# Op/Ed in Journal of the American Medical Association: Hand Severely Obese Children Over to CPS



## Turquesa (May 30, 2007)

I don't have a JAMA subscription, so I'll link to an article about the article: http://www.medpagetoday.com/Pediatrics/Obesity/27698?utm_content&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&userid=345221

More from the Nanny State....


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## Sarah W (Feb 9, 2008)

Well, if it wasn't for the "Nanny State" at least one of those children in the article would probably be dead by now.

This article looks like it was based on another article that made headlines recently. We're not talking about removing overweight children from their homes or even obese children. This article discusses removing children that are beyond morbidly obese with no underlying medical causes. One girl was 90 lbs by the time she was 3 and 400lbs by the time she was 12. She lost 130lb in one year in another home.

Another boy was a 555lb 14 yr old. He lost 200lb while living with his aunt.

Yes, let's educate parents and work with them. However, one mother said that she didn't have the time to cook. I feel terribly for her that she has to work two jobs, it can't be easy. However, at the end of the day her child wasn't being cared for.


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## Super~Single~Mama (Sep 23, 2008)

I worked for a weight loss camp one summer, and there was an absolutely HEARTBREAKING case where a girl was sent as an absolutely last resort before removing her from her home.

She had literally never been active, and couldn't even walk up a flight of stairs hardly. She was so overweight that there was so much fat sitting on her lungs that she could hardly breathe. She had to lean over, and prop herself up with her arms in order to take complete breaths. She wasn't merely overweight, or merely obese - she was in danger of DYING at any moment. We were terrified the whole time she was there, b/c she was at risk of having a stroke, she was at risk of heart failure, she was at risk of having HORRIBLE health issues (heck, she was almost 500lbs and she was 10!! She already had horrible health issues!! the STATE was paying for her to attend a PRIVATELY OWNED camp!!), we were literally afraid she was going to drop dead at any moment.

I'm not sure I agree with this happening a lot, but in certain dire circumstances, I think it can be lifesaving.


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## MusicianDad (Jun 24, 2008)

Some kids need "the nanny state" to survive to adulthood. Parents who are doing everything in their power to help their obese child should be provided with resources, etc to help them. Parents who don't give a damn about their 12 year old is 400lbs and have no intention of doing anything at all to help need more intervention than that. In some cases the best interest of the child is to remove them from a home where they are essentially being neglected.


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## AnkaJones (Jul 21, 2011)

Hi,

I'm sorry you don't have a JAMA subscription -- this is one of those papers you have to read to understand why everyone is so worked up about it. I've read the paper, and the reason this opinion piece is so controversial is that it isn't clear that what they are saying is, "In cases of severe (>99th percentile) morbid obesity with complications, child protective services should be involved to first intensify home-based therapy, then if the family is neglectful the child should be removed from the home." Rather, it seems that what they're saying is that the presence of severe morbid obesity with complications is in itself a reason for removing the child from the home, if home-based therapy is unsuccessful (regardless of whether or not the parents are neglecting the child). They argue that this is a better option than obesity surgery because it is reversible.

Especially for people on this forum, I would think that we would be suspicious of these sorts of arguements. Here are a few other things many pediatricians think constitute neglect:

cosleeping

not vaccinating

home birth (and certainly unattended homebirth)

We need to be very cautious when physicians make broad reaching statements about removal from the home as a medical intervention, which is what the article proposes. Art Kaplan, ethicist at the University of Pennsylvania, has argued against the piece on ethical grounds. Several experts in obesity treatment for pediatric patients have also publicly denounced the JAMA article because it creates a culture of blame, which on purely utilitarian grounds undermines treatment for obesity.

Best,

Anka


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## Super~Single~Mama (Sep 23, 2008)

You know, allowing a child (a CHILD) to reach 500lbs before the age of 10, is simply NOT on the same level as co-sleeping. Co-sleeping isn't deadly (unless a parent is intoxicated or on strong medications, then it can be), but a child cannot survive, and cannot have any kind of decent life if they weigh that much. We're not talking about fat kids, or chubby kids, we're talking about children who weigh 3x the size of a health adult. HUGE difference.

The child that I mentioned up-thread? We couldn't even keep her at camp, b/c we were not set up to deal with her health problems - and it was a WEIGHT LOSS camp. She was the heaviest person there, and she was TEN. We had to send her home, b/c she was a heart attack/sever stroke/diabetic coma waiting to happen. Her poor counselors were so scared she was going to die, we never knew if she would wake up in the morning, or if she would be able to walk to the dining hall. It was devastating - and she deserved a better life than that. Can you imagine being too fat for fat camp? I wonder what happened to her, and I hope that she was able to find the help she so desperately needed - her family certainly wasn't giving it to her.

Quote:


> Originally Posted by *AnkaJones*
> 
> Especially for people on this forum, I would think that we would be suspicious of these sorts of arguements. Here are a few other things many pediatricians think constitute neglect:
> 
> ...


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## AnkaJones (Jul 21, 2011)

I'm not saying all was right in your client's world, nor would I argue, being a cosleeping parent myself, that cosleeping is medical neglect (although you should know that many pediatricians would say that it is). I'm letting you know what the op/ed actually argued, i.e. that in the absence of neglect, severe obesity not responsive to treatment (which can be due to genetic mutations, as is discussed in the paper, and outside of the parent's control) would justify removal from the home. I think this is a very dangerous line of arguement. What should be demonstrated before removal is neglect, otherwise the child should be supported in the home (or hospital with the family having normal visiting rights) and the family given the resources necessary to help their child.

Anka


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## Super~Single~Mama (Sep 23, 2008)

I'm wondering how there could be a case of severe obesity in the absence of neglect? The example I gave is clearly unusual, as the vast majority of 10yo's do not weight anywhere near 500lbs, or even 300lbs - but I wonder how a child could possibly get to be that big, without any sort of neglect??


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## AnkaJones (Jul 21, 2011)

There are specific syndromes associated with severe obesity like you describe, including specific genetic mutations, e.g. leptin resistence (leptin is a hormone which controls energy intake and expenditure including appetite), Prader Willi Syndrome. These are actually specifically mentioned in the op/ed, along with the possibility there are other as yet identified mutations. The authors argue, however, that because these diagnoses don't have treatments, they don't obviate their arguement.

I understand where you're coming from. One of the problems with obesity as a disease is that it is highly stigmatized. We want to blame it on someone, either the patient or the parent. In some cases, weight gain really is someone's fault. I would be the first to argue that as a society, we are committing social injustice when we fail to provide access to healthy foods both in school and at home, as well as places and time where children and teenagers can play actively. I think we should fund programs to help parents (often obese themselves) take care of themselves better so that they can model good behavior for their children and understand what constitutes a healthy meal. At the same time, I think it is the parent's and in the case of older adolescents the child's responsibility to fully access and use the resources presented to them. In extreme cases, I agree that the failure to do this constitutes neglect. But that is what has to be documented, not the mere fact of obesity however severe.

Anka


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## Super~Single~Mama (Sep 23, 2008)

Quote:


> Originally Posted by *AnkaJones*
> 
> There are specific syndromes associated with severe obesity like you describe, including specific genetic mutations, e.g. leptin resistence (leptin is a hormone which controls energy intake and expenditure including appetite), Prader Willi Syndrome. These are actually specifically mentioned in the op/ed, along with the possibility there are other as yet identified mutations. The authors argue, however, that because these diagnoses don't have treatments, they don't obviate their arguement.
> 
> ...


Again, I'm not talking about obesity. I'm talking about children who are in danger of dying b/c they are so huge. The girl at the camp I worked at did lose weight while she was with us, but we could not keep her for long enough to make a real impact b/c her health conditions were too much for us to handle. Seriously, we were afraid she was going to drop dead, or not wake up in the morning. The other girls at camp were overweight, but they certainly weren't in danger of dying - they just wanted to lose weight, learn healthier eating habits (we had a range of girls and young women from about 10-26yo), and I would not advocate taking them away from their parents. Ever. Only the one girl - whose health problems had become so dangerous she wasn't even allowed to exercise most of the time, b/c just walking around campus was so difficult and caused so many problems.

I don't know why she was so big, but no one even tried to do anything about it until she was SO huge, that she was 3-4times my size. And I was pregnant at the time.

In situations where the child is not so large as to be in danger of literally dropping dead, yes, there should be MAJOR support systems in place to help people change their lifestyle and eating habits. It would be better for entire families to have access to healthy, whole foods, and fruits and vegetables. Its a shame that healthy foods are so expensive, I wish that they were more accessible to everyone. In moderate cases, I think that should be the goal - and schools should be serving healthy foods as well! But then what do you do about children who bring their lunch, and its full of junk?

Its a very complicated issue, and there isn't a single solution. Once a child gets dangerously large (again, I'm not talking about fat, or chubby, or even moderately obese children - I'm talking about those on the high end of morbidly obese), there health needs to be whats considered - and getting them somewhere that they are encouraged to exercise and eat healthy, and are provided healthy options, should be the most important.


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