You don’t need to be a doctor or scientist to see that Americans are getting fatter and fatter. We are the United States of obesity. Twelve states now have obesity rates above 30 percent, a just-released report from Trust for America's Health shows.
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Even the state with the highest percentage of people who are normal weight, Colorado, has a 20 percent obesity rate.
What's even worse is the epidemic of blubber among children. Obesity rates have skyrocketed among the nation's kids in the past two decades. Nearly 32 percent of U.S. children ages 2 to 19 are overweight or obese, according to the Centers for Disease Control and Prevention. Fully 12 percent have topped the category of extreme obesity. That's a lot of heavy kids.
This well-documented epidemic now has led two prominent Harvard School of Public Health researchers to call for consideration of drastic action: Use state laws governing child abuse and neglect to empower protective services staff to pull dangerously fat kids out of their homes, saving them from the diabetes, strokes, heart attacks, cancer, depression and arthritis that surely await.
"Involvement of state protective services might be considered, including placement into foster care in carefully selected situations," write Dr. David S. Ludwig and lawyer Lindsey Murtagh in the latest issue of the Journal of the American Medical Association.
The researchers carefully trace the history of a movement that has seen a few severely obese children removed from homes in which parents were unable or unwilling to address their weight — and the serious health problems it presented. They note that a handful of states — including California, Indiana, Iowa, New Mexico, New York, Pennsylvania and Texas — have precedent to apply laws governing intervention in cases of malnourishment to "overnourishment" and severe obesity.
As Murtagh noted in a 2007 article in the journal American Society of Law, Medicine and Ethics, Brittany, a morbidly obese 9-year-old girl in Chemung County, N.Y., was shuttled between her home and foster care for four years with her parents under orders to watch her diet and take her to the gym two to three times a week. When the parents failed to heed the order, the child was placed in the care of the state.
Such a case may be dramatic, and, indeed, the obesity epidemic is the single biggest health crisis facing this country and its kids. But forcing heavy children out of their homes is not the solution.
Our laws give enormous authority to parents and rightly so. The only basis for compelling medical treatment against a parent’s wishes are if a child is at imminent risk of death — meaning days or hours — and a proven cure exists for what threatens to kill them. Obesity does not pass these requirements.
The risk of death from obesity is real, but it is way down the road for kids. There is no proven cure for obesity. The ability to treat a child with diet or a lifestyle change who does not want to be "treated" by strangers is a long shot at best. The number of kids involved — an estimated 2 million children with body-mass index above the 99th percentile — would quickly swamp already overwhelmed social service departments. And, no matter what you do with overweight children, sooner or later they are going back home where their often overweight parents will still be.
In Brittany's case, for instance, her mother weighed more than 430 pounds.
Fat chance this is going to become widespread public policy. But if we don't yank heavy kids from their obesity-encouraging homes, what should we do?
We live in a society that is awash in food. Everywhere you turn, from billboards, to television, to magazines to the radio, someone is trying to tell you to rush down to a fast-food joint, an all you can eat buffet at the mall, to imbibe more sugary drinks or consume the largest portions ever to fall off a plate at your local steakhouse or rib joint. Add to this the fact that barely anyone in the entire nation is moving around — including kids, for whom gym, recess and sports are fast becoming topics for history class. Overall, you have a population lumbering toward XXXL.
But before we start grabbing porky youths out of their homes and sending them off to government fat camps, might we try to change our food culture? This means doing what we have done for smoking. Demonize the companies that sell and market food that is not nutritious. That means you, candy, soda, fried food and snack food outfits. Tax them too. And get Hollywood and television to make overeating and not exercising uncool just like they did with smoking. Put exercise back on the menu for all school kids.
I am not letting parents off the hook. But, putting the blame for childhood obesity on the home and then arguing that moving kids out of homes where obesity reigns is the answer is short-sighted and doomed to fail. We need the nation to go on a diet together and the most important places to start are at the grocery store, schools and media.
Arthur Caplan, Ph.D., is director of the Center for Bioethics at the University of Pennsylvania.
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