Is obesity a child protection issue?
How should social workers react when presented with a very overweight child? Julie Griffiths reports on whether official guidelines are needed
(Picture: an overweight child visits a gym with friends. Model released. Credit: Rex)
There are an estimated three million children in the UK classified as overweight or obese. A 2007 report, Tackling Obesities: Future Choices, from the government’s Foresight group, predicted that without action two-thirds of children will be overweight or obese by 2050. But the point at which obesity turns into a child protection issue has always been a controversial area.
Although public health officials agree obesity is one of the biggest issues affecting children’s health, the public so far appears divided on the issue of whether children should be removed from parents who make no effort to address their child’s weight.
In 2007, North Tyneside Council’s social services received significant media coverage and was featured on ITV’s Tonight with Trevor McDonald, for looking into the case of an eight-year-old boy who weighed more than 14 stone. Later the same year, Cumbria Council was in the press because it took an obese child into care. A year later, Dundee Council’s involvement with an obese family attracted the same attention.
Recently the debate flared up again after the British Medical Journal published an editorial from doctors at University College London Hospitals which proposed a framework for when obesity should be considered a child protection issue (see graphic).
Dr Russell Viner and his colleagues say obesity alone is not a child protection concern but that there is growing evidence linking adolescent and adult obesity with childhood sexual abuse, violence and neglect.
Social workers should act if parents fail to engage with treatment for their child’s obesity (where it presents a morbidity risk) and should have a high index suspicion around children who are very obese because it could be a symptom of other forms of abuse.
Dr David Haslam, chair of the National Obesity Forum (NOF), says social workers could have a valuable role in tackling obesity because they have statutory clout that health professionals lack.
"It might be easier than for primary care because, if it’s a child protection case, the law can be laid down," he says.
He has welcomed the framework: "It’s worth considering. It may be something the NOF should be thinking about," he adds.
No guidance needed
Ray Jones, professor of social work at Kingston University, disagrees. He says that, although there is no doubt that in extreme cases obesity is a child protection issue, no guidance is needed. "The last thing we need is to create separate guidelines to cover every issue that social workers need to deal with. It would paralyse social workers from acting because they’d be having to dig out and look up guidelines all the time."
But Nushra Mansuri, joint England manager of the British Association of Social Workers, says guidelines on obesity and child protection would be useful.
"We don’t want to get into anything that’s heavily prescriptive," she says. "But social workers may find it hard to work out when obesity has more to do with poverty or lack of education than neglect. After all, it is relatively new on the child protection radar."
However, councils would resist adding obesity to the child protection symptom list when thresholds are under pressure.
National debate needed
Helen Johnston, programme director for children at the Local Government Association, says: "There is already pressure on the care system; we have been clear on those figures." It is, she says, a matter for national debate about the extent to which councils take action in obesity cases.
Until then, it seems unlikely that any guidelines or proposed frameworks will be implemented by social work teams. Whether this is helpful for those on the frontline remains open to debate.
Community Care inform subscribers can access a guide to obesity in children and young people written by Deborah Christie, consultant clinical psychologist at the Department of Child and Adolescent Psychological Services, University College London Hospitals, London. Go to www.ccinform.co.uk or phone Kim Poupart on 020 8652 4848 for more information.
"Overseeing a child’s diet, nutrition, fitness and health are key fundamental requirements for parents and carers. Failures in these areas could and should be grounds for investigating neglect and abuse.
"There’s an obvious snag though: if we say little Jimmy’s too fat and has a bad diet and doesn’t do enough exercise, and as a result may suffer future health problems that lead to an early death, and it’s Mum and Dad’s fault, fine.
"But what if little Jimmy’s in a care home, or is being fostered, and has been so for quite a while? Then, the local authority invariably has parental authority.
"And so little Jimmy had better not leave care obese, with bad diet knowledge and unable to run 100 metres. Because (big) Jimmy might just walk into a solicitor, who will co-opt a few experts. Before you know it, the local authority is in the High Court, with the words of its own Local Government Association being used in evidence against it. The local authority, having parental responsibility, has an equal responsibility to children and young adults."
Childhood obesity should be a very serious consideration when considering neglect. It does set a dangerous precedent, however, in terms of professional involvement.
For example, how would it look if a child was removed from their family for being obese and the social worker involved was, shall we say, well rounded?
Or the judge in the courts was tubby and enjoyed way too many of those glorious Sunday lunches and lazy afternoons?
It really does put enormous pressure on all the adults working with the child. The underpinning question would surely be how wide do you cast the net?
Would you make judgements based upon body mass index and say that concerns are validated if the child reaches a BMI of 30? Lower?"
"How do you define ‘extremely obese’? I’ve seen many foster carers and residential workers who would fit this description. Many just had a particular appetite for crisps. And how do you talk to children about weight management issues on their own? During CP visits? Sorry to hear Daddy hit you; do you think you are fat?
If any policy is to be implemented, it needs to be universal, not one that singles out vulnerable people because they just happen to be known to us. I would agree for support with weight management should be offered as part of a supportive service or part of a CP plan, but it should not turn us into a "fat police", which is what appears to be happening.