Extremely Obese Children…Should Their Parents Lose Custody?

When parents neglect or fail to provide even basic food, shelter, or medical care for their children, we would all agree that Children’s Services needs to step in and remove a child from their parent’s control.  If a child’s immediate safety and well being are at risk, we would argue that such a situation must not be allowed to continue.

But what about parents who allow their children to become extremely obese over time…obese to the point that a child’s health, or even life, is in danger?  If a child is experiencing medical problems because his or her parent allows them to eat to excess and maintain an inactive lifestyle, should Children’s Services remove a child from that environment?  Doesn’t the situation amount to a form of child abuse that authorities should act upon?  A recent commentary in one of the nation’s most distinguished medical journals, the Journal of the American Medical Association, argues “Yes!”, and it’s causing quite a debate across the country.

The commentary that has generated numerous news stories and blog articles was written by Dr. David Ludwig, an obesity specialist at Harvard-affiliated Children’s Hospital in Boston, and Lindsey Murtagh, a lawyer and researcher at Harvard’s School of Public Health.  The two were inspired to write their article after Dr. Ludwig was involved with the following case:

Several years ago a 90-pound, 3-year-old girl came to his obesity clinic.  The girl’s parents had physical disabilities, little money, and had been unable to control her weight.  Last year the girl, who is now 12, returned to Dr. Ludwig’s clinic weighing 400 pounds.  She had developed diabetes, cholesterol problems, high blood pressure and sleep apnea.

Because health care providers are required to report children who are at immediate risk, the girl’s case was referred to the local agency and she was placed in foster care.  Over the last year, away from her parents, she has lost 130 pounds and her diabetes and apnea have disappeared.  She is still in foster care.  A separate case cites the story of a 555-pound teen who was removed by the state from his mother’s home.  That boy was able to lose 200 pounds in two years, but only after being sent to live at his aunt’s home.

As with any other dangerous situation where children are at risk, Dr. Ludwig explains that the point isn’t to blame parents but to act in a child’s best interest and to get them the help and care that their parents are not providing.  He points to the roughly 2 million U.S. children who are extremely obese.  Most are not in imminent danger, but many have obesity-related conditions such as Type-2 diabetes, breathing difficulties and liver problems that could kill them by age 30.

Dr. Ludwig argues that it is those extreme cases where government intervention (temporary protective custody by Children’s Services) should be considered.  After removing a child from a home for their own protection, Dr. Ludwig contends that the goal should then be to educate the parents and reunite the family as quickly as possible.  He believes that solution is much more preferable and ethical than having a child undergo gastric bypass surgery, which unfortunately is sometimes used to treat obese adolescents.  Finally, Dr. Ludwig proposes a new litmus test for taking kids away from their parents.  Instead of demonstrating abuse or dangerous neglect, the state need only document a child’s weight-related health risks and the parent’s “chronic failure to address” the problem.

A 2009 opinion article in Pediatrics magazine made similar arguments, and last year a commentary in the British Medical Journal cited that obesity was a factor in several child protection cases in Britain.

Since Dr. Ludwig’s article was published, opinions have become more vocal and intense on both sides of the issue.  Some advocates say that, of course, the government should be allowed to intervene in extreme cases.  If the government doesn’t intervene, no one will because the parents obviously aren’t protecting the child’s best interests.  Conversely, others feel that the government already has too much power to remove children and to break up a family.  They contend that it is a parent’s prerogative as to what and how much their children eat as well as how much exercise their children get.

Ohio’s custody laws, like the laws of most states, still hold that a child cannot be removed from the home unless there is reason to believe the child is likely to suffer imminent serious physical harm, injury or death.  Federal laws establish the minimum standard for states for defining child abuse and neglect as “any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm…or an act or failure to act which presents an imminent risk of serious harm.”

My legal research does not indicate any litigated Ohio cases concerning Children’s Services removing a child from a family primarily because of the excessive weight of a child.  Now that the debate has become more intense, though, don’t be surprised if one day in the near future you hear about an Ohio child who has been removed from their home by the local Children’s Services agency because a child is dangerously obese.  The case will no doubt involve a child who is experiencing serious medical problems because the child’s parents have failed to take action to correct the child’s diet and activity levels.  Medical and social work personnel will charge that the child’s immediate health is at risk because of the excessive weight and the problems it is causing.  The child’s parents will tearfully plead for the return of their children so that they can be raised in the best way the parents know how.

Regardless of what happens, it will be a sad situation for the child and their family.  It will be a difficult case for every social worker, attorney or Judge who is involved, and it will generate strong opinions from all who hear about the case.

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