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Joanna Dolgoff, M.D.

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Should Child Obesity Be Considered Child Abuse?

Posted: 04/13/10 07:02 AM ET

A South Carolina woman was charged with criminal neglect when her 14-year-old son reached a shocking 555 pounds. I am sure that many of you can understand the charge because the example is so egregious. But how do we know this is really the mother's fault? And if we do decide to charge parents of obese kids with child abuse, where do we draw the line?

As a Pediatrician and Child Obesity Expert, I see a wide range of overweight children. Some patients are simply 10 pounds overweight while others are more than one hundred pounds overweight. How do you decide who to charge with criminal neglect?

Many of the parents of my morbidly obese patients have been struggling (unsuccessfully) to keep their kids' weights down. They beg. They plead. They keep junk food out of the house. They lock their refrigerators. Yet these kids still manage to gain access to food.

It is somewhat easier to protect a younger child. But even at school, a kid can overeat. All a child has to do is cry that he is hungry and the lunch aides will serve him a second (or even a third) helping. And many a heavy child has begged their thinner classmates for some of their lunch. At the many parties thrown in class (for birthdays, holidays, and "special" days), these kids try to eat as many servings as possible. Even worse, a Mom may give her daughter some money to buy a turkey sandwich and never know that she used it to buy French fries and cookies instead. Parents have very little control over what their kids are eating out of the house.

Socioeconomic factors also play a role in the development of child obesity. I will admit, my family and I ate at McDonald's last month during a long car trip and I was shocked at how little it cost. My family of four ate for less than $15. It's no wonder that families with little money often opt for this cheap, but unhealthy, option.

Obesity rates are also affected by environmental factors, like access to playgrounds and parks. Many families live in unsafe areas where kids can't simply go outside to play. These children are often kept indoors for their own safety. And what do these kids do while cooped up in the house? Eat and watch television, more risk factors for weight gain. How can we blame parents for these inequities?

Some kids are genetically predisposed for obesity. While less than 10 percent of all cases of child obesity are due to known genetic defects, it does happen. Some individuals are deficient (or resistant to) the effects of a protein called leptin. Leptin is what tells our brain that we are full and no longer need to eat. Mice studies prove that mice with leptin defects become obese, sometimes to the point of eating themselves to death! These mice will eat until they become sick... and then they eat some more.

Some obese individuals have been found to have these same leptin defects. Clearly, obesity in these kids cannot be their parents' fault. It is possible that genetic defects are responsible for more cases of child obesity than we realize because we haven't yet discovered the responsible genes. I would hate to put a mother in jail or separate a family only to find out a few years later that the child suffers from a previously unheard of genetic defect. There is simply no way to know for sure whether a child is obese because of a parent's neglect or some genetic predisposition.

This is not simply conjecture. A family in Britain was on a Social Service's watch list, at risk for losing their children, due to their kids' weights. Luckily, Dr. Sadaf Forooqi discovered a gene deletion that left these kids unresponsive to leptin, causing them to live in constant hunger. Dr. Forooqi spoke to authorities and Social Services dropped the investigation. Had Dr. Forooqi not made that discovery in time, this family would have been devastated for no reason!

So let's go back to our initial example of the 555 pound South Carolina teen, Alexander Draper. His mother, Jerri Gray lost custody of her son and is being charged with criminal neglect. Gray is facing 15 years on two felony counts, the first U.S. felony case involving childhood obesity, said her lawyer, Grant Varner. Could Alexander suffer from an unknown genetic abnormality? Are we sure that he can control his hunger in a normal way? Alexander Draper hasn't even been tested for genetic causes of obesity, according to Varner. How can we justify putting this woman in jail for something that may not be her fault? We don't know what goes on in that house. It is possible that the problem lies within Alexander's DNA. And how can we punish his mother for that?

Now I am not saying that all parents are blameless. It is horrifying to see parents feeding obese children unhealthy foods and parents must be responsibility for keeping their kids as healthy as possible. I am just not sure that jail is the answer.

 
 
 

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A South Carolina woman was charged with criminal neglect when her 14-year-old son reached a shocking 555 pounds. I am sure that many of you can understand the charge because the example is so egregio...
A South Carolina woman was charged with criminal neglect when her 14-year-old son reached a shocking 555 pounds. I am sure that many of you can understand the charge because the example is so egregio...
 
 
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HUFFPOST SUPER USER
BlackYowe
I am a classical- liberal woman and a Jeweler.
04:57 PM on 04/16/2010
Child Obesity is a symptom of deeper problems in self esteem or in parenting skills and should set off alarms but abuse its not. The parents need to be educated and someone has to reach out and help in a non judgmental way.
09:02 AM on 04/16/2010
I disagree totally with the author of the article and I am even surprised it was allowed on HuffPo. Parents are very responsible because they are teaching their kids how to eat and excercise. I grew up in Europe where ALL mother cooked and none of my colleagues in school were OBESE. We had only one overweight kid for a class of 38 kids - but by no means she or he was obese. Mainly because parents fed them too many vitamins at an early age. Most American women don't know how to cook, they grew up on pizza, big macs and KFC and they don't know better. So they wreck the childhoods of their kids by enabling them to become obese.
03:57 AM on 04/16/2010
What kind of place doesn't have a park?
05:10 PM on 04/21/2010
Public Housing. You should volunteer sometime. You risk getting shot but it really opens your eyes to poverty and the challenges.
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puntybunny
01:21 PM on 04/15/2010
Ever travel in the less developed areas of mexico or asia? NO fat people. America has a mixed population. Do you really think it's possible that in cambodia they don't have that leptin defect? If it's here, it's there. But they don't eat the crap we do. And they practice this little thing called self awareness to keep track of when they're close to full, something americans seem to have given themselves permission to ignore. Why is it that when you suggest this to an overweight person here in the US they gripe that "you just don't know what it's like!" I'll tell you what I DO know - the US has a huge population of really, really fat people. and other countries are not like this. Do we have some kind of genetically anomalous population? That's impossible for our numbers. We have, & I am sorry to sound callous here, a weird situation in which we're led to treat hugely fat people with the same averted stare & tolerance that one would grant a mentally challenged person, or a person with some physical handicap. This doesn't work for me. There is a vast difference between a detrimental physical condition you get by reaching out for it with both hands, eagerly inviting it to take you over, & a condition that is there with you no matter your actions, such as autism or a withered arm. I have sympathy for those people.
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puntybunny
01:23 PM on 04/15/2010
I do NOT have sympathy for - as an example - the extremely fat woman I worked with back in college who worked at a vitamin store with me (Oh, the irony.) She was so fat she would ask me to tie her shoes. One time her sister had to help her - she got stuck in the bathtub. We worked at a health food store & she ate her meals from the food court. She wasn't stupid. She had no excuse. She had the self indulgence of a spoiled child. I see no hope for such people & regrettably this new tolerance in attitude shift we're seeing takes away even the last vestiges of peer pressure that might remind people to use some self control. "I WANT to do this, it makes me FEEL good, & I WANT it, how can you pick on me for that, it's not FAIR!" This is the mantra of a bratty child. Since when did it become an defensible statement for reasoning adults?
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KristinNoelle
10:30 PM on 04/20/2010
I know I shouldn't have, but I laughed out loud at the part about her asking you to tie her shoes.
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puntybunny
01:20 PM on 04/15/2010
While I am absolutely disgusted with the self serving avarice of food marketers, I am aghast at the number of parents who plain make stupid, non-thinking choices. A banana makes a fine after school snack. Kid whines for oreos? Tough. I just don't get it because the news about unprocessed simple food being better is ALL around us.

And to those who say it's genetic or you just don't appreciate what it's like to struggle with weight...ever look at any pictures of the concentration camps in Germany? See any fat people? no, right? That's because CALORIES = FAT, & for those of you who have indignantly been posting otherwise, go back & look at those Auschwitz pix some more. If you get tired of that, do a search for Ethiopian children. You know, the ones with sticks for arms & legs. So what if you have a slower metabolism. It's not like you have a "normal" quota of food you're supposed to eat every day.
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puntybunny
01:18 PM on 04/15/2010
Yes, yes, yes, the entire food industry is hugely to blame, along with the govt, which, as an example, subsidizes corn farmers so we can have cheap calories in the form of high fructose corn syrup, which we're then told we shouldn't eat.

BUT. We know drugs are out there, right? So as parents, we take it as our personal duty to tell our kids about drugs, their names, what they do, the dangers. You can complain, fairly I will say, about the companies selling faux food but - what - eating a big mac lobotomizes you? Why aren't these parents doing some critical thinking? I have a nine year old & I feed him lots of raw food, smoothies, fruit. I go online & keep up to date on the latest nutritional research. I have a good IQ, which I am just saying as...I have some spare bandwidth to pay attention to these things. But what the heck...all these other parents, the ones who frequent McDonalds & buy lunchables, they're at least hominids smart enough to drive cars & boil water. "Unprocessed food is better for you." That's a pretty simple & short sentence. Yes, I'm in the city. I can get organic vegges etc. But if I were off away from stores, broke, I'd stick some lentil beans in a crockpot & serve it with a nice homemade cornbread. That is totally cheap & easy.
12:17 PM on 04/15/2010
Slippery slope.

I see all the JudgeyMcJudgersons have weighed in on the topic.

I have one thin child and one obese child. Now what?
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KristinNoelle
10:31 PM on 04/20/2010
Scape some food off the plate of one on to the plate of the other?
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Stagmom
11:54 AM on 04/15/2010
For many of us, food equals love. I'm Italian. "Mangia!" is our battle cry. I cook for people to tell them I love them. Some parents might overfeed their children as a sign of love. I don't think it's a form of abuse. I recall a family member crowing that his 3 year old daughter could eat two McDonald's breakfast sandwiches. Much of her praise revolved around her ability to eat. Even her nickname was a play on how large she was. She is now fighting obesity. Was it her fault? I don't think so. Was it her parents fault? Perhaps. But I don't think it was malicious or with an intent to harm, and isn't that a requirement for a crime?
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KristinNoelle
10:36 PM on 04/20/2010
I don't think you understand how seriously harmful it is for a 14 year old child to weigh 555 pounds. This child could literally go into respiratory arrest and die in his sleep, will most likely develop diabetes at an early age, if he hasn't already, and begin having cardiac issues by 30. His lifespan has easily been reduced by 20 years if not more. That isn't love. I do not believe for a second that this child's doctor never informed the mother of the seriousness of his weight and so if she continued to feed him, then it is absolutely abuse.
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Hellbilly
09:19 AM on 04/15/2010
This is a hot topic, I can tell. Lots of Americans seem to believe that being grotesquely overweight can't be helped.

That's BS. You have a genetic predisposition to fat? Don't have that 3rd Big Mac. You've got a slow metabolism? Well, cut down to a 12 to 1500 cal diet and eat more protien.

Any parent that allows her child to grow obese and cannot show proof of a medical condition should indeed be prosecuted by CPS under the 'medical neglect', 'psychological abuse', and 'physical abuse' provisions of the law.

1.) Medical Neglect- Parents are obligated to take proper medical care of their children. Failing to do so is neglect, plain and simple. Either the parent isn't monitoring the child's medical needs via a preexisting condition or the parent is neglecting to prevent the child from unhealthy choices. Either way, serious medical complications are sure to result.

2.) Psychological Abuse- BBW claims to the contrary, morbidly obese people are not attractive or excessively popular. They tend to be mocked and abused by peers. This constitutes psychological abuse on the parent's part because said parent did not prevent the child from causing harm to themselves.

3.) Physical Abuse- This ties into #1, Medical Neglect. It's not too hard to figure out why.


Now look. Being fat isn't a disability. In 90% of the cases, being fat is a sign of being lazy. Get over it, go on a diet, exersize, and get out of that Powerchair!
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qaan
Cake or Death!!!
07:30 AM on 04/15/2010
No it shouldn't.

How would a criminal punishment positively affect the problem?

Kids need to socialize, to be around other kids their own age, an the best way to do this from a health standpoint is by doing some group physical activity. Some children are unable to keep up with the most of the other kids in the group because of a number of factors (obesity, asthma, etc). Those children need a more specialized group activity in order to remain in a social setting. Whether it is a more individualized physical program, or playing an instrument in a marching band, it's vital for the socialized activity to take place, especially between the ages of 8 and 12. Otherwise these children may become extremely introverted, and that creates a much greater risk of isolation becoming their norm in adulthood.

People need other people to help them have life perspective. And the parents are responsible for that. So the problem occues when a parent does not know how to deal with the situation or is too selfish to care.
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HUFFPOST COMMUNITY MODERATOR
KJLSanDiego
12:50 AM on 04/15/2010
Yes, yes it should.
03:09 PM on 04/14/2010
obesity is related to laziness. one can run, or do jumping jacks. one may prepare whole food instead of grabbing boxed junk. one can close the mouth and do something worthwhile, like read, create, lean, etc. its not brain surgery. so incredibly idiotic for tv shows to coach people on how to lose weight. 1-stop eating. 2- dont eat junk 3-exercise. a 500 lb kid is abuse, unless he has what the 10% of fat people are missing, that 'you're full button'. wonder if that mother is fat? if so, then its not abuse as the mother is messed up. i don't mean 10 lbs overweight, i am talking about obese.
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HUFFPOST COMMUNITY MODERATOR
Atchka
Fierce, Freethinking Fatties
12:09 PM on 04/14/2010
The people who comment on these issues with such simplistic pronouncements as "Calories In/Calories Out" do a disservice to those working to improve our health as a nation.

The Wall Street Journal just had a story about how the currently accepted diet math (aka Calories In/Calories Out) does not work the way we always assumed it did.

http://online.wsj.com/article/SB10001424052702303960604575157820324371484.html?mod=WSJ_hpp_RIGHTTopCarousel

Yet this information is slow to pervade the American psyche. It's much easier and satisfying to our snark-centered culture to blame fat people entirely for their being fat. It's the strategy of such fat hating extremists as MeMe "Cupcake" Roth and Michael Karolchyk of the Anti-Gym.

Well, I've debated Ms. Roth and demonstrated how her logic is fundamentally flawed. Hell, I even stumped her for about 2-3 seconds.

Tomorrow, I'll be presenting an interview with Mr. Karolchyk that will further demonstrate that these extremist viewpoints aren't based in fact. And, in fact, Karolchyk and Roth take the extreme view because it has been profitable for them personally. Sadly, there are people who completely believe that Karolchyk and Roth are "experts" on the subject of obesity, when they are poorly misinformed and, unfortunately, have nearly unlimited access to a national forum.

It should get interesting.

Peace,
Shannon
http://atchka.podbean.com
09:11 AM on 04/16/2010
You can be sure that the WSJ article you mention presents research sponsored by the food and/or drug industry. How naive? Who else is doing food/nutritional related research in this country?
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HUFFPOST COMMUNITY MODERATOR
Atchka
Fierce, Freethinking Fatties
10:46 AM on 04/16/2010
First of all, yeah, most research is funded by food and drug industries. However, they are required to disclose that funding source. Here are two of the studies mentioned in the article:

Katan and Ludwig: http://jama.ama-assn.org/cgi/content/extract/303/1/65

Kevin Hall: http://www.ajcn.org/cgi/content/abstract/88/6/1495#otherarticles

I couldn't find the article by Barry Popkin that is referenced. But I keep seeing Popkin's name associated with studies refuting the health dangers of HFCS (however, he used to be a critic). So, I can't vouch for his credibility.

However, in the two articles above, I could not find any disclosure regarding funding sources. I invite you to check for yourself and correct me if I'm wrong.

Peace,
Shannon
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KristinNoelle
10:42 PM on 04/20/2010
There might be some variation in the calories in/calories out thing, but you cannot tell me that a person who eats a reasonable number of calories is going to weigh in at over 550 lbs.
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HUFFPOST COMMUNITY MODERATOR
Atchka
Fierce, Freethinking Fatties
02:04 PM on 04/21/2010
Typically the problem with a child who is so significantly overweight is not necessarily the food environment as it is the feeding environment. Children have natural self-regulatory systems in place and when a parent tries to tamper with that system (either by pushing a picky eater to finish their meal or attempting to restrict a very hungry eater to keep them lean), they end up replacing that natural system with an arbitrary set of external cues (eat until you clean your plate or eat as much as you can when you have access to food because you don't know when you'll be satiated again).

And the number of people who weight 550 pounds (let alone children who weigh this much) is statistically insignificant. Only 3% of the population have a BMI of 40 and above (or what is technically referred to as "morbidly obese"). But society doesn't think in terms of actual facts... they hear "fat" they think "morbidly obese," they think "550 pound child," (thanks to news segments that talk about the "obesity epidemic" in terms of 2/3 of the nation and show pictures of headless fatties lumbering across the street) when in reality the majority of fat people are not that heavy nor are they that unhealthy.

Peace,
Shannon
Atchka.com
FierceFatties.com
11:17 AM on 04/14/2010
Of course some parents abuse their kids in this way, but some do all they can, and still fail, to keep their kids healthy. Where do we draw the line not just with this but with everything? If you can be arrested because your kid is too fat, what about for your dangerous second-hand smoke? What if you don't make him exercise for an hour every day? Allow him to participate in dangerous sports, like football? Read to him when he's young? Take him on intellectually stimulating vacations? Make him take piano lessons? Hire a tutor to teach him Spanish? Failure to address any of these could have adverse effects on your child's development but are they crimes? If so, we're all guilty at times so are we all going to jail? If these failures are a byproduct of economics who is to pay for them all?

The food police want to firebomb McDonald's but NOBODY FORCES YOU TO EAT THERE. Lots of things aren't good for us but you have no right to tell us we can't have them.

The author mentioned how cheap it is to eat at McDonald's, which brings up another point: There's almost no food that's cheap, healthy, quick, filling and tastes good. Oatmeal is the exception, but who wants to eat that three times a day? Come up with something that satisfies all five requirements and I'll be there, but so far I haven't found it.
11:58 AM on 04/14/2010
Second paragraph, second sentence -- untrue. Yes, this can and did happen. Please read copied info below:
"In 1976, due to public controversy surrounding a particular red food coloring, red M&M'S Chocolate Candies were removed from the traditional color mix. "

Good idea for fast food places, too. Remove the choice to eat this junk.
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KJLSanDiego
12:55 AM on 04/15/2010
Is that about the red coming from ground up bug shells?
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KarenM
Former Air Force Brat.... I've lived all over the
10:22 AM on 04/14/2010
I don't think parents should be charged with abuse for having obese children...

not when schools still sell sodas in vending machines

not when school lunch and breakfast programs rely too heavily on carbohydrates, so that students will feel full

not when children's programming relies on adverstisements for sugary cereals and ridiculous junk foods

not when our FoodManufacturers insist on putting HFCS in practically everything they produce

not when nutritionists continue to tell people to eat more grains, even though eating too many grains results in an imbalance in Omega 6's & 3's, resulting in inflammation and obesity

not when urban centers are allowed to exist without supermarkets, and must survive with convenience markets and delis

not when artificial sweeteners are considered the primary alternative to HFCS (rather than real sugar), since the body doesn't know what to do with it and must store it... where? in fat!

Until these structural problems are resolved, parents cannot reasonably be held responsible for their children's obesity.
11:00 AM on 04/14/2010
It still comes down to the parents.

We are completely responsible for the situations in which we find ourselves. As children are too young for that responsibility, it lies squarely on the parents.
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KarenM
Former Air Force Brat.... I've lived all over the
12:11 PM on 04/14/2010
Structural problems still trump personal responsibility. We're all just cannon fodder for the industrial food giants, the health food "industry," the military, the big banks, and so on...

Have you tried to buy a jar of relish without HFCS? A can of soup that doesn't have wheat gluten, dairy or soy in it?

If you don't have any dietary restrictions of your own, you may not be aware of how difficult it can be to avoid eating things that can make you either too thin or too fat.

Have you ever lived in an area without a supermarket, and without owning a car?

It's easy to be judgmental about parents who cannot, for one reason or another... (maybe they're working several jobs just to make ends meet) meet your specific standards. Doesn't make you right, though.
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KarenM
Former Air Force Brat.... I've lived all over the
12:12 PM on 04/14/2010
Yikes!

That was supposed to read health "care" industry!