Thursday, July 21, 2011

Childhood Obesity is Not Child Abuse

rebecca puhl, Other, 01:54PM Jul 13, 2011

This week, JAMA published a commentary (authored by Lindsey Murtagh and David Ludwig), discussing extreme cases of childhood obesity where state intervention (e.g., child protection services) may be warranted. While the authors wrote that state intervention would not be desirable or ethical for many obese children and that removal from the home does not guarantee improved physical health, they propose that “involvement of state protective services might be considered, including placement into foster care in carefully selected situations”. 

Perhaps not surprisingly, there has been significant media attention to this article. 

This editorial raises a very complex and difficult issue that must be handled sensitively and without unfair bias. We cannot assume that childhood obesity is child abuse, and we need to ensure that the pervasive stigma that exists toward obese individuals does not color the judgments of authority figures who are making decisions about obese children and their families.

Unless there is clear evidence that parents are truly incapable of caring for their child, a child should not be removed from their family on the basis of obesity alone. In making decisions about these families, the same legal standards that are used for parental neglect or abuse in other circumstances (unrelated to body weight) should be used, to ensure that the focus is appropriately on the parents capability of caring for their children – not on the child’s weight per se.

Obesity may indeed be a sign of medical risk, but we need to be careful in our understanding of what role the home environment plays, versus the larger societal environment, the economics of food, and other major societal conditions that have created obesity.

I believe that the intentions of the JAMA article were to discuss how to approach extreme cases of obesity where parental abuse and neglect may be suspected, and the authors were not suggesting that all obese children should be removed from their families. Unfortunately, the media headlines surrounding this story suggest otherwise. Of course, the issue remains very complex even if we limit the discussion to extreme, unlikely cases. 

If anything, this editorial and the resulting media response indicate the need to find effective ways to support parents in their efforts to help their children become healthier. This means we need to make it a priority to change the societal conditions that have created obesity in the first place, such as the fast food industry, widespread marketing practices that target children and families with unhealthy foods, and the economics and pricing of food which make healthier foods more expensive, and unhealthy foods cheap and readily accessible. 

There simply is no magic pill to cure obesity – regardless of whether a child is with or without their parents. We cannot ignore the complexity of this issue, and we must ensure that stigmatization does not play a role in determining the fate of families who are affected by extreme obesity.

Rebecca Puhl, PhD is the Director of Research at the Rudd Center for Food Policy and Obesity at Yale University.

No comments: