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    Should parents lose custody of super-obese kids?

    In this July 11, 2011 photo, Stormy Bradley, right, and her daughter Maya, 14, walk their dog Bubbles in their neighborhood in Atlanta. Maya, who is 5'4In this July 11, 2011 photo, Stormy Bradley, right, and her daughter Maya, 14, walk their dog Bubbles in their …By LINDSEY TANNER - AP Medical Writer

    CHICAGO (AP) - 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, and its authors are joining a quiet chorus of advocates who say the 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," Murtagh said.

    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.

    "If you're going to change a child's weight, you're going to have to change all of them," Caplan 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.

    Related: Factors that increase a child's risk of becoming overweight

    While some doctors promote weight-loss surgery for severely obese teens, Ludwig said it hasn't been used for very long in adolescents and can have serious, sometimes life-threatening complications.

    "We don't know the long-term safety and effectiveness of these procedures done at an early age," he said.

    Ludwig said he starting 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; she remains in foster care, he said.

    In a commentary in the medical journal BMJ last year, London pediatrician Dr. Russell Viner and colleagues said obesity was a factor in several child protection cases in Britain. They argued that child protection services should be considered if parents are neglectful or actively reject efforts to control an extremely obese child's weight.

    A 2009 opinion article in Pediatrics made similar arguments. Its authors said temporary removal from the home would be warranted "when all reasonable alternative options have been exhausted."

    That piece discussed a 440-pound 16-year-old girl who developed breathing problems from excess weight and nearly died at a University of Wisconsin hospital. Doctors discussed whether to report her family for neglect. But they didn't need to, because her medical crisis "was a wake-up call" for her family, and the girl ended up losing about 100 pounds, said co-author Dr. Norman Fost, a medical ethicist at the university's Madison campus.

    How to tell if your child is at risk for obesity

    State intervention in obesity "doesn't necessarily involve new legal requirements," Ludwig said. Health care providers are required to report children who are at immediate risk, and that can be for a variety of reasons, including neglect, abuse and what doctors call "failure to thrive." That's when children are severely underweight.

    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 may face in trying to control their kids' weight.

    "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. She said she asked doctors for help for her son's big appetite but was accused of neglect.

    Her sister has custody of the boy, now 16. The sister has the money to help him with a special diet and exercise, and the boy 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," Gray said.

    Stormy Bradley, an Atlanta mother whose overweight 14-year-old daughter is participating in a Georgia advocacy group's "Stop Childhood Obesity" campaign, said she sympathizes with families facing legal action because of their kids' weight.

    Healthier food often costs more, and trying to monitor kids' weight can be difficult, especially when they reach their teens and shun parental control, Bradley said. But taking youngsters away from their parents "definitely seems too extreme," she said.

    Dr. Lainie Ross, a medical ethicist at the University of Chicago, said: "There's a stigma with state intervention. We just have to do it with caution and humility and make sure we really can say that our interventions are going to do more good than harm."

    ___

    Online:

    JAMA: http://jama.ama-assn.org

    Pediatrics: http://www.pediatrics.org

    --

    Related on Shine:

     
    • B.A.M.  •  Corpus Christi, Texas  •  3 months ago
      Forgot to mention on my previous post a few minutes ago. There used to be this thing in schools from grades K-12 that was called Phys. Ed.--it was a REQUIRED course. Does anyone remember that?--it required all physically able children to participate in exercise, volleyball, basketball, baseball, gymnastics, depending on the sport & weather conditions, some classes were outside. Who am I to think that Educators would consider this again, it just seems it would be a good and healthy thing to do, kids don't play outside much anymore--they get their exercise indoors from their hand controllers---I suppose that is good for concentration and coordination.
      • Rae 3 months ago
        Wonder why M. Obama has not gotten behind this? Wonderful exercise, program plus doing P.E. seems to open children up to other kids that they might not have done in a regular classroom. P.E needs to be back in schools. If they fail this class, like all of the others, it needs to be redone!!
      • Rydangel 3 months ago
        gym class would be nice. but some schools can't even afford books let alone sports equipment. my nephews school was one such place. after the insurance company my sister worked for went bankrupt she had to take him out of private school and put him in public school in atlanta. the school couldn't afford to give each kid their own books. they had one set for classroom use. any homework given was done from a handout and their notes. and the sports program had the kids standing on the street with their fooball helmets begging for money to buy uniforms and other equipment. and his teacher actually reported her because his lunch a pb&j sandwhich, chhips, juicebox and fruitcup wasn't considered healthy enough. but the greasy, fried foods the cafeteria served was?nver mind the fact that there are no refrigerators for kids to store their lunches in. yes kids need to receive healthy food and exeercise, but taking away people's kids for being fat is a bit much. of course if it's proven that the parents are at fault, then an intervention should be done. but there are already so many orphans or sexually and physically abused kids in foster care who don't get everything they need physically or emotionally, where will we put the kids who got parents? educating the parents on proper nutrition is the better route. you need a license to drive, one to marry, why not make parenting classes a mandatory part of pre-natal care. instruct people on good parenting habits before the kid arrives.
    • Nicholas  •  Milwaukee, Wisconsin  •  2 months ago
      Each case has to be judged independently. My 7-year-old ADHD granddaughter is extremely active. Participates in all sports and dance and all types of physical play. Three months ago at her physical, her weight put her in the obese range on the chart. Luckily, her doctor recognized that because of her hyperactivity, she has developed more muscle mass than most children her age and therefore weighs more. At her last doctor visit she had grown taller, and is now in the "skinny" range. If this was a law, some overzealous doctor could have reported her parents as neglectful and taken her away and had her parents charged. A more useful way of handling these cases would be to start with counseling and providing nutritious school lunches for all kids; and for goodness sake, lets bring back phyed and recess for all kids. I remember gym classes, and two recesses a day PLUS a one hour lunch break when after eating all kids had to go outside to play. Not only have many schools eliminated phys ed, but recess as well and the lunch break at some schools is only 20 minutes, just enough time to gulp your food and get back to work.
    • B.A.M.  •  Corpus Christi, Texas  •  3 months ago
      Sadly, sometimes it is a hereditary thing (or family thing) that doesn't make it ok, however, the more it gets pointed out to someone, it just may make it worse. Kids are very sensitive to remarks made to them and about them, and the more they are reminded, the worse it gets. What is a foster family actually going to do to correct another child's obesity?? There definitely would not be any love for the child, no comforting, I would think the child would be scared to be away from home and all in all, make the whole situation WORSE ! Kids get food from other sources than their own homes--my son used to eat what other kids didn't for their lunch. I found that out by him telling me that I didn't need to make him a lunch anymore because alot of his friends didn't want their own lunch. My son was not obese, but for those that are, it sure is an easy way to get more food. By the way, what gets done when kids are too thin (anorexia) are the parents accused of starving them? Are foster family's supposed to shove food in them 24/7 and make sure they don't vomit it up? Educating the family's and kids involved and their doctor monitoring them on a reasonable schedule (not over doing it), is about the best that could be done whether the kids are obese or anorexic, it just seems like common sense.
      • Sharon 3 months ago
        Do you have a #$%$ MS, MD, or PhD in any discipline of science. No? Do you have any idea how incredibly rare a genetic disorder is that would cause weight gain not to mention other devastating constraints: mental retardation, muscular/skeletal dimorphism, congenital defects lasting into adulthood, etc. Google Momo Syndrome. Do not tell me some crap about how being fat is hereditary...no sweety...food habits, along with other contributing conditions result in obesity. Don't rush in with your thyroid defense or pre/diabetes defense because the vast majority of these preventable, albeit type 1 diabetes, conditions result in weight loss...You my infantile, uninformed, I-get-my-opinions-and-thoughts-from-a-media-source ought to do the world and yourself a favor and just be honest. You haven't a clue what you are babbling about. So stop.
    • MELISSA  •  Collierville, Tennessee  •  3 months ago
      I was an overweight child, and though I do think that my parents could have taught me to eat better, they would not have deserved to take complete blame for my overeating. I remember being pressured by my aunt and put on a diet by my mother and it was more damaging than you can imagine. I have children now and I try to teach them the right way to eat, but I would never deny them food if they were hungry, even if they were clearly overeating.
    • Ladonna  •  Evansville, Indiana  •  3 months ago
      yes if thier is not a medical reason. its a death sentance for some children . ive seen parents feed kids five times what should be eaten . The child weighs 525. Someone should do something . Hes only 13 years old. autisic. they feed him to controll him. Its so sad.
    • hatecowboys  •  Saratoga Springs, New York  •  3 months ago
      great now we have ppl wanting to control us even more when is this #$%$ gonna stop land of the free my arse
    • Tammie  •  Indianapolis, Indiana  •  3 months ago
      the world has gone nut's about taking peoples kids away from them, i turn in my daughter because ,she was on crack this went on for years ,she would leave for a day or week,what every time she wanted the kids would call me,or her boyfriend mom would call me,and say come get the kids julie is gone again,so i would this went on to many times.there was no food and no heat but four heaters,someing like this i understand. to take the kids away but the cps takes people kids for ai,am from old schoolnything.if someone get's mad at you they call in on you ,i have my grandkids the cps patted my daughter on the back and gave us hell.i tought they would make her get help or go to jail if she didn't,there are to many kids getting took from their homes,i am the kids real grandma and foster care for my grandkids.my daughter has it made no kids and freedom it's been 4 years she told me they are better here with us. i did this to get help for my daughter ,the court should have made her get help or put her in jail.i'am from old school ,when you could make your kids mind with get one belt ,my kids said yes mom and was very repectable.know if the kid has a buies they want to take them away form there home. cps said you can wpoo a kid but you can't leave a make,how can you do this without leaveing a mark, belt makes go away,my mom and me an my kids got the belt we are not dead,and we are repestable to people.my grandkids do not know what a belt whooping is if they did they would have alot of respect.the gov has takeing everyones right's away that why these kids in the world are so bad.
    • renee  •  6 months ago
      That's just what these children need...take them away from their parents, that will whip them into shape....that will definitely let them think it was their fault stress them out and make them want to eat even more not to mention scar them for the rest of their life.. dealing with dhr is harder on families than what some believe.
    • Maria Desrosiers  •  7 months ago
      First, I think some kids may have an underlying illness that can contribute to being obese. Doctors need to make sure with a thorough work up of the child that it isn't one of these things. I've heard stories of parents fighting with doctors.... Second, I know some obese kids and their parents are obese and they have very poor attitudes towards trying to eat healthy. I knew a 16 year old boy who kept asking his mom to buy healthy food. She would ignore him and bring him home ribs and MacDonald and stuff like that. I think in a case where the mother is unwilling to listen to the child who desires to lose weight there needs to be something done. But then again this same mother gave her son some one else s prescription for an ear infection. It got so bad he finally had to go to the ER. He hasn't gone to school since he was 14, don't know how the state of Ohio let her get away with it. The boy is now 16 and very very messed up. I really feel sorry for him and thinks that this is all normal. Their house was condemned last year for being messy and smelling really strongly of animal urine. I really would have liked to see him get help... and counseling. He's like 350 lbs and climbing. The father isn't in the picture much. All the mother is concerned with is keeping her son at him because as she says "he's her life" Very unhealthy relationship and I'm afraid he will indeed be with her for life with no education and prospect for a better future than what he has... he's always very depressed. Not sure why the state never looked into him not going to school though. I thought it was illegal to not go to school till you are at least 16. But the mother has a very poor attitude, she thinks buying him whatever he wants and being his best friend is good parenting.
      • Erin 3 months ago
        well YOU could report a tip to the dept. of Children and Family services and they would have someone check up on it...
    • Donnie  •  9 months ago
      Just a comment, don't blame just the parents for obese children.We all play a part in this, the ones who grow the food,the ones that put the prices on the food ,the ones who purchases the food and the ones who prepare the food is to blame. What I think need to be done, is change the prices in the stores. Instead of unhealthy food been the cheapes,let's change that and let the healthy food be the cheapes in the stores. As a parent I do pick up items that I can afford, no it's not always unhealthy food choices.Yes I rather the healthy food choices for my family. If u have high bills to pay, nine time of ten your food bill is going to be lacking. So u have to work with the amount u have in your pocket or purse. Parents we play a major part in our children lives, just do all u can to keep them from gaining the extra weigh. I'm a small person in weigh, but guess what my stomach is the largers thing on my body.It's what they putting in the food.
      • anonymous 3 months ago
        #$%$ Whom do you think places the food on the table? In the grocery basket? In the pantry? IT IS THE PARENT. DUH!The parent has a BEHAVIOR problem. The parent can not control their own behavior (purchases).
      • Sandi 2 months ago
        This "unhealthy food is cheaper" argument is nothing but crap. Example: 1 family size bag of doritos = $3.89. For the same amount of money you can buy 3 lbs of bananas and a lb of apples. 1 frozen pizza = $4.29-$7.99. A lb of boneless skinless chicken breast =$4.99. I could go on and on. The reality is that it takes a little more effort to prepare healthy meals than to just throw a pizza in the oven or run through the drive thru
    • Amanda  •  9 months ago
      I myself have never been obese, but have been around an obese child who is suffering. The parents believe feeding them, is loving them. I don't think a child should be removed from the home, however, in some circumstances I do believe social services should step in the picture. I know parents who will give their child anything to eat so long as they "shut up." Yes this is not right, and yes this is the parents fault. I agree with many of you regarding the educating parents on how to eat healthy and help their children eat right. But these people get letters in the mail every month from school on healthy eating habits, they get letters stating their childs inability to perform activites in the gym. And still nothing is done, sometimes I think the ignorance of parents is what leads these children to suffer, they think the fatter the kid the healthier they are. When in fact these kids are suffering from diabetes, high blood pressure, and problems with their bones because they cannot hold their weight.
      • Erin 3 months ago
        well overfeeding IS child abuse. Plus it has more far reaching consequences. Spanking a child doesn't give them diabetes or heart attacks. Overfeeding is one of the worst forms of abuse because it deprives children of not only happiness, but it takes years of life away from them.
    • BethB  •  10 months ago
      Wouldn't the money the government provides to foster caregivers be better spent improving the home situation in these cases? How many of these kids are in low to low-middle income homes, the ones that typically have problems obtaining healthy foods and don't always have time to make sure their kids are exercising or the means to put them in extracurricular activities? Somehow, I have a feeling this is a policy that wouldn't affect the upper income level homes.
    • EMW  •  10 months ago
      I wonder how many of the people who would be pulling these kids out of their homes are obese? How about the judges signing the papers? Pull the plank out of your own eye before the speck in someone else's.
    • Suzanne  •  10 months ago
      Taking a child out of their home is much more damaging than being over weight. I say we raise the taxes on food that are not healthy, nor needed for nutritional value, and use the extra money earned to substidize stores like Whole Foods, Sunflower Market, Trader Joes, that focus on selling good quality foods. That way everyone can afford to eat healthy. Adding additonal emotional strain to a child for being obese is a horrible idea. With the money spent on foster care, the state could instead hire a personal trainer for the family that teaches them the value of exercise and eating for nutritional value.
    • Julie  •  10 months ago
      This is one of many examples of our government "intervening for our own good" and where we need to collectively, as American citizens, put a stop to the insidious, ever-growing government intrusion into our private lives! Yes, we need to protect children from molesters and other evil predators out there--absolutely; I'm all for that--always. But, removing a child from the family just because of obesity? No. The only time intervention from the state should happen is if the child is being mentally/physically/emotionally abused. If it's simply a matter of lacking healthy nutrition and exercise habits, children and their parents/guardians need to be offered help together--not apart.
    • Christie  •  10 months ago
      Considering the condition of the foster care system (enough said) and the cost to already struggling state governments to maintain programs I seriously doubt that anything like that would happen very often. It also seems that Child Protective Services like the police often target the easy cases as opposed to the ones that really need intervention or the ones that need dealt with. I think the money is better spent on education and programs to promote healthy eating alternatives, gardening and fresh produce as well as health and exercise programs. It is not safe in most areas to even walk and that is; if there are walking paths so people stay in glued to the proliferation of media and games systems available these days. There are some few rules governing what can be purchased with Food Stamps and in trying to feed large families people tend to buy packaged processed starchy foods..due both to portion size, and shelf life. Those rules could be changed so people have to buy some healthier stuff.
    • thomass  •  10 months ago
      The government screws up everything it gets involved in,and now wants to remove obeses kids from their parents.. whats next, short kids,red haired kids, kids that stutter. The government should stick to what it does the very best,--nothing.
    • JT  •  10 months ago
      I work as a barber and have tryed to report this kind of child abuse, The department of childrens welfare wanted to know all my information. why? Poor MIKA that lives in Lena Illinois is 500 plus pounds,He is only 14 yrs old. wheres the school nurse? DR? Is anyone going to something to save this poor childs life? Lena Illinois is a small town it won't be too hard to track a 500 pound teenager down, I hope someone reads this that can help him, I tryed to all I got is buricratic red tape.
    • Peaches  •  10 months ago
      Should parents of obese kids lose them? No they should be educated and if you notice an awful lot of heavy kids come from fat parents. You cant stop your children from eating, you can only provide more healthful selections and teach your kids to incorporate low fat and produce, Dont buy soda it makes you fat. Teach them to drink water or natural juices. Please note: food is very expensive and people on food stamps have to make selections of heavily ladened starchy and fatty foods.. cause the prices are lower. IF Michelle Obama is serious about doing away with childhood obesity. Then congress should legislate that food not be a capitalism product and the fair market value should apply to all foods. Look at the cookies that are home baked at the store as opposed to processed. The difference is home baked is $4.99 and processed is $2.99.. see this is what im talking about.
      Why do you need to pay $5.00 for cookies anyway? This is so with all food products. Kudos to groceries like SAVE ALOT AND ALDIS that try to keep groceries affordable. thank you for that.!
    • DOGDEMON  •  10 months ago
      Observing people's eating habits in this country and others, Americans tend to have VOLUME issues and INACTIVITY issues.

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