Dan Murphy   |   Updated: July 14, 2011

The statistics from the Centers for Disease Control and Prevention are piling up so relentlessly that they cannot be ignored: Nearly 32% of U.S. children ages 2 to 19 are overweight or obese, according to CDC, with some 12% of them considered morbidly obesity. Now, thanks to a provocative new editorial in a leading medical journal, the question is being asked: Should the parents of morbidly obese children lose custody? Should obese kids, who are unquestionably at risk medically, be committed to a foster care system?

The commentary in the current issue of theJournal of the American Medical Association argued that in extreme cases, it’s worth it to improve the child’s health. The authors, Dr. David S. Ludwig, a pediatric endocrinologist at Children’s Hospital Boston and Director of the Optimal Weight for Life Clinic, and lawyer Lindsey Murtagh, argued that the household environment and (lack of) parenting practices mandate removal of morbidly obese children for their own health and well-being.

Of course, it is well-known that problem with obesity—not just adolescent weight problems, but frank, clinically significant obesity as defined by a Body Mass Index above the 95^th percentile (using an age- and gender-specific ratio of weight to height) confers a high risk of adult obesity. In a major study in 2010, also reported in JAMA, 60 of 79 children who were obese in adolescence ended up as obese adults.

Those odds aren’t very good.

Even worse, over the long term, obesity almost guarantees lifetime problems with coronary heart disease and stroke, type 2 diabetes, hypertension, sleep apnea and respiratory problems and even gynecological problems for women. Obesity is also strongly correlated with a higher risk of certain cancers, liver disease and osteoarthritis.

And although the causes of medically significant, morbid obesity are often complex, the basis for virtually all kids who become overweight—at least initially—is the same: Consuming too many calories while engaging in too little activity. That means that prevention really does start in the home. Kids whose diets are closely monitored, who are restricted from overconsumption of fast-foods and junk foods and who are encouraged—or ordered, as the case may be—to play sports, get regular exercise and stay active rarely become obese to the point that it compromises their health.

Likewise, kids who gain literally hundreds of pounds as teens and even as younger children are almost always raised in households where food choices are suspect, physical activity is non-existent and bad nutritional and lifestyle choices are rampant. Disproportionately they’re lower income and/or minorities, often single-parent families where adult supervision and guidance are in short supply.

Researching the real problem

So to protect children whose very lives may be at risk, should the state remove those morbidly obese kids and place them in foster homes? Shouldn’t the same rationale that supports intervention when there is physical or sexual abuse be applied to a potentially life-threatening risk to kids?

The answer is no, in my opinion, anyway. Here’s why.

First of all, it’s well-documented that many low-income and inner city neighborhoods exist in what urban planners call “grocery deserts.” There simply are far fewer full-service supermarkets nearby to provide wholesome alternatives to fast-foods and snack items that, unfortunately, are available at virtually every other food outlet. Those are the food choices that fuel obesity.

Second, not only the availability but the price of fresh fruits and vegetables that would be a superior choice for kiss at risk of gaining too much weight is prohibitive. Here in Washington state, which only happens to be the nation’s No. 1 fresh cherry-growing state, a carton of sweet cherries goes for anywhere from $4 to $6 a pound. And that’s at the height of the season!

It’s just not that easy when you’re living on a tight budget to provide the recommended servings of fresh vegetables and fruits for a family.

But most importantly, there are larger cultural issues that argue against removal of children from their homes and families as the solution to obesity.With advertising for less-than-healthy foods simply saturating the media, it’s a constant battle to wean kids away from highly sugared cereals, overly processed snack foods and high-calorie fast-foods that contribute directly to the obesity epidemic.

Plus, there is no guarantee that a child will lose weight if placed ina foster care system. The network of foster homes and support services are already stretched to the limits in most states, with ongoing budget crises nationwide guaranteed to constrain state agencies’ resources even further in the future.

As Arthur Caplan, Ph.D., the director of the University of Pennsylvania’s Center for Bioethics, wrote on MSNBC.com, “The only basis for compelling medical treatment against a parent’s wishes are if a child is at imminent risk of death—meaning days or hours—and a proven cure exists for what threatens to kill them. Obesity does not pass these requirements.”

As a society, we need to focus far less on the rare but undoubtedly necessary medical interventions for the tiny percentage of obese children requiring immediate clinical care and instead look to the social institutions that support healthy, active adolescence for the millions of kids at risk for obesity: well-funded schools with robust physical activity programs, nutritious foods that are affordable and available and economic opportunities that allow families to have the resources to deal with the challenges of raising children capable of making positive choices about their diets and their health.

Then—and only then—should we start worrying about taking kids out of their homes and away from their families. Those families with obese kids need help, not punishment.

Dan Murphy is a veteran food-industry journalist and commentator

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Madison, Wisconsin  |  July, 14, 2011 at 09:51 AM

Very well written, Dan. I hope that your article gets a lot of press. I find it ironic and even horrific that a medical journal would suggest such a traumatic, expensive, punishing, illegal and unproven "solution" for a problem that is largely not a medical issue. Your solution is right on. Thank you.

OK  |  July, 14, 2011 at 10:55 AM

Evidently there's no limit to how low some folks will stoop to get their 15 minutes of fame. This is a typical ivory-tower approach where the symptoms receive great attention while the disease goes untreated. While admitting that diet and exercise play a huge role, I'd suggest the Dr. should do a little research into high-fructose corn syrup and the gamut of artificial sweetners in regards to their effect on obesity and health. He'd find himself in a whole new world, and his lawyer cohert would haver plenty of corporate and Government agency toes to step on. But I suspect instantaneous fame is far easier to attain by proposing tyranical Marxist tactics against the American people, than to take on the sources of all those research grant dollars. If the current U.S. Surgeon General steps down, don't be suprised if this jerk gets the nod as the replacement. Folks it's way past time to stand and fight back. As the author correctly stated: "Those families - - need help, not punishment.

ct  |  July, 14, 2011 at 02:32 PM

So, you're making the argument that these parents are not capable of providing their children good enough food to keep them healthy? I would aregue a parent who truly cares about the welfare of their child will find a way (like the parents of the 68% of kids that are not overweight)... A parent who doesn't care enough to find proper nutrition SHOULD have their kids taken away! Your argument is equivilent to a parent incapable of providing a safe home... If the environment prohibits healthy growth (physical and mental) the child should be removed. If it is a lack of effort on the part of the parent to find apropriate nutrition (or a safe home, etc.) they have failed as a parent and are putting their children in danger - and you're saying that's okay because they're poor (all of them???) and a family shouldn't be broken up.

Oregon  |  July, 14, 2011 at 03:01 PM

Treat them like smokers.I know how I feel whem some 350lb lard ass tells me that smoke offends them. I tell them to move on the second hand gas is about to kill me.