Is childhood obesity a symptom of neglect?

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The issue of whether parents whose children are obese should be charged with neglect has fueled debate and generated controversial court cases, but, according to an article published this week in BMJ, so far there is little research analyzing negligence and obesity — and particularly whether obese children who are put into foster care fare better than they did with their parents — and a paucity of resources for health professionals attempting to determine what’s best for their young patients. Given the absence of in-depth analysis, the team of authors — including experts in child and adolescent health and psychiatry — suggest a way forward that attempts to distinguish when childhood obesity is a symptom of parental neglect or abuse.

To begin with, the authors stress that obesity on its own should not necessarily ring child abuse alarms, nor should failure to help obese children shed excess weight. As the authors parse it, “a family with an obese child should not raise child protection concerns if obesity is the only cause for concern” but “clinicians should be mindful of the possible role of abuse or neglect in contributing to obesity.” They point to research showing that children with strong family support can still struggle to lose weight, as well as mixed success of weight-loss programs run by professionals.

Still, that’s not to say obesity isn’t often be a symptom of problems at home. As the authors point out, there has been research suggesting a correlation between childhood abuse and obesity in adulthood, and a study of American school children found that, after controlling for socioeconomic status, those who were physically abused were more likely to be obese. Additionally, a growing body of research suggests that early decisions made by parents — even before conceiving as well as during pregnancy and infancy — can have a significant impact on a their baby’s risk for obesity throughout childhood and later in life.

So how can care providers determine when negligence or abuse is a cause of childhood obesity? The authors suggest that similar standards to other types of disease-related neglect be applied. That is, “parental failure to provide their children with adequate treatment for a chronic illness (asthma, diabetes, epilepsy, etc) is a well accepted reason for a child protection registration for neglect” and as such, failure to adhere to obesity treatment — missing appointments, refusing to support children with treatment programs or actively undermining those programs — should convey neglect, especially among children who are at high risk for obesity-related conditions such as type 2 diabetes, they argue. Yet, the authors stress, having adequate evidence of this negligence is key. “Clear objective evidence of this behaviour over a sustained period is required, and the treatment offered must have been adequate and evidence based.”

They also stress the need to consider obesity in the context of broader emotional and physical health, and to collaborate with other caregivers in the child’s life to “evaluate other aspects of the child’s health and wellbeing and determine if concerns are shared by others professionals such as the family general practitioner or education services.”

In order to best protect children from abuse and promote sound physical and mental health, the authors argue for additional research into childhood obesity and neglect, as well as whether being taken into custody by child protective services ultimately is in the best interest of each individual child. As they sum up:

“As in all areas of child health, we have a duty to be open to the possibility of child neglect or abuse in any form. When assessing such children, a comprehensive picture of the child’s functioning from a health, psychological, and educational perspective is necessary. Guidelines for professionals are urgently needed, as is further research on the outcomes of child protection actions in obesity and links between early adversity and later obesity.”