Is childhood obesity neglect?

By the time they start school, nearly 30% of children are overweight or obese. Some will lose weight, others will get heavier and join the 31.6% of children who are fat by the time they are 10. They risk growth problems, as their developing bones and joints struggle to cope with the strain of carrying extra weight, as well as the premature onset of puberty. In adulthood they will be more likely to develop certain types of cancers and heart problems.

Childhood obesity is such a serious issue that the Department of Health has drawn up guidance that means, from this month, parents in England will, for the first time, be informed if their child is overweight. However, it advises that letters to parents should not use the terms fat or obese because they can be considered stigmatising. In itself this advice sums up the sensitivity around talking frankly about weight problems.

Recently, the media have dedicated more space and time to the issue of obesity, ­especially as experienced by children and young people. Among the slew of stories was one about the Local Government Association warning parents of obese children that social services could take their offspring into care.

Parental neglect

David Rogers, LGA spokesperson on public health, said morbid obesity in children should be viewed as parental neglect, much in the same way as malnourishment is at the other end of the spectrum.

It is not a new argument. In recent years concern about the growing number of dangerously overweight children has been increasing. Health professionals, who deal first-hand with the consequences, have suggested parents of very overweight children should, in certain and rare circumstances, be seen as neglectful.

Matthew Capehorn, a GP from Rotherham, Yorkshire, proposed a motion along these lines at a British Medical Associ­ation conference in 2007. It was rejected, he believes, because his initial motion was reworded so that it read like he was proposing a blanket policy on doctors referring all overweight children to social services.

Held to account

Capehorn wanted to develop a policy whereby parents of dangerously overweight children who persistently ignored warnings and advice about the risks to their child’s health would be held to account and the child protected. He emphasises he was talking about a very small percentage of children. “Most people who bring their child to my surgery do so because they are loving parents and so most will follow advice about their weight. Many are initially in denial but most will eventually listen.”

He says it is a tricky subject to broach with parents and that colleagues are often hesitant to raise it. Capehorn’s approach is to be matter-of-fact and speak about weight issues as he would any other medical condition.

It is not surprising that professionals have difficulty telling parents their child is overweight. Ann Baxter, chair of the healthcare additional needs committee at the Association of Directors of Children’s Services, says: “Weight is an emotive issue. You are talking about a family’s culture and questioning parenting ability.”

Tread with caution

She says that professionals must tread with caution. She adds: “It’s not a black and white issue, neglect or not neglect. It is not neglect in, say, the same way as a bruise. There will be a small number of children where we feel health and safety is at risk but there are likely to be other neglect indicators. Intervention would be at the end of a long line of actions.”

Instead it would be better for social services, with other agencies, to focus their efforts on working with parents to prevent it reaching a serious level. “It is not as if the child is ok one day and morbidly obese the next. I see a role here for family support workers to help makes changes to lifestyles.”

Parents are likely to need support on many levels to address their child’s weight issues, especially if they, too, are overweight. According to charity Weight Concern, children with two overweight parents have a 70% chance of being overweight themselves, while those with one overweight parent have a 30% likelihood. In comparison, if neither parent is fat a child has just a 10% chance of being overweight as an adult.

Although it is hard to believe, some parents may be ignorant about what constitutes a healthy diet. Tam Fry, a board member of the National Obesity Forum, says he has encountered cases where parents have fed puréed Chinese takeaway food to toddlers. “There are children who have a body mass index of 45, which is 15 points higher than a male adult. That is atrocious. Things get muddled when you have fat parents because they often do not recognise fatness in their children.”

Finger-wagging

But others warn against a finger-wagging approach to parents, arguing that even professionals who should be aware of what a healthy weight is for a child are routinely getting it wrong. Mary Rudolf, consultant paediatrician at Leeds Primary Care Trust and Leeds University, says: “Health professionals are not so great at recognising obesity and which children are obese. Sometimes they also don’t want to categorise a child as overweight because they will compare them to a child in their own family and think ‘I wouldn’t want them described in that way’.

“Mums of overweight pre-school children have reported feeling upset by disparaging and judgemental attitudes when they have raised concerns about their child’s weight. There is a lot of work to be done before we start pointing the finger at parents. Health visitors, for example, often feel uncomfortable about raising the fact a baby is fat, especially if the parents are obese,” she adds.

Not only is it difficult for professionals to raise the subject of a child’s weight, but in wider society perceptions have become skewed. “Obesity has been normalised to the point where we see children who are skinny as having a problem,” Rudolf says.

Capehorn agrees. He deals with a number of overweight people, and parents, who eat healthy, nutritious food but have no idea what constitutes a reasonable portion and become confused when they gain weight.

“The problem is most of us eat until we can’t move,” he says. “But are we to blame or is society in general? The number of buy-one-get-one-free offers influences what people buy. Then there are the supersize offers. They encourage people to eat more. Then again some studies show we are not eating more but exercising less and that the obesity epidemic is about becoming more lazy. Commonsense says it is a mix of both.”

● More from http://www.weightconcern.org.uk and http://www.henry.org.uk

● Read Community Care’s GP columnist Dr Michael Fitzpatrick’s views on childhood obesity

Key points

● Obesity can be measured by body mass index (BMI), which is calculated by taking weight in kilogrammes and dividing by height in metres squared.

● People with a BMI of 30 are categorised as obese and those with 40 and above morbidly obese.

● By 2010, 33% of men and 28% of women will be obese in the UK. There are similar trends for children. By 2050 it is estimated half of adults will be obese.

● Interventions that engage the whole family are most likely to be successful.

● Source: Tackling Obesities: Future Choices Project, published October 2007 www.communitycare.co.uk/obesity

This article is published in the 18 September edition of Community Care magazine under the headline Caught in the Fat Trap