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posted: 7/17/2011 3:00 AM

Yes, obesity in children can be abuse

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Finally, two experts had the courage to state the obvious: Parents who let their children become obese enough to suffer from serious medical complications are committing child abuse.

In their Journal of the American Medical Association commentary "State Intervention in Life-Threatening Childhood Obesity," Lindsey Murtagh, a lawyer and research associate at the Harvard School of Public Health, and David S. Ludwig, a doctor for the Optimal Weight for Life Program at Children's Hospital in Boston, say that despite the well-established right of parents to raise their children as they choose, the state should step into family life in severe cases of life-threatening childhood obesity, just as it would in any other neglect or abuse situation.

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Contrary to the worst-case scenarios that flood the mind when you hear someone suggest that obese children need state intervention, the authors did not propose that all parents with overweight kids should have them taken away.

In fact, in their piece, they go to great pains to note that for "most of the approximately 2 million children in the United States with a (body mass index) at or beyond the 99th percentile ... state intervention would clearly not be desirable or practical, and probably not be legally justifiable."

They advocate for interventions in the form of in-home social supports, parenting training, counseling and financial assistance, all of which should be offered before resorting to putting an ill child in foster care. But they say such a desperate measure is preferable to letting a child languish under the parents' chronic failure to address a disease with possibly life-threatening and irreversible surgical options, such as bariatric surgery, as a last resort.

Indignant reaction to the authors' level-headed remarks illustrates perfectly the sad state America finds itself in: Our children are not merely overweight but increasingly morbidly obese, and they're pounded by an unending stream of junk-food marketing and being raised by parents who, by and large, don't understand the basic tenets of sound nutrition or exercise.

Children are fed cheap, low-quality junk food at school and live in a country where, according to some studies, doctors rarely discuss nutrition with adult patients and are sheepish about telling them they are overweight. Their average neighbor is outraged that in the middle of an obesity epidemic, the government wants to label fast food and sugary breakfast cereals as being bad for you.

Murtagh and Ludwig's commentary comes a week after the latest round of startling facts about the scope of this epidemic were released by the Trust for America's Health and the Robert Wood Johnson Foundation in their report "F as in Fat." Nationally, about 16 percent of all children 10 to 17 are not just overweight but obese. Other studies have found that almost 10 percent of infants and toddlers carry excess weight for their length, and slightly more than 20 percent of children between the ages of 2 and 5 are already overweight or obese.

Have we gotten so numb to these astounding numbers that anyone can seriously question whether letting a child balloon to a life-threatening weight is actual child abuse? Why is this controversial at all?

I spoke to Ludwig to give him a chance to respond to the uniform fury his commentary inspired.

"We were not trying to say we should penalize people for their choices -- we live in a very unhealthy environment for children where there is a lot of government inaction on this health issue and little regulation on the practices of food industry," Ludwig said. "This is a hot-button issue at a time where there's a lot of anger at the government and any notion that they could be coming to take away children creates anxiety.

"But the government plays a role in protecting children -- that's commonly understood and no one objects to intervening when there is physical abuse and failure to thrive. We're facing just such a situation with obesity. We have never before seen so many children so massively obese facing not just down-the-road risks, but Type 2 diabetes, sleep apnea and actual heart attack collapse immediately resulting from their weight."

By any reasonable measure, children who are living in homes where their lives are at very real risk because their disease is not being well-managed need government intervention -- whether it's parenting training, family counseling, financial assistance or foster care. To think otherwise is to write off millions of sick children and the parents who can't, don't know how, or won't take care of them.

estherjcepeda@washpost.com.

2011, Washington Post Writers Group

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