Is A Morbidly Obese Child “Medically Neglected?”

We’ve dealt with this issue before when I reported about an article in the JAMA recommending the removal of morbidly obese children from their homes to foster care in very rare cases.  That is how things start in matters such as this. A highly nuanced article may lead to a blunt instrument-type response.

Whether or not the JAMA piece influenced this case, it does seem unduly blunt and beyond the parameters suggested by the authors.  In Ohio, a 200 pound 8-year old has been put into foster care because authorities think his mother is not doing enough to control his weight. From the Cleveland Plain Dealer story:

Cleveland Heights boy was taken from his family and placed in foster care last month after county case workers said his mother wasn’t doing enough to control his weight. At more than 200 pounds, the third-grader is considered severely obese and at risk for developing such diseases as diabetes and hypertension. But even though the state health department estimates more than 12 percent of third-graders statewide are severely obese — that could mean 1,380 in Cuyahoga County alone — this is the first time anyone in the county or the state can recall a child being taken from a parent for a strictly weight-related issue

The case plays into an emerging national debate that has some urging social-service agencies to step in when parents have failed to address a weight problem. Others suggest there’s hypocrisy in a government that would advocate taking children away for being overweight while saying it’s OK to advertise unhealthy food and put toys in fast-food kids’ meals.

That’s irrelevant to the case.  What matters is how to best promote the child’s welfare.  But back to the story:

Cuyahoga County does not have a specific policy on dealing with obese children. It removed the boy because case workers considered this mother’s inability to get her son’s weight down a form of medical neglect, said Mary Louise Madigan, a spokeswoman for the Department of Children and Family Services. They said that the child’s weight gain was caused by his environment and that the mother wasn’t following doctor’s orders — which she disputes. “This child’s problem was so severe that we had to take custody,” Madigan said. The agency worked with the mother for more than a year before asking Juvenile Court for custody of the child, she said.

This isn’t the same as starving a child, which—unlike here—would also be a matter for criminal sanction.  But it is a serious concern and I think the state was probably right to intervene here and assume authority over the child.

That said, there must be measures that could be taken short of removing a child from his home even if the mother has not been able to act adequately to control her son’s eating. Morbid obesity is not just a matter of food.  There are deep emotional issues involved that can be difficult with which to cope even under optimal familial situations.

Note, that the foster situation does not appear to be working out either:

But now lawyers for the mother say they’ve been told that the foster mother who has the child in a neighboring suburb is having trouble keeping up with all of his appointments. There was even a discussion about getting the foster mother additional help or moving the child again, this time to a foster home with a personal trainer, Amata said. “I wonder why they didn’t offer the mother that kind of extra help,” Amata said.

That’s a very good question.  If the foster parents are having the same problems, doesn’t it make sense to return the child home instead of looking for another foster home?  And if that doesn’t work, what next, another foster home?  And then another?  It wouldn’t surprise me. Bureaucratic inertia is a powerful thing.  Once they get a head of steam up, it is hard to get them to stand down. I saw it first hand when I was actively practicing law.

Bottom line: I suppose if the mother were actively thwarting weight loss efforts, removing the child could be warranted. But short of that, it seems to me that unless the state can demonstrate positively and convincingly that it is in the best interests of the child to live with strangers, he should go home under supervision and with active assistance to help the boy lose weight and keep it off.  I just don’t see how traumatizing this boy can help overcome what is likely to be a life-long weight problem.