Childhood/Adolescent Obesity and State Intervention—Parents Not Solely to Blame in the Battle

Dear Bariatric Times Editor:

This letter is in response to the an article published in The Journal of the American Medical Association (JAMA) by Ludwig and Murtagh entitled, “State intervention in life-threatening childhood obesity.”[1] As a frontline childhood obesity physician, I strongly disagree with the premise of this article.

Genetic predisposition, environment in utero, and birth weight all affect obesity rates long before any active parenting occurs.[2] Race, ethnicity, poverty, infant feeding practices, and the well-recognized cost disparity between healthy and less healthy foods play a role.[3] Children do not expend energy as in the past, and school vending machines, poor-quality school lunches, and the regrettable removal of physical education, recess, and health education classes are also factors in this issue.[4,5]

This is not to say that parents are completely defenseless to our obesogenic environment.[5] Simple changes, such as sitting down to dinner as a family, decreasing fast food consumption, controlling use of  electronics, and modeling good behavior, can have a significant impact on a child’s weight. But what happens when an engaged family has made these changes and the child remains severely obese (body mass index [BMI] at or beyond the 99th percentile)?[6] Are our only answers to put him or her through surgery or remove the child from his or her home?

Approximately two million children in the United States have severe obesity,[6] clearly more than an overburdened foster care system can handle. Children with obesity are discriminated against by peers and teachers and are bullied relentlessly. The added insult of removing a child from his or her home will, in most cases, do more harm than good. In addition, with 75 percent of our society being overweight, the chances that a child will be placed in a home where the family members also struggle with a weight problem is more likely than not.[7]

Choices do exist for a child with obesity besides experimental surgery and state intervention. The 2007 Expert Committee on Child and Adolescent Overweight and Obesity (of which Dr. Ludwig was a member) developed an eloquent algorithm that involves early identification and assessment by primary care providers followed by prevention and treatment by clinical obesity experts. Bariatricians and other childhood obesity experts are in the process of rolling out these recommendations nationally while simultaneously conducting outcomes research, with initial results that look very promising.

Certainly, the premise of turning a child with severe obesity over to the state is thought provoking, but unless there are clear signs of neglect or abuse in conjunction with the obesity, it is unnecessary, unrealistic, and likely damaging to that child long term.

References

1.    Murtagh L, Ludwig DS. State intervention in life-threatening childhood obesity. JAMA. 2011;306(2):206–207.
2.    Zhao J, Grant SF. Genetics of childhood obesity. J Obes. 2011;2011:845148.
3.    Van Cleave J, Gortmaker SL, Perrin JM. Dynamics of obesity and chronic health conditions among children and youth. JAMA. 2010;303(7):623–630.
4.    Rahman T, Cushing RA, Jackson RJ. Contributions of built environment to childhood obesity. Mt Sinai J Med. 2011;78(1):49–57.
5.    Eisenmann JC, Gundersen C, Lohman BJ, et al. Is food insecurity related to overweight and obesity in children and adolescents? A summary of studies, 1995–2009. Obes Rev. 2011;12(5):e73–83.
6.    Skelton JA, Cook SR, Aulinger P, et al. Prevalence and trends of severe obesity among US children and adolescents: what could be better? Acad Peds. 2009;9(5): 322–329.
7.    Hadfield SC, Preece PM. Obesity in looked after children: is foster care protective from the dangers of obesity? Child Care Health Dev. 2008;34(6):710–712.

With regards,

Wendy Scinta, MD, MS, FAAFP, FASBP
Medical Director, Medical Weight Loss of NY, BOUNCE Program for Childhood Obesity, Manilus, New York; Clinical Assistant Professor of Family Medicine, Upstate Medical University, Syracuse, New York

Category: Letters to the Editor, Past Articles