Should obese children be put in foster care?

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In some cases, obese children should be removed from their homes, according to a group of child health specialists from England and Ireland.

If parents fail to provide medical treatment for a child with a chronic disease like asthma or epilepsy, government welfare officials can put the young patient in foster care. Should they do the same for children who are obese — and therefore at risk of developing lifelong complications such as heart disease and type 2 diabetes?

In some cases, the answer is yes, according to a group of child health specialists from England and Ireland.

“Childhood obesity can be seen as a failure to adequately care for your children by failing to provide a healthy diet and sufficient activity, whether through direct neglect or more subtly through an inability to deny children the pleasures of energy dense fast food and television viewing,” the experts write in a paper published online Wednesday by the British Medical Journal.

The question isn’t academic. There are sporadic reports in the U.S. of courts removing obese kids from their homes, and it has happened at least 20 times in Britain.

The neglect that leads to obesity may be a sign of other problems in the home. As many as one-third of obese adults say they were sexually abused as children. In addition, one-third report being victims of other kinds of abuse, such as corporal punishment, according to the paper.

With this in mind, pediatricians and other professionals should think about whether obese kids would be better off in the custody of child protective services, the experts write. There are anecdotal reports of dramatic weight loss by kids in foster care, though there are no long-term studies showing that removing obese children from their families results in weight loss. (In fact, one study of 106 British children placed in foster care found that 38 of them became overweight after they joined the foster system.)

Obesity alone isn’t sufficient to warrant a call to child welfare officials, according to the experts. Nor is a kid’s failure to lose weight after being counseled to do so, they added. Even families that put a lot of effort into helping a child shed extra pounds don’t necessarily succeed. But parents who don’t at least try to help their kids should be viewed with suspicion, according to the paper.

“Parental behaviors of concern include consistently failing to attend appointments, refusing to engage with various professionals or with weight management initiatives, or actively subverting weight management initiatives,” the experts wrote. “Clear objective evidence of this behavior over a sustained period is required.”

Researchers should gather hard data on whether children gain or lose weight during time spent in foster care, they wrote. In the meantime, they added, guidelines should be drafted to help professionals decide when to intervene on behalf of obese kids.