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Is it child abuse if your youngster gets obese?

Marla Richter comes from, to use her term, a "fat family." Her mom was fat, as are her kids and most of her grandkids. So a recent case hit home: A 219-pound Cleveland third-grader was taken from his mother by child welfare officials, in part, because of his obesity hit home. • Richter, 61, of Corinth, Texas, says a 13-year-old relative who weighs more than 200 pounds saw a news report on the case and immediately tried to nix an upcoming medical appointment. "I'm not going to the doctor now," Richter quoted the girl as saying. "No way. I'm not going to be taken away from my mother."

Cases of children being temporarily taken from their homes due to obesity-related concerns remain extremely rare. In Florida, the Department of Children and Families has stepped in when parents fail to provide adequate medical care for their children. But children have never been removed from their homes due to weight issues, said agency spokeswoman Erin Gillespie.

Still, the Ohio case has fanned concern among obese kids, their relatives and their advocates.

"I see our freedom being stripped from us more and more every day, so I don't really see (removing kids) as so outrageous that it's not a real possibility," says Peggy Howell, a spokeswoman for the National Association to Advance Fat Acceptance. "We don't even have enough foster parents as it is in this country, so what are we going to do? Create fat concentration camps that we're going to put these children in?"

A handful of influential doctors have come forward in recent years to discuss the possibility of temporarily removing extremely obese kids from their homes. But that discussion has generally been extremely cautious and moderate, with an emphasis on a very small subset of very obese kids who face severe and immediate health risks because of their weight.

A high risk of developing diabetes as an adult, for instance, wouldn't meet the standard outlined in a 2009 article in the journal Pediatrics. A respiratory condition that could lead to death in a matter of days, on the other hand, very well could.

"These are extraordinarily unusual situations," says David Allen, a professor of pediatrics at the University of Wisconsin School of Medicine and a co-author of the Pediatrics study.

Allen and his co-authors wrote that removal of a child from his home could be justified, but only if the child faced a high risk of serious and immediate harm. Mere obesity, however severe, would not meet the standard. Plus, there would need to be effective treatment available for the child, and all other alternatives to removal would have to be exhausted.

Advocates object that the vast majority of people who lose a large amount of weight gain it back, making all obesity treatment ineffective in the long run; that claim is backed by numerous scientific studies. But Allen says kids are different, because parents and other adults really can control their calorie intake and exercise. He pointed to group homes where children with genetic syndromes that lead to obesity have lost weight.

In the Cleveland case, Allen said, news reports haven't provided a lot of detail, but it appears that child welfare workers made substantial efforts to help the family of the 8-year-old honor student who lost and then rapidly regained weight.

Fat rights advocates, however, see the Cleveland case as part of a broader threat to the well-being of fat people and their families.

"Most people I've talked to are disgusted. They think about the emotional toll it takes on the child, the parents and the other children (in the family)," says Richter.

"I have a friend who's thin, her husband is thin, her girls are thin, but she has this chubby little boy. She says, 'He eats just like we do. What are we supposed to do? Are they going to come and take him away from me?'"

Times staff writer Irene Maher contributed to this report.

Dr. Pallavi Iyer, a pediatric endocrinologist at All Children's Hospital in St. Petersburg, specializes in helping obese children and their families. We talked to her about the controversy.

Is a child's weight a reason to call the authorities and report abuse?

There is a precedent already for reporting kids and removing them from families where they have failure to thrive — they don't gain adequate weight or height for their age or if we believe they aren't getting sufficient love or food. That can be dangerous and stunt their growth. But there's not much precedent on the other side of the issue for kids who are obese ... If the child is the victim of abuse or neglect, or the child's safety is in danger, of course, we would report that. (But) just being overweight isn't reason enough to remove a child from the home.

Could putting an obese child in a new environment even temporarily help deal with the weight problem?

Taking the child away doesn't resolve the family issues that led to the obesity. You have to work on the whole family. Everyone has to be willing to change, not just the child.

So many kids are big these days. Why are doctors so concerned about obese children?

Left untreated obesity can lead to heart problems, high blood pressure, diabetes, joint problems, psycho-social issues. That's why we speak with (parents) when we are concerned, give them useful recommendations that are realistic for that family and help them find a solution.

How do parents react when you tell them they need to help their child lose weight?

I speak with families routinely about their children who have weight problems. That's why they come to see us, to be evaluated for metabolic or endocrine disorders that could be causing weight gain. Most families are receptive to guidance, especially if you tell them that it's not about how your child looks, it's about preventing serious health problems. Families get that.

Are there some kids who simply can't lose weight, no matter what you try?

Only in rare cases will a child remain obese despite their best efforts to lose weight. There are genetic conditions that can prevent weight loss, but that is extremely rare. There's always something that you can do, something you can change with diet and exercise, to lose weight. We explain that there are certain people who hold on to food differently than others. You may be more at risk, but that doesn't mean you can't change it.

Is it child abuse if your youngster gets obese? 01/04/12 [Last modified: Wednesday, January 4, 2012 4:56pm]

    

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