Should the state intervene on behalf of morbidly obese children?

When we think of child abuse and neglect, we think of burns and bruises and children left unattended. We don’t think of obesity. But maybe, in some cases, we should.

In a recent commentary in the Journal of the American Medical Association (JAMA), David Ludwig, MD, PhD, director of the Optimal Weight for Life (OWL) Program at Children’s Hospital Boston, argues that life-threatening obesity—where a child’s body mass index (BMI) is beyond the 99 percentile and multiple attempts to help the child lose weight have failed—could call for state intervention, and in extreme cases foster care.

Children in this highest BMI category are at great risk for many serious health complications. We all know that childhood obesity can lead to life-long health complications, but in extreme cases it can be life-threatening in the short term. For example, type 2 diabetes, which is being seen in younger and younger patients as the childhood obesity epidemic continues, can cause very serious complications and even be fatal. Sleep apnea, which often occurs in obese children, can lead to very dangerous heart problems.

Because of these dangers Ludwig says the most severe instances of childhood obesity may justify a child’s removal from the home because of imminent health risks to the child and the parents’ continued failure to address those problems.

It’s a controversial stance, but not one without precedent. To date seven states have seen legal cases where the over-nourishment of a minor ended in sate intervention. According to Federal law, parental abuse or neglect takes place when:


“Any recent act or failure to act on the part of the parent or caretaker, which results in death, serious physical or emotional harm… or an act or failure to act presents an imminent risk of serious harm.”

David Ludwig, MD, PhD

By these definitions, it’s possible that parents of children whose obesity is life-threatening could be found negligent. But Ludwig says those parents are up against tough odds, and feels that any form of intervention has far more to do with acting on behalf of children than pointing fingers.

“The point isn’t to blame the parents, but rather to act in the child’s best interest and get them help that for whatever reason their parents can’t provide,” he says. “It’s ironic that we would blame parents for their child’s obesity when we tolerate as a society policies that directly promote obesity, like food ads aimed at young people, atrocious-quality school lunches, cutbacks in school budgets to support regular physical education. There’s plenty of blame to spread around.”

It’s also important to note that the term state intervention in most cases doesn’t mean foster care. Ludwig notes that often when protective services visit with a family they try many options before removing a child, and feels the same approach should apply to life threatening obesity. To accomplish this Ludwig advocates for in-home social support for parents. By providing nutritional education, family counseling, training on the importance of an active lifestyle, financial assistance and/or help accessing fresh fruit and vegetables and opportunities for physical activity, the state can treat the underlying problems that cause childhood obesity without disrupting homes.

In cases where interventions have been tried and failed, and the child’s obesity is presenting immediate health risks, bariatric surgery could be considered as well, but only in select cases. Ludwig says that because there hasn’t been much data collected on the long-term affects of pediatric bariatric surgery, its safety for young people is questionable and should only be considered on a case-to-case basis.

In the end Ludwig says he supports the consideration of state intervention for extreme cases of childhood obesity, but feels the government’s real goal should be creating preventive programs that treat the condition’s root causes. “Ultimately, government can reduce the need for such interventions through investments in the social infrastructure and polices to improve diet and promote physical activity among children,” he says in the JAMA piece.

To read the JAMA commentary in its entirety, click here.