AMA Journal Recommends That Seriously Obese Children be Placed in Foster Care

Childhood obesity is the latest reason being promoted for CPS taking kids from parents. This article reports on a recent piece in the prestigious Journal of the American Medical Association recommending that seriously obese children be placed “temporarily in foster care.” (Worcester Telegram, 7/13/11).

Dr. David Ludwig, an obesity specialist at Harvard-affiliated Children”s Hospital Boston, said the point isn”t to blame parents, but rather to act in children”s best interest and get them help that for whatever reason their parents can”t provide.

State intervention “ideally will support not just the child but the whole family, with the goal of reuniting child and family as soon as possible. That may require instruction on parenting,’ said Ludwig, who wrote the article with Lindsey Murtagh, a lawyer and a researcher at Harvard”s School of Public Health.

“Despite the discomfort posed by state intervention, it may sometimes be necessary to protect a child,’ Murtagh said.

That’s actually been done in a few extreme cases, such as the son of the single mother in South Carolina who weighed 555 at age 14.  For his part, Dr. Ludwig has seen some cases that would give anyone pause.

Ludwig said he started thinking about the issue after a 90-pound 3-year-old girl came to his obesity clinic several years ago. Her parents had physical disabilities, little money and difficulty controlling her weight.

Last year, at age 12, she weighed 400 pounds and had developed diabetes, cholesterol problems, high blood pressure and sleep apnea.

“Out of medical concern, the state placed this girl in foster care, where she simply received three balanced meals a day and a snack or two and moderate physical activity,’ he said. After a year, she lost 130 pounds. Though she is still obese, her diabetes and apnea disappeared; she remains in foster care, he said.

Indeed, she did better in one year of foster care than in nine years at Dr. Ludwig’s obesity clinic, but that’s another story. As Ludwig makes clear, obesity in anyone tends to cause a host of other problems like Type 2 diabetes, high blood pressure, bone and joint problems, etc.  And some 2 million children in the United States are clinically obese, according to the article. All of that is to say the obvious – obesity is a serious medical problem in children and adults. However, there’s a vast distance between identifying a problem and solving it, and the notion that foster care is the answer because obesity is the problem requires far more thorough examination than Ludwig or anyone quoted in the article has given it. In the first place, everyone quoted in the article who expresses reservations about foster care as the cure for obesity does so because having their children taken by CPS is a slap at the parents.

University of Pennsylvania bioethicist Art Caplan said he worries that the debate risks putting too much blame on parents. Obese children are victims of advertising, marketing, peer pressure and bullying — things a parent can”t control, he said.

Surely the stigma attached to the parents and the children is one issue to be considered, but far from the only one and far from the most important.  Tellingly, none of the people espousing this new increase in state power over families seems to notice.  Indeed, they seem to know precious little about the state child welfare agencies they’d entrust with making the decisions about whether to take a child from his/her parents.  And the same holds true for their understanding of foster care. In order to place a child in foster care, the home environment must be investigated, and not by Dr. Ludwig, but by a CPS caseworker who is undereducated, undertrained, underpaid and overworked.  The U.S. news media have horror stories virtually every day about the mistakes of CPS agencies and their caseworkers. I’ve gone to bat for those workers many times, saying the state doesn’t give them the tools to do one of the toughest jobs anyone can be asked to do.  But my defense of them is nothing more than “given the circumstances, they’re bound to get it wrong sometimes.”  That’s hardly a ringing endorsement of CPS. So one question becomes “do we really want to give yet more power to caseworkers who arguably can’t handle what they already have?”  Do we want them eyeing every fat kid with a view toward foster care? In case after case, CPS overreaches.  Last week in Houston, a good, intact family had its children taken by CPS because, as a temporary measure, they had to walk a few feet to get running water.  In Detroit, CPS called the S.W.A.T. team down on Maryanne Godboldo for the crime of not giving her daughter certain psychotropic medication.  Once out of her mother’s care, psychiatrists did exactly what Mom had done – refrain from giving her the medication. The stories are virtually limitless and people who follow the actions of child welfare agencies know them all too well.  Those opining on Ludwig’s obesity proposal seem not to.

Dr. Lainie Ross, a medical ethicist at the University of Chicago, said: “There”s a stigma with state intervention. We just have to do it with caution and humility and make sure we really can say that our interventions are going to do more good than harm.’

Face it, those words weren’t said by a person who knows much about child welfare agencies.  “Caution and humility” isn’t exactly the motto of CPS. And when it comes to doing more good than harm, foster care often accomplishes the opposite.  Many foster parents are fine, loving people of course and many are the adults who call their foster care as children a godsend. But the other side of the coin is that children are far more likely to be physically abused, neglected, injured, sexually abused or killed in foster care than in parental care.  The ongoing scandal that is the foster care system of the State of Texas would by itself educate Ross and Ludwig.  As but one example, a single group home was finally closed this year after the sixth child died there in the past four years. It’s easy to see a problem and conclude that we must act to solve it.  What’s harder is to see the problem and also see that the cure may be worse than the disease.  Dr. Ludwig cites two cases in which foster care of obese children seemed to help.  I’m glad it did. But he’s not proposing changes to two families.  He’s proposing changes to the family issues every child welfare caseworker in the country is tasked with evaluating and making the right decision about.  Why does he suppose caseworkers will be better at that than they’ve been at deciding other issues?  And why does he suppose foster care would be better at addressing obesity than it is at other childhood problems? He doesn’t say, but he must.  It’s the core of his proposal, after all.

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