ago, said authorities don't understand the challenges families face.
"I was always working two jobs so we wouldn't end up living in ghettos," Gray said. She said she often didn't have time to cook, so she would buy her son fast food.
Her sister has custody of the boy, now 16. She has the money to help him with a special diet and exercise, and he has lost more than 200 pounds, Gray said. "Even though good has come out of this as far as him losing weight, he told me just last week, 'Mommy, I want to be back with you so bad.' They've done damage by pulling us apart."