What to do about really obese kids

Some of my libertarian friends are losing their minds over this:

Despite a well-established constitutional right of parents to raise their children as they choose, the state may intervene to protect the child’s interests. Federal law, which establishes a minimum standard for states, defines 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.” The seriousness of neglect is judged according to the magnitude or risk of harm and by its chronicity. Improper feeding practices, causing undernourishment and failure to thrive, have long been addressed through the child abuse and neglect framework. However, only a handful of states, including California, Indiana, Iowa, New Mexico, New York, Pennsylvania, and Texas, have legal precedent for applying this framework to overnourishment and severe obesity. Nevertheless, mandated reporter laws may obligate physicians to contact child protective services in the cases of children for whom chronic parental neglect has resulted in severe weight-related health complications.

State intervention may serve the best interests of many children with life-threatening obesity, comprising the only realistic way to control harmful behaviors. Child protective services typically provide intermediate options such as in-home social supports, parenting training, counseling, and financial assistance, that may address underlying problems without resorting to removal. These less burdensome forms of legal intervention may be sufficient and therefore preferable in many cases. In some instances, support services may be insufficient to prevent severe harm, leaving foster care or bariatric surgery as the only alternatives. Although removal of the child from the home can cause families great emotional pain, this option lacks the physical risks of bariatric surgery. Moreover, family reunification can occur when conditions warrant, whereas the most common bariatric procedure (Roux-en-Y anastomosis [gastric bypass]) is generally irreversible.

I have to agree with them. Although I loathe slippery slope arguments, parents do tons and tons and tons of things that are inherently unhealthy for their kids. I’m guilty, too. Some of my friends are horrified that I let my kids drink soda. I’d argue that I’m happier with them drinking diet decaffeinated soda than sugar-laden juice. Others may think I’m a terrible parent for letting them play video games. Or watch TV. Or, you might question what I let them watch on TV. I also let them eat popcorn before the AAP recommended age. And hot dogs. And steak, for that matter.

On the other hand, I’m horrified by parents who smoke around their kids. I probably should stop my kids when they yell at other kids who don’t wear bike helmets, but I don’t. And many people I know let their kids out of booster seats far too early.

But I’m not advocating for protective services for those kids. The foster care system is WAY overtaxed already.

Moreover, I’m uncomfortable with too much state interference into private matters, and this feels like it crosses the line.

That said, this is a big issue with real health consequences, and I think we need solutions. Austin sent me this yesterday, and it burned my eyes. (via Tyler Cowen who shares the blame)

I’m pleased JAMA is allowing the debate.

UPDATE: Many of you are putting me in the same camp as those who are “angry” about the editorial or who equate this with “jack-booted thugs” invading homes.  Please. That’s not what I’m saying.  Look at the sentence at the end of the post.

I’m a pediatrician. I have personally been involved in many cases where my gut reaction is to get the kid out of the home. I feel that way more than I’d like. But I can tell you that we need to be very careful in removing a child from his or her family. It’s possible to do more harm than good, emotionally as well as physically. I’m not saying it should never happen. I’m saying it should happen only when absolutely necessary.

I’m not convinced this is one of those areas. I’m not convinced that this is where we should be aiming the state. Personally, I’m much more comfortable with financially penalizing groups and other solutions before breaking up families.

And for those of you who think there is no slippery slope here, what’s the line? Is it a certain weight? Is it a certain BMI? What’s the point when you take a child out of their family?

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