Childhood obesity is not abuse

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

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