An editorial in JAMA today by Murtagh and Ludwig proposes that in the case of severe childhood obesity, we should be prepared to consider state intervention. In other words, the state should potentially react to severe "overfeeding" and its consequences as it would to parents starving a child. Protecting the well-being, and life, of the child trumps the sanctity of the family.
But along with the knee-jerk opposition such a proposal evokes (in my opinion, unwarranted in this case, by the way, because Ms. Murtagh and Dr. Ludwig make a very thoughtful, nuanced argument), there is a subtle problem that may go overlooked. Namely, we condemn the outcome, but not the behavior that leads to it.
Adults are criminally liable if they give cigarettes or alcohol or illicit drugs to a child. And they are criminally liable for starving a child as well -- this constitutes abuse. But our society does not view giving a child a donut or fries or soda as abusive -- even if it occurs day after day. How do we sanction state intervention for a bad outcome attached to behaviors we condone every day?
Thinking along these lines led me back to an experience I had a few years ago, when I went to Maui to give a talk at a health conference.
What is relevant to my topic about this is the plane I took to get here. I happened to be sitting in first class, courtesy of those hosting the conference. In my row was a woman who moved to Maui a year prior, her sister and her sister's two-year-old daughter.
I did not get to know her well, but enough to recognize that she was intelligent and warm-hearted. She was thrilled to be bringing her sister and baby niece to visit her new island home for the first time. I liked her.
There was something else I got to know about her, which required no conversation at all. Namely, she was a very large woman. Her sister, just a couple of seats away, was at least as large.
At one point during the flight, my neighbor's sister returned from the airplane lavatory and told her sister, with a chuckle in her voice, "If I get any bigger I'm not going to fit in there!" The two of them had a good laugh and exchanged quips about the need to "extend" those little toilets.
Throughout the entire flight, my neighbor (and her sister) were eating and drinking. This is hard to resist in first class, where you are constantly offered temptations. So my neighbor consumed several glasses of wine. She ate everything that was served. And she ate a box of some kind of glow-in-the-dark cheese puffs she had brought with her.
I watched my very delightful neighbor and her probably equally delightful sister share their eminently destructive behaviors with the two-year-old in their company. I have essentially no doubt that this child -- still lean at age two -- is destined for even more extreme obesity than her mother and aunt, and destined for the chronic diseases that ensue. In other words, I was observing a pattern of familial behavior that would destroy an innocent child's health.
Imagine if two drug addicts joked in public about the health consequences of their drug use, even as they shared their drugs with a small child. Children are removed from their parents for less.
Imagine if smokers joking about their worsening emphysema put their cigarettes into the mouths of their infants. Would anyone observing this feel inclined to mind their own business?
Don't get me wrong; I am not maligning these women. Nor am I am suggesting their harmful behavior was even their fault. Our society has yet to provide any clear guidelines on what is, and is not, acceptable when it comes to second-hand obesity.
That is what has to change, certainly before we sanction the state taking an obese child from a parent. Let's react to the process, not just the outcome. You don't get to decide for yourself if giving drugs or cigarettes or alcohol to small children is appropriate. Society has decided for us: It is not! Good call.
Data from the CDC indicate that children growing up in the United States today will suffer more chronic disease and premature death over their lifetimes from eating badly and lack of physical activity than from exposure to alcohol, tobacco and drugs combined. If the principle we care about is protecting children from harm, the practice should pertain to all threats comparably. At present, it does not. We are feeding our children to death.
Obesity is not the fault of its many victims, but it's no joke either. I like a good laugh as much as the next guy. But unless we start recognizing obesity for the serious threat that it is, the fate of our children will be cause for tears. And unless we take such matters into our own hands, there is the prospect in severe cases- of the state taking our children into theirs.
-fin
Dr. David L. Katz; www.davidkatzmd.com
www.turnthetidefoundation.org
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