A recent study published in the British Medical Journal by Russell Viner at the UCL Institute of Child Health, London, England.... caught my eye: “Childhood Protection and Obesity: Framework for Practice." I know that my colleagues across the pond have been quite aggressive about finding creative solutions for countering the childhood obesity epidemic in England. Their Academy of Pediatrics has recently proposed a ban on junk food and beverage TV ads aimed at kids, a stiff tax on sugary items, and a requirement that fast food restaurants be located far away from schools. But this BMJ analysis takes the discussion to a different and understandably more contentious place. Should parents be blamed for their child’s obesity? Intrigued, I did some homework to share with you.

The childhood obesity-child protection issue has emerged over the past several years, garnering increased media and professional attention. At the 2007 British Medical Association’s annual meeting, members rejected a motion in which obesity occurring in kids under 12 constituted a reason to charge parents with neglect and removal of the child into protective custody. This action followed on the heels of a BBC survey of 50 pediatricians who noted that childhood obesity had been a factor in at least 20 child protection cases in 2006. The UK is not alone in its concerns, which are evident internationally, including US courts which have already been removing some obese children from parents considered neglectful. Here’s an example from Missouri, where an boy was removed from his foster home because his foster father was obese.

The BMJ authors examined the existing literature on childhood obesity and protective actions and suggested a blueprint for action. What they found is that there is indeed evidence of an association between obesity and sexual abuse, violence and neglect. However, there is no data on the relationship between child protection actions and weight control in the long term. Moreover, there’s no information about the long-term physical and mental welfare of an obese child who undergoes removal from the home and placement into foster care. 

The BMJ authors note that obesity is part of a larger constellation of child welfare concerns related to child protection. This means that all aspects of the child’s family and living environment, including nutrition and activity, need to be closely assessed when determining what’s best for the child’s welfare. To further complicate things, there is good research that shows even when obese children have strong family support or ready access to credible weight-loss programs, kids can still struggle to remove the pounds.

They suggest that failure to comply with obesity treatment (missing appointments, not supporting obese children with weight management programs or even actively sabotaging their kids' efforts) is tantamount to neglect, especially in those kids who are already suffering medical consequences arising from their obesity. 

In reviewing the media coverage on this topic, it’s clear that the Brits are more open to aggressive legal actions, especially for children under 12. They see it as an issue of “extreme overfeeding”, which, they believe, constitutes abuse. They argue that malnutrition and starvation of a child results in immediate court interventions, so why not obesity? But the Royal College of Paediatrics and Child Health has continued to argue that obesity is a public health problem, not a child protection issue....

The bottom line is that this is a very complex and controversial issue. The real goal is to protect children from serious harm. Most pediatricians have gone on record noting that the majority of parents do care about their children, but may not be knowledgeable about how to do it.

That means that every parent must be a role model for their children by walking the talk and creating a healthy living environment for the whole family.

Doctors and all medical care providers are also role models and mentors who need to provide counseling, education and programs for parents to help obese children and their families.

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