An interesting discussion is emerging in the United States, Canada and elsewhere, considering the possibility of child protective services involvement, including foster care, in cases of severe childhood obesity.
Most people’s immediate reaction to this idea is rejection. Not only does it seem wrong to separate a child from their family on account of their weight status, it seems likely that foster care might not improve a child’s health at all.
In their editorial in the Journal of the American Medical Association, Lindsey Murtagh and David S. Ludwig, present a well-balanced argument for foster care as an alternative to surgery for those children facing potentially irreversible health consequences of their weight, including type 2 diabetes. In the case of extreme childhood obesity, it is possible to consider a failure to act on the part of the parent as neglect. The article speaks of the most extreme (‘life-threatening’) cases of childhood obesity, where typical diet and exercise treatments are known to be generally ineffective, and the only other alternative is bariatric surgery (eg: gastric bypass). In such cases where the risk of health consequences is so great, one can begin to understand the reasoning behind the suggestion of foster care.
However, the authors also acknowledge the barriers and problems that this idea presents: “… state intervention would clearly not be desirable or practical, and probably not be legally justifiable, for most of the approximately 2 million children in the United States with a BMI at or beyond the 99th percentile. Moreover, the quality of foster care varies greatly; removal from the home does not guarantee improved physical health, and substantial psychosocial morbidity may ensue. Thus, the decision to pursue this option must be guided by carefully defined criteria… …with less intrusive methods used whenever possible.” Indeed, intermediate interventions options, such as government-mandated “in-home social supports, parenting training, counseling, and financial assistance, that may address underlying problems” are a more palatable suggestion.
With such large barriers to implementing a policy such as this, it may be a long time before any action is taken. Either way, there is bound to much passionate debate of such a controversial issue. What do you think? Is foster care for severely obese children warranted?
