Obese 8-year-old taken from family, placed in foster care

posted at 12:23 pm on November 28, 2011 by Howard Portnoy

How much is too much? It’s a question that the Ohio Department of Children and Family Services (DCFS) answered last month when the agency removed an 8-year-old child weighing 200 pounds from his home.

The action, described by the Cleveland Plain Dealer as a first for Cuyahoga County and possibly the state, loops back to the same question: How much is too much? How much government intervention on “beneficent grounds” is acceptable before a line is crossed?

County case workers would answer that question in this case by claiming the child’s mother wasn’t doing enough to control his weight. Mary Louise Madigan, a spokeswoman for DCFS, calls this an instance of medical neglect. “This child’s problem was so severe,” she is quoted as saying, “that we had to take custody.” The agency worked with the mother for more than a year before asking Juvenile Court to intervene, she adds, emphasizing the child’s risk of developing diabetes and hypertension.

But as the article reports, except for his weight problem and a sleep apnea condition that is under control, the boy is a normal elementary school student. Records indicate that he is on the honor roll and participates in school activities.

Lawyers for the mother, a substitute elementary school teacher, see the situation not in terms of overweight but of overreach. Juvenile Public Defender Sam Amata points out that children in homes where there is drug abuse or physical violence are in imminent danger, which justifies the state stepping in. But this case, he argues, is different:

[W]e would concede that some intervention is appropriate. But what risk became imminent [in the child’s health]? When did it become an immediate problem?

Members of the medical community are themselves divided on the question of whether the state should become involved in deciding whether parents of obese children are fit to raise their offspring. Arthur Caplan, a professor of bioethics and medical ethics at the University of Pennsylvania, takes a pragmatic approach. He acknowledges:

A 218-pound 8-year-old is a time bomb. But the government cannot raise these children. A third of kids are fat. We aren’t going to move them all to foster care. We can’t afford it, and I’m not sure there are enough foster parents to do it.

David Ludwig, a Harvard University professor and pediatric obesity expert, co-authored an article that appeared in the Journal of American Medical Association this summer that maintained that other interventions should be tried first and that children should be removed only as a last resort. But “last resort” is a subjective diagnosis. In his article, he cited the example of one of his own patients, a 12-year-old who weighed 400 pounds and had developed diabetes, cholesterol problems, high blood pressure, and sleep apnea—conditions that could kill her before the age of 30. But even in such extreme situations, who gets to make the call? And what is the official cut-off?

The Plain Dealer article reports 12% of third-graders, or 11,500 children, in Ohio are severely obese. How many are too many to become wards of the state?

And then there is the opposite problem, exemplified earlier this month in Madison, Wisconsin, where a couple worried that their infant daughter would become obese starved her for months. When the child was picked up by family services, she was found to have gained just 5 pounds in the 14 months after her birth—well short of the expected weight of 22 pounds.

Maybe it is time for the government to take a moratorium from its role as self-appointed arbiter of what is best for the nation’s children. The Wisconsin story additionally suggests that the First Lady’s well-intentioned, though misguided, campaign to end childhood obesity may be frightening some parents into making choices antithetical to their children’s health.

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