According to David Rogers, public health spokesperson for the
Local Government Association, "parents who allow their children to
eat too much could be as guilty of neglect as those who did not
feed their children at all".
The LGA's conviction that overweight children should become the
subject of child protection procedures was reported under the
headline "Fat children 'should be taken from parents' to curb
obesity epidemic" (The Times, 16 August).
I first encountered this facile presentation of obesity as a
form of child abuse at a case conference about a teenage girl some
years ago. Social workers accepted that her parents were devoted
and there was no hint of neglect. Nevertheless, they cited a case
in the US in which authorities had been blamed for the death of a
morbidly obese young woman and insisted that drastic action had to
be taken.
I pointed out the inappropriateness of the parallel between the
situation of an under-nourished and neglected infant and an
overweight and pampered adolescent. In the former case, actual
bodily harm is the direct result of parental abuse and is, at least
in physical terms, readily susceptible to intervention. In the
latter case, long-term risks to health are the result of a complex
(and poorly understood) combination of factors, including the wider
"obesogenic" environment - cheap, fast and fattening food,
sedentary lifestyles, and so on - as well as the behaviour of the
child and her parents.
Stigmatising measures
A paediatrician told the case conference that there was only
weak and contradictory evidence supporting the efficacy of any
particular treatment for childhood obesity. She argued against the
proposal for coercive action on the basis that obesity is "a public
health problem, not a child protection issue".
As the family GP, I was concerned that imposing stigmatising
statutory measures on the family would alienate them from health
and social services without providing any benefit for the child.
However, it seemed that the anxieties of the child protection
authorities to avert blame outweighed these concerns and the child
was duly placed on the "at risk" register.
I recently asked the girl, who is now in further education and
still considerably overweight, if the intervention had worked. "No"
was her candid response. The only benefit of being on the register
was that she was enrolled in an exercise course. But, as she
recalled with some bitterness, this ceased on her 16th birthday
when she was no longer the responsibility of the child protection
authorities.
As children return to school in September, parents will be
receiving official warnings if their children are overweight and
instructions from the government about healthy eating, physical
activity and the risks of being overweight (despite the abundant
evidence that such exhortations are useless). In their crusade
against childhood obesity, public health zealots would do well to
heed the wise words of paediatric experts, who emphasis that
obesity "remains extremely difficult to treat, thus criticising
parents for what professionals are frequently unable to do smacks
of hypocrisy".
Dr Michael Fitzpatrick is a GP in Hackney
This article appeared in the 28 August edition of Community Care
under the headline There Is no Parallel between Being Underfed and
Overfed
Related articles
Outside Left's take on
the official warnings
Child Obesity is not
Child Abuse!