Severely obese children should be removed from parents, placed in care: Expert opinion

By Dr. Ananya Mandal, MDJul 13 2011

In a controversial new opinion piece in the Journal of the American Medical Association the authors suggest taking severely obese children out of their homes and placing them in foster care. Dr. David Ludwig, an obesity specialist at Harvard-affiliated Children’s Hospital Boston and Lindsey Murtagh, a lawyer and a researcher at Harvard’s School of Public Health, write that in some cases it may be justified to take an extremely obese child out of their parents’ custody.

Childhood obesity affects nearly two million kids in the United States and is quickly becoming a problem in Canada as well. Short of better parental education and medical intervention, however, doctors and health care workers struggle with how to tackle the issue.

Dr. David Ludwig, claims he's not blaming parents but protecting children. He said State intervention will “support not just the child but the whole family, with the goal of reuniting child and family as soon as possible.” Ludwig proposes foster care in drastic cases, where surgery might have been the alternative.

The opinion argues that some kids who suffer from Type 2 diabetes, breathing difficulties or liver problems should be removed from their home for their own protection. The goal would be to educate the parent and reunite the family as quickly as possible.

Ludwig explained that 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.” However Art Caplan, a University of Pennsylvania bioethicist, believes there's no getting around the parental blame game.