Trimming the fat of the land

In their recent JAMA commentary on the problem of malignant childhood obesity (State Intervention in Life-Threatening Childhood Obesity, JAMA, July 13, 2011: Vol. 306, No. 2, p. 206-7), Murtagh and Ludwig advocate the referral of morbidly obese children to state protective service agencies in cases where their families fail to implement and follow plans for effective weight reduction. In short, in the opinion of these authors, morbid childhood obesity should be considered a form of parental neglect.

Having dealt with a good number of child abuse cases over the span of my professional career, I have learned that if proving abuse is difficult, substantiating neglect is even more so.  The burden of proof lies with the clinician.  I for one would not look forward to appearing in the dock charged with supporting the recommendation that a morbidly obese child be removed from the home because the parents were unable to control his weight.  more»

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