Press one of the expand buttons to see the full text of an article. Later press collapse to revert to the original form. The buttons below expand or collapse all articles.
Fattening Foster Care
July 13, 2011 permalink
Ever alert for ways to expand intervention, the child protection industry is eying obesity as its newest pretext. Lindsey Murtagh and David S Ludwig writing in the Journal of the American Medical Association propose that obese children should be placed in foster care. Only the first 150 words of the article State Intervention in Life-Threatening Childhood Obesity are available online. While professionals lay plans to steal your children, only members are permitted to see the plans in detail. Alex Jones has regular commentary on this kind of elitism.
In the absence of the real article, here is a video (YouTube or local copy mp4) by a journalist giving the opinion of Dr Ludwig. Another journalist summarizes the doctors below. They present a dreamy view of foster care in which social services support not just the child but the whole family. They show no understanding of the devastating effects of long-term foster care on later adult outcomes. A contrary opinion by Arthur Caplan is also enclosed.
Translated into practice, intervention will not be limited to the over-300-pound children in the literature. The social worker seeing a child even one pound over the standard weight table will check off a risk-assessment box labeled "overweight". A half-dozen boxes checked means off to foster care.
Should parents lose custody of super obese kids?
Should parents of extremely obese children lose custody for not controlling their kids' weight? A provocative commentary in one of the nation's most distinguished medical journals argues yes, and its authors are joining a quiet chorus of advocates who say the government should be allowed to intervene in extreme cases.
It has happened a few times in the U.S., and the opinion piece in Wednesday's Journal of the American Medical Association says putting children temporarily in foster care is in some cases more ethical than obesity surgery.
Dr. David Ludwig, an obesity specialist at Harvard-affiliated Children's Hospital Boston, said the point isn't to blame parents, but rather to act in children's best interest and get them help that for whatever reason their parents can't provide.
State intervention "ideally will support not just the child but the whole family, with the goal of reuniting child and family as soon as possible. That may require instruction on parenting," said Ludwig, who wrote the article with Lindsey Murtagh, a lawyer and a researcher at Harvard's School of Public Health.
"Despite the discomfort posed by state intervention, it may sometimes be necessary to protect a child," Murtagh said.
But University of Pennsylvania bioethicist Art Caplan said he worries that the debate risks putting too much blame on parents. Obese children are victims of advertising, marketing, peer pressure and bullying -- things a parent can't control, he said.
"If you're going to change a child's weight, you're going to have to change all of them," Caplan said.
Roughly 2 million U.S. children are extremely obese. Most are not in imminent danger, Ludwig said. But some have obesity-related conditions such as Type 2 diabetes, breathing difficulties and liver problems that could kill them by age 30. It is these kids for whom state intervention, including education, parent training, and temporary protective custody in the most extreme cases, should be considered, Ludwig said.
While some doctors promote weight-loss surgery for severely obese teens, Ludwig said it hasn't been used for very long in adolescents and can have serious, sometimes life-threatening complications.
"We don't know the long-term safety and effectiveness of these procedures done at an early age," he said.
Ludwig said 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."
That piece discussed a 440-pound 16-year-old girl who developed breathing problems from excess weight and nearly died at a University of Wisconsin hospital. Doctors discussed whether to report her family for neglect. But they didn't need to, because her medical crisis "was a wake-up call" for her family, and the girl ended up losing about 100 pounds, said co-author Dr. Norman Fost, a medical ethicist at the university's Madison campus.
State intervention in obesity "doesn't necessarily involve new legal requirements," Ludwig said. Health care providers are required to report children who are at immediate risk, and that can be for a variety of reasons, including neglect, abuse and what doctors call "failure to thrive." That's when children are severely underweight.
Jerri Gray, a Greenville, S.C., single mother who lost custody of her 555-pound 14-year-old son two years ago, said authorities don't understand the challenges families may face in trying to control their kids' weight.
"I was always working two jobs so we wouldn't end up living in ghettos," Gray said. She said she often didn't have time to cook, so she would buy her son fast food. She said she asked doctors for help for her son's big appetite but was accused of neglect.
Her sister has custody of the boy, now 16. The sister has the money to help him with a special diet and exercise, and the boy has lost more than 200 pounds, Gray said.
"Even though good has come out of this as far as him losing weight, he told me just last week, 'Mommy, I want to be back with you so bad.' They've done damage by pulling us apart," Gray said.
Stormy Bradley, an Atlanta mother whose overweight 14-year-old daughter is participating in a Georgia advocacy group's "Stop Childhood Obesity" campaign, said she sympathizes with families facing legal action because of their kids' weight.
Healthier food often costs more, and trying to monitor kids' weight can be difficult, especially when they reach their teens and shun parental control, Bradley said. But taking youngsters away from their parents "definitely seems too extreme," she said.
Dr. Lainie Ross, a medical ethicist at the University of Chicago, said: "There's a stigma with state intervention. We just have to do it with caution and humility and make sure we really can say that our interventions are going to do more good than harm."
Source: Lancaster Online
Obesity alone is no reason to remove kids from their homes
Opinion: State laws governing abuse and neglect shouldn't apply to weighty issue
You don’t need to be a doctor or scientist to see that Americans are getting fatter and fatter. We are the United States of obesity. Twelve states now have obesity rates above 30 percent, a just-released report from Trust for America's Health shows.
Even the state with the highest percentage of people who are normal weight, Colorado, has a 20 percent obesity rate.
What's even worse is the epidemic of blubber among children. Obesity rates have skyrocketed among the nation's kids in the past two decades. Nearly 32 percent of U.S. children ages 2 to 19 are overweight or obese, according to the Centers for Disease Control and Prevention. Fully 12 percent have topped the category of extreme obesity. That's a lot of heavy kids.
This well-documented epidemic now has led two prominent Harvard School of Public Health researchers to call for consideration of drastic action: Use state laws governing child abuse and neglect to empower protective services staff to pull dangerously fat kids out of their homes, saving them from the diabetes, strokes, heart attacks, cancer, depression and arthritis that surely await.
"Involvement of state protective services might be considered, including placement into foster care in carefully selected situations," write Dr. David S. Ludwig and lawyer Lindsey Murtagh in the latest issue of the Journal of the American Medical Association.
The researchers carefully trace the history of a movement that has seen a few severely obese children removed from homes in which parents were unable or unwilling to address their weight — and the serious health problems it presented. They note that a handful of states — including California, Indiana, Iowa, New Mexico, New York, Pennsylvania and Texas — have precedent to apply laws governing intervention in cases of malnourishment to "overnourishment" and severe obesity.
As Murtagh noted in a 2007 article in the journal American Society of Law, Medicine and Ethics, Brittany, a morbidly obese 9-year-old girl in Chemung County, N.Y., was shuttled between her home and foster care for four years with her parents under orders to watch her diet and take her to the gym two to three times a week. When the parents failed to heed the order, the child was placed in the care of the state.
Such a case may be dramatic, and, indeed, the obesity epidemic is the single biggest health crisis facing this country and its kids. But forcing heavy children out of their homes is not the solution.
Our laws give enormous authority to parents and rightly so. The only basis for compelling medical treatment against a parent’s wishes are if a child is at imminent risk of death — meaning days or hours — and a proven cure exists for what threatens to kill them. Obesity does not pass these requirements.
The risk of death from obesity is real, but it is way down the road for kids. There is no proven cure for obesity. The ability to treat a child with diet or a lifestyle change who does not want to be "treated" by strangers is a long shot at best. The number of kids involved — an estimated 2 million children with body-mass index above the 99th percentile — would quickly swamp already overwhelmed social service departments. And, no matter what you do with overweight children, sooner or later they are going back home where their often overweight parents will still be.
In Brittany's case, for instance, her mother weighed more than 430 pounds.
Fat chance this is going to become widespread public policy. But if we don't yank heavy kids from their obesity-encouraging homes, what should we do?
We live in a society that is awash in food. Everywhere you turn, from billboards, to television, to magazines to the radio, someone is trying to tell you to rush down to a fast-food joint, an all you can eat buffet at the mall, to imbibe more sugary drinks or consume the largest portions ever to fall off a plate at your local steakhouse or rib joint. Add to this the fact that barely anyone in the entire nation is moving around — including kids, for whom gym, recess and sports are fast becoming topics for history class. Overall, you have a population lumbering toward XXXL.
But before we start grabbing porky youths out of their homes and sending them off to government fat camps, might we try to change our food culture? This means doing what we have done for smoking. Demonize the companies that sell and market food that is not nutritious. That means you, candy, soda, fried food and snack food outfits. Tax them too. And get Hollywood and television to make overeating and not exercising uncool just like they did with smoking. Put exercise back on the menu for all school kids.
I am not letting parents off the hook. But, putting the blame for childhood obesity on the home and then arguing that moving kids out of homes where obesity reigns is the answer is short-sighted and doomed to fail. We need the nation to go on a diet together and the most important places to start are at the grocery store, schools and media.
Addendum: Larry Killens writes on the subject.
Dumb and dumber
Obesity a problem in Canada?
A good question for people to consider in Ontario, as well as other provinces is, "How do we deal with obesity in children in Ontario?" Absolutely no one is arguing that it is not a monumental problem.
The solution, as suggested by social services agencies, in my humble opinion is off the end of the scale, dumb. They propose taking the children from the parents.
Did the government consider the real problem may be that parents cannot sustain and afford nourishing foods, fruits and vegetables, but junk food is within their means? Government mishandling of the economy, cumbersome rules and regulations, inspectors inspecting inspectors put the costs of food out of sight.
With all the Ontario government cutbacks and slashing of expenditures, new income from HST, would it be too much to ask the government what it is doing with all our money? I mean, other than the raise they gave themselves, taking more time off, building fake lakes, arenas that were, well, just a nice thing to build and other hidden foolish expenditures.
I do not care if it is federal or provincial. Premier Dalton McGuinty has proven he has somewhat of a mind and a mouth. He could speak up for the federal waste and Algoma Manitoulin MPP Mike Brown could remind McGuinty that people do live past Parry Sound.
What a solution. Take children away from their loving parents and place them in a system run by social services agencies such as children's aid societies. This same private entities of CAS where newspaper reports claim every year children die in the CAS care and foster homes -eight alone one year in Hamilton. In February 2009, Ontario's child advocate Irwin Elman reported that 90 children had died in the care of Ontario's children's aid societies in one year.
Criticism originating with the Ontario Association of Children's Aid Societies quickly claimed that in 36 cases, children's aid only got involved after the death of the child, reducing the number of CAS fatalities to 54. Spread over Ontario's 18,800 foster children (Sept. 30, 2004, figure from OACAS), the two alternatives give death rates of 479 or 287 per 100,000 child years -- 17.1 or 10.2 times the parental care rate.
May I be so bold as to suggest that children are starving in our own country/neighbourhood. A real hard fact is that, in our democratic, free society, our children do not have parents who can afford the nourishing foods they need.
Please remember this when you are unselfishly donating monies to Oxfam, United Way, Save the Children fund globally: our own home is not looked after and least of all by our government. Also remember that only a small portion of every dollar you donate is helping the person you intended to help.
Take children away from parents who allow them to be obese? No, let's educate our parents and help them afford nourishing foods and above all, keep the government out of the mix and look to our non-profit helping organizations. If an obese child isn't mentally distraught about being obese, that child will certainly be when removed from their parents.
I have a saying: you cannot fix stupid, not even with duct tape. So there is no shock and horror at my statement, I am referring to government bureaucracy.
Larry Killens South Baymouth
Source: Sudbury Star