What is to blame for child obesity?

When Dr. Sadaf Farooqi and colleagues discovered a genetic abnormality that caused severe obesity in a handful of children, she had no cure. Yet the scientist transformed four families’ lives nonetheless.

The British parents had been living in fear of losing their children -- the youngsters’ severe obesity had been seen as a possible sign of abuse or neglect, and they had been put on the list of the country’s social services department.

“They were being blamed for their children’s condition, receiving frequent visits from social services, frequent reviews, knowing people could have their children taken away,” Farooqi said.

Farooqi told authorities that this abnormality -- a DNA deletion -- wiped out a key gene involved in the body’s response to leptin, a hormone that controls appetite. The children were taken off the list.

Farooqi’s study, published Dec. 6 in Nature, affected only five of about 1,200 severely obese youngsters. But as more genes related to obesity are unearthed, and as rates of childhood obesity climb, courts, social services and parents will increasingly have to grapple with difficult social and legal questions:

Can extreme childhood obesity be considered abuse? How much of a child’s weight can be blamed on the parents, and how much is out of their control?

Rising rates

A three-decade rise in childhood obesity rates has meant that related abuse and neglect cases are more often making their way into the courts. According to a 2008 report by the Child Welfare League of America, “California, Indiana, New Mexico, New York, Pennsylvania, and Texas have had to determine whether morbidly obese children whose parents are unable or unwilling to control their children’s weight against medical orders are properly considered abused or neglected.”

In 2007, North Carolina mother Joyce Painter was told she would lose her 255-pound, 7-year-old son if he did not show progress in his weight loss within two months.

And in June, South Carolina mother Jerri Gray lost custody of her son Alexander Draper after being charged with criminal neglect. The 14-year-old weighed 555 pounds. Gray is facing 15 years on two felony counts, the first U.S. felony case involving childhood obesity, said her lawyer, Grant Varner.

Such cases will require authorities to consider not only genetics but the helplessness parents can face in trying to regulate a child’s behavior, especially that of a teen, in today’s calorie-dense environment.

So far, genetic tests have played a very limited role in cases of childhood obesity in which authorities have become involved (Alexander Draper has not been tested, Varner says). The tests are fairly new, expensive and assess only a few of the genes known so far to strongly influence obesity.

In any case, for all but a small number of people, genes tell only part of the obesity story.

“What genetics does is sort of set the range of weights for you,” said James O. Hill, director of the Center for Human Nutrition at the University of Colorado in Denver. “If you’re somebody who is genetically predisposed . . . you may never be lean, but there’s still a wide range of weights in there.”

But today’s environment is likely to push many kids to the higher end of their range, said Dr. Marc Jacobson, who sits on the American Academy of Pediatrics’ obesity leadership work group. In 1955, he said, McDonald’s fries were 210 calories but the large portions more often consumed today are 500. A Coke was 6.5 ounces, versus 20 ounces in today’s plastic bottles. No wonder, he said, that today U.S. kids have an obesity rate of 15%, and that another 15% are overweight.

Food is everywhere

“Food is available 24/7. Domino’s delivers. We’re not programmed for that kind of environment,” Jacobson said. “We’re programmed for an environment where food is scarce.”

Some of the factors are hard for parents to control, especially if they live in disadvantaged communities, said ethicist Erika Blacksher, a research fellow at the Hastings Center, a nonpartisan bioethics research institution in Garrison, N.Y.

“It’s unfair to hold parents accountable for factors such as whether their neighborhoods have safe places for their children to play . . . or when their neighborhoods don’t have grocery stores that sell healthy foods,” she said. “We don’t want quick, easy, negative, punitive responses and tools.”

Melinda Sothern, a clinical exercise physiologist at Louisiana State University New Orleans who works with obese children, says physicians and social workers can be quick to rush to judgment and assume a parent is neglectful in such cases.

She cites an 8-year-old she treated who, at 6, had a body mass index of 48. The boy was so obese that he had to have knee surgery and use a machine to counteract his sleep apnea.

Genetic tests for two known obesity genes came up negative. The endocrinologist and social worker then suggested he be taken out of the home.

But, Sothern said, her patient’s mother was a single working mom in post-Katrina Louisiana who was not quite poor enough to qualify for Medicaid. She was making her doctors’ visits and enrolling her son in karate class.

Similarly, Varner said, Jerri Gray could not be held entirely responsible for what her son ate and did outside the home.

“She’s a single mom. She’s at work, busting her butt to make sure there’s a roof over their heads, and this kid’s at school six, seven hours a day,” Varner said. “Trying to control a teenager -- that’s trying to knock down a solid brick wall with your bare hands.”

Virginia Williamson, general counsel for the South Carolina Department of Social Services, would not comment on the particulars of Gray’s case.

But, she said, “I think everybody wanted to see the mom supported and able to take care of her child. Our intervention only comes when we get information that there’s been a breakdown, in the form of a parent who isn’t following up with what the child’s doctors or treatment team would be recommending. That failure to follow up is placing the child at risk of harm.”

amina.khan@latimes.com