An Obese Boy Is Placed in Foster Care. Can It Help?

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An 8-year-old boy in Cleveland Heights, Ohio, was taken from his family and placed in foster care last month because his mother failed to control the third-grader’s ballooning weight. The county’s family services department considered it a form of medical neglect.

The boy weighed more than 200 lbs., which put him at risk for developing serious health problems like high blood pressure and Type 2 diabetes. Case workers from the county’s department of children and family services said the boy’s environment contributed to his obesity and that his mother didn’t follow doctor’s orders for weight loss — a claim the mother disputes — the Cleveland Plain Dealer‘s Rachel Dissell reported.

At issue in this case, as in a handful of similar past cases in the U.S., is whether a child’s obesity can be considered an imminent danger to his or her life. Lawyers for the Ohio mother say the fact that excess weight puts her son at risk for future health problems — problems he doesn’t have yet — doesn’t qualify.

But other experts, noting that states typically remove children from their homes for physical abuse, neglect or undernourishment, argue that overnourishment should be handled the same way. In July, Harvard pediatrics professor and obesity expert David Ludwig published a controversial commentary in the Journal of the American Medical Association suggesting that some children who are extremely obese — with a BMI at or above the 99th percentile — do face life-threatening risks. Their situation is not merely a matter of “poor parenting,” Ludwig wrote in the commentary, proposing that “state intervention may serve the best interests of many children with life-threatening obesity, comprising the only realistic way to control harmful behaviors.”

Ideally, Ludwig said, children should be put in foster care for short periods and only as a last resort in the most severe situations. Before turning to foster care, child protective services should offer “intermediate options such as in-home social supports, parenting training, counseling, and financial assistance, that may address underlying problems without resorting to removal,” he wrote with his co-author, Lindsey Murtagh, a Harvard public-health researcher.

It’s not clear what types of interventions Cuyahoga County’s department of children and family services offered the Cleveland Heights mother, but a spokeswoman for the agency told the Plain Dealer that it had worked with her for more than a year before asking the courts to remove the boy from his home. The mother had enrolled her son in a program for obese children at the Rainbow Babies & Children’s Hospital in Cleveland, but after losing weight last year, the boy had recently begun gaining it back.

Public defender Sam Amata, a lawyer for the boy’s mother, who is a substitute elementary school teacher, acknowledged that some intervention on behalf of the child was warranted, but putting him in foster care was overreaching, the Plain Dealer reported. Amata noted that the boy’s only current medical problem was sleep apnea, for which he was receiving treatment, and that aside from his weight, he was a normal elementary school student who participated in school activities and made good enough grades to be on the honor roll.

But even if experts could agree that obesity should be considered life-threatening, who’s to say that snatching a child from his family and putting him in foster care is an effective or affordable solution? If a child’s own family is unable to encourage him to exercise or eat right, is it any more likely that a foster family will succeed?

The foster-care arrangement also ignores the fact that when an obese child returns to his family, he may also be returning to his original unhealthy environment — at home, school or otherwise. If the child had been, say, surrounded by fatty foods or spending a lot of time watching TV — being bombarded with junk-food ads — or being bullied at school, there’s no guarantee that any of these obesity risk factors would have been eliminated. The only difference may be that the child will bear the added emotional burden of having been taken from his family.

“This is really dangerous stuff we’re talking about,” Vivek Sankaran, a University of Michigan law professor and director of the Detroit Center for Family Advocacy, told Healthland’s Bonnie Rochman in July. “A lot of people don’t realize how traumatic it is for children to be ripped away from their parents.”

Sankaran described the case of an obese Michigan 2-year-old whom the Center was trying to retrieve from foster care. Rochman reported:

“What we’ve seen in this case is that the actual removal causes irreparable damage to the child — emotional problems, behavioral problems — and it’s the type of thing that can’t be remedied,” says Sankaran. “People think this is a quick fix, but you need to make sure you have tried every other possibility to protect the child.”

As University of Pennsylvania bioethicist Art Caplan has pointed out, such protective measures must involve the larger food culture. It’s not that parents shouldn’t be blamed for some part of the nation’s child obesity problem, but so should the makers and marketers of fast food and sugary soda. And let’s not forget the junk food-vending machines in schools, P.E. being cut from school curricula, and a government that counts tomato paste on pizza as a vegetable.

In many cases, maintaining a healthy weight — both for adults and children — is a group effort. People do better when they have social support from their friends, family or from an organized weight-loss program. And children especially do better when their entire family is educated in healthy eating and exercise behaviors along with them.

So, what if government funds could funneled to such interventions, instead of foster care? In the Cleveland Heights case, the Plain Dealer reported:

[N]ow lawyers for the mother say they’ve been told that the foster mother who has the child in a neighboring suburb is having trouble keeping up with all of his appointments.

There was even a discussion about getting the foster mother additional help or moving the child again, this time to a foster home with a personal trainer, Amata said.

“I wonder why they didn’t offer the mother that kind of extra help,” Amata said.

Sora Song is the editor of TIME Healthland. Find her on Twitter at @sora_song. You can also continue the discussion on TIME Healthland’s Facebook page and on Twitter at @TIMEHealthland.