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Arguments in favour of charging the parents of obese children with neglect
1. Obesity is a major health risk for children
The Australian Bureau of Statistics has noted that in 2007-08, one-quarter of all Australian children, or around 600,000 children aged 5-17, were overweight or obese, up four percentage points from 1995. The obesity rate for children increased from 5% in 1995 to 8% in 2007-08
The federal Australian Department of Health has indicated that the most important long term consequence of childhood obesity is its persistence into adulthood.
Once a child is overweight or obese it is unlikely that they will spontaneously revert to a healthy weight, predisposing them to the health concerns that afflict obese adults. These include musculo-skeletal problems, cardiovascular disease, some cancers, sleep apnoea, type 2 diabetes, and hypertension.
Other problems associated with excess weight, in children and adolescents, include heat intolerance, breathlessness on exertion, tiredness and flat feet. Some research suggests that obese children (particularly older girls) also tend to exhibit decreased self-esteem and depression, while a significant proportion of overweight or obese children use unhealthy dietary practices for weight control.
A recent joint study from Australian and United Kingdom researchers has found excess weight and obesity in children may also be fuelling the asthma epidemic facing many countries. This has prompted peak asthma groups to re-emphasise the importance of a healthy lifestyle and healthy weight in childhood.
Further, a recent study in Perth confirmed that overweight or obese children are more likely to be bullied than normal or underweight children, such that, being overweight is now considered a risk factor for becoming a target of bullying.
2. Children are unable to manage their weight without parental support
It has been observed that children are unable to control their weight without the active assistance of their parents.
Dr Melinda Sothern, an exercise physiologist with Louisiana State University and lead author of the popular childhood weight loss book 'Trim Kids', has claimed that parents generally have more control over a child's weight than anyone else, including doctors, nutritionists, and school friends.
Dr Sothern has stated, 'No matter how deeply children may yearn for a slimmer body, they will not be able to achieve this without the support of the people who buy the groceries, make the dinners, and set the rules'.
A landmark study published in the Journal of the American Medical Association dramatically illustrated the value of family-centred treatments. Leonard Epstein and colleagues from the University of Pittsburgh put 76 overweight children and their parents through one of three different educational programs. The basic content of each program was the same, but the approach was very different. One program strongly encouraged both children and parents to make healthy lifestyle changes, one encouraged change in children only, and one emphasized the importance of a healthy lifestyle but gave few practical tips for putting that ideal into action. Ten years later, the rate of obesity in the first group - the group that took a family approach to the problem - had dropped about 8 percent. In contrast, the rates significantly climbed in the other groups.
Studies such as this have demonstrated the central role that parental support plays in allowing children to control their weight. Proponents of penalties for parents whose children become obese stress the importance of informed and active parents in enabling children to achieve and maintain a healthy body weight.
3. Severe childhood obesity fits the criteria for parental neglect
Definitions of 'neglect' and 'medical neglect' (parental neglect of a child's medical needs) are not universally consistent. However, there are generalised concepts and standards that are expected of parents in their treatment of their child.
Failure to meet these standards may legitimately be considered neglect. Many of the parental behaviours associated with families in which children become obese match the criteria generally applied to determine neglect.
Though not all obese children are neglected as parents of obese children may be very devoted to their child, obesity often develops within families where there are concerns about parenting skills, such as lack of parental limit-setting or parental supervision.
In 1989, an Australian case series report of 12 children with severe obesity in early childhood observed that, in all cases, parental limit-setting, including around eating, was impaired. Such findings have lead to recommendations that obese children should be regarded as potentially at risk and that physicians and other clinicians should be prepared to report the parents of such children to the relevant authorities.
In an article published in the Australian Medical Journal in 2009, Shirley M Alexander, Louise A Baur, Roger Magnusson and Bernadette Tobin conducted a study of the role of parents in childhood obesity in which they stated that in situations where parents of severely obese children seem unwilling or unable to adhere to weight-loss programs formal intervention may be necessary.
Alexander, Baur, Magnusson and Tobin concluded, 'Both the duty of care that a physician owes to a child who is a patient and statutory duties support the physician's duty to report severe cases of inadequately managed paediatric obesity to child protection agencies'.
4. Removing severely obese children from their parents can be a life-saving intervention
Harvard paediatrics professor David Ludwig and Lindsey Murtagh, a Harvard public-health researcher, have stated, 'When children become ...obese, with a BMI at or above the 99th percentile, it signals a fundamentally different situation than mere poor parenting. State intervention may serve the best interests of many children with life-threatening obesity, comprising the only realistic way to control harmful behaviours.'
Professor Ludwig has indicated that he starting thinking about the idea of state intervention after a 3-year-old girl came to his obesity clinic weighing 41 kilos. By last year (2010), at age 12, she had reached 180 kilos and had developed diabetes, cholesterol problems, high blood pressure and sleep apnoea.
Her parents had physical disabilities, little money and difficulty controlling her weight. Professor Ludwig stated, '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. After a year, she lost 130 pounds. Though she is still obese, her diabetes and apnoea disappeared; she remains in foster care.'
Similarly, it was reported in June, 2014, that the parents of an 11-year-old boy were arrested in Britain on suspicion of neglect and child cruelty after authorities grew alarmed about the child's weight. The boy weighed about 95 kg (210 pounds), is 155 cm (5 feet 1 inch) and had a body mass index of 41.8, higher than is classified as obese for an average adult male
While in Australia, it was reported in July, 2012, that on at least two recent occasions Victorian welfare authorities have used extreme obesity as a partial justification for having children removed from the custody of their parents. One case involved a pre-teenage boy who weighed 110 kilograms and the other a teenage girl whose waist circumference of 169 centimetres was greater than her height. The girl had gained 30 kilograms in 18 months and was described by a Children's Court magistrate as 'incredibly unhealthy ... To hear that her waist measurement is greater than her height is so concerning.'
In all these cases the children's weight was judged life-threatening.
5. Such interventions in relation to childhood obesity are case appropriate
It has been claimed that government intervention in the lives of families with obese children only occurs in extreme cases, in which each situation was carefully and individually assessed.
In Britain, child protection authorities note that they adopt a 'proportionate and necessary' response. Police, who took an obese child from his parents in June, 2014, stated, 'Intervention at this level is very rare and will only occur where other attempts to protect the child have been unsuccessful.'
Victorian child protection authorities have stated that obesity is not of itself grounds for child protection workers to become involved with a family. However, they have noted that 'obesity may be a symptom of other issues that could place a child at risk or harm that would warrant child-protection involvement'. Thus, obesity is sometimes one of a complex of issues that indicate that a child is in danger of suffering serious harm.