Obesity in Children Equals Parental Neglect?

I was struggling to start an intravenous the other day on a 12 year-old girl when this question went through my mind: when does obesity in children become an issue of child abuse?

The girl was 77 kg, about 170 lbs, and she stood 150 cm or about 5 feet tall. She was obese. She had rolls of fat on her upper arms. She had a double chin. I felt an awful sort of sorrow for her being on the cusp of adolescence, knowing the capricious cruelties that teenagers inflict on each other. Her lot in life was about to get worse. And my immediate problem: she had some much adipose tissue that I couldn’t palpate a suitable vein to start the IV in her hands or arms, much less visualize one. Even the antecubital veins, the cephalic and basilic, the big monsters found on the inside of the elbows, were difficult to locate. Thank God, I thought to myself, we don’t need emergency venous access.

It may well be possible to construct a case that childhood obesity represents child abuse, in the form of parental neglect and negligence, of knowing the negative impact of obesity on your children and doing nothing about it in terms of changing diet and increasing physical activity. The sequellae of childhood obesity, as we know, are fairly dire. According to the American CDC:

Childhood obesity is associated with various health-related consequences. Obese children and adolescents may experience immediate health consequences and may be at risk for weight-related health problems in adulthood.

Psychosocial Risks

Some consequences of childhood and adolescent obesity are psychosocial. Obese children and adolescents are targets of early and systematic social discrimination. The psychological stress of social stigmatization can cause low self-esteem which, in turn, can hinder academic and social functioning, and persist into adulthood.

Cardiovascular Disease Risks

Obese children and teens have been found to have risk factors for cardiovascular disease (CVD), including high cholesterol levels, high blood pressure, and abnormal glucose tolerance. In a population-based sample of 5- to 17-year-olds, 70% of obese children had at least one CVD risk factor while 39% of obese children had two or more CVD risk factors.

Additional Health Risks

Asthma is a disease of the lungs in which the airways become blocked or narrowed causing breathing difficulty. Studies have identified an association between childhood obesity and asthma.

Hepatic steatosis is the fatty degeneration of the liver caused by a high concentration of liver enzymes. . .

Sleep apnea is a less common complication of obesity for children and adolescents. . .

Type 2 diabetes is increasingly being reported among children and adolescents who are obese.

[snip]

So if starving a child represents neglect, which for obvious reasons puts a child at risk for serious harm, shouldn’t giving a child too much food be considered neglect and negligence as well? Both present a failure to provide adequate care to a child. And if this is true, is punishing the parents appropriate? Would education, rather than calling the authorities, more effectively help the child?

We’re a bit two-faced about this, culturally at least. A few years ago here in Toronto the case of Jeffrey Baldwin, a child who was starved to death by his grandparents, provoked a furious, outraged public response. We’re a more phelgmatic about the reverse situation. Fat children are a sort of societal meme, poor sots, stupid and inept. Think of the movies you’ve seen featuring obese children. Do you think of abused? Probably not.

For nurses and other health care professionals, the question is not just academic. We have a moral and ethical duty, not to mention a legal one, to report cases of abuse to child protective services, even if only abuse is suspected. At what point do we consider obesity in children to be abusive? Do we need guidelines on this point?

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  1. #1 by JennJilks on Wednesday 20 January 2010 - 1100

    This is a thoughtful post, and yet, often obese children are raised by obese parents. I think there is a difference between telling a hungry child they cannot eat, and permitting an overweight child to keep over eating.

    Or providing food that is not nutritious out of ignorance.
    These families need education, as much for themselves as their children. It is a bitter battle I lost every year that I taught.

    Many parents overindulge children out of guilt. All of it requires further education.

  2. #2 by Christina on Wednesday 20 January 2010 - 1547

    It seems like that being overweight has become the norm in our culture for both adults and children. I laugh when our local newspaper ocassionally runs an article on anorexia. When I wait outside the high school to pick up my son, I see far more overweight teenagers than normal, more girls than boys. Even some of the “normal” sized ones would have been considered “fat” a generation ago.

    Part of the problem is rewarding children with food like you would when you train your dog. When my kids were in elementary and middle school, it was a never-ending source of frustration. Sometimes the day would start with a donut in the classroom. A snack for the after school care group would be some sugary treat or a fruit-roll up (that’s NOT fruit, you know). Also after children’s sports games, they expect a sugary or salty snack, even if the game ends right before dinner and they’re going straight home to the table.

    Education is part of the answer. Fast food is not nutritious. It’s okay to not eat everything on your plate. It is definitely okay to say NO if you aren’t hungry for more. Food and love are not the same thing.

    There’s part of an Oriental prayer that often crosses my mind at mealtimes. It is translated something like, “Please let me be 80% full.”

    Yes, 80% full is really about right. If we could change our culture to leave the table at 80% full, it would solve the problem.

  3. #3 by Halie on Wednesday 20 January 2010 - 1824

    You are very brave to write this entry Childhood obesity is such a problem and you are right to bring up the questions that you do. thanks for posting!

  4. #4 by no on important on Thursday 21 January 2010 - 1017

    Do we have the resources to be considering every fat kid a potential abuse victim? You’re talking about engaging some machinery that has been put in place and reserved for some seriously messed up situations. Not only are you considering taking resources away from where they are more appropriate and urgently needed, but this machine is real hard to turn off again, and it’s a real mean machine. The potential for harm from an intervention is very high and shouldn’t be considered if the potential for harm is not even more serious without.

    Maybe you should just talk to the parent. If you call in child services, you are not doing anyone a favor.

  5. #5 by no on important on Thursday 21 January 2010 - 1023

    In the interest of full disclosure: I have suffered greatly because health care professionals decided following the full letter of the law (ie, “covering your ass”) was more important than my well-being. I do *not* believe that a government intervention can possibly be less harmful than obesity, but I am biased by my experience.

  6. #6 by D Morton on Friday 15 July 2011 - 1215

    I have a relative in the same position. He is 12, his doctors in Ajax Ontario have warned his mother and family about his weight, but they maintain that he “needs to be husky to be a real man”. The problem has gotten worse since his grandfather died of a weak heart and complications due to being overweight. They are now determined to remake him in his grandfather’s image “hoping he tops 200 lbs in the coming year.” I wish someone would step in. If it is ever mentioned by the school, teachers, or other family members we are told it is “their lifestyle choice”.

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