Thursday, 14 July 2011

#9: Carry That Weight

Childhood obesity and what we ought to do about...

Many of you will be familiar with an editorial that appeared in the prestigious Journal of the American Medical Association (JAMA) and which quickly swept through local, national and international newspapers; twitter and on facebook and to which everyone seemed to voice a strong opinion. The piece suggested that perhaps children who are extremely obese (as indicated by being above the 99% percentile of the infamous these kids are huge!) should be subject to some form of state (government) intervention. Note: this does NOT mean they are taken from there families and placed in foster care. Those are extreme and rare situations. Rather, it means that Family Aid and Child Services would have the right to investigate, assess the home environment as being supportive and safe, probe for abuse or neglect, suggest reasonable interventions/solutions and if all else fails, consider removing children and placing them in temporary alternative care. Similar to children who fail to thrive and are underweight or malnourished, it is argued that these obese children are being over-nourished and overfed to the point where their health and well-being is being compromised (which quite frankly I agree with completely). Whether this constitutes child abuse is far from clear, but certainly it is far from optimal as (extreme) childhood obesity is associated with a multitude of physical (sleep apnea, respiratory/breathing difficulties, liver disease, diabetes and many more), emotional and social (bullying, social stigma, body image issues, depression) health problems.

Obese adults are one thing, and whether they are at fault for their condition based on individual choices or whether it is a result of the complex ‘obesogenic’ environment we currently live is heavily debated (Personally I contend that obesity is a social/collective epidemic, but essentially stems from poor individual choices). However, I find it extremely hard to place blame directly on children for their own obesity, and especially in cases where the parents are themselves obese. Clearly, these children are not being given the optimal healthy environments in which to develop and so perhaps there is a point where this does in fact constitute abuse. But how do we possibly draw a line? Does feeding a child McDonalds and donuts equate to abuse? Not really. Certainly no one would argue that offering a child cigarettes, alcohol or illicit drugs is abuse; yet providing food of questionable nutritional value is normalized and accepted. Perhaps this needs to change!

Taking children away from their parents may also create a number of equally traumatizing and negative outcomes which could prove more debilitating than the state of being obese, but this too is impossible to determine. Removing children from their homes and their parents would, again, likely be done only in the most extreme of cases when all alternative options have been exhausted. Uncovering the underlying 'causes' of a childs obesity will be essential for any sort of meaningful intervention. Certainly there are socioeconomic, race and gender considerations to contend with; but feeding a child hot dogs and ding-dongs because they cry when they don't get them is not a legitimate excuse.

So what are we to do?

We know that obese children are much more likely to turn into obese adults. We also know that obese children are far more likely to be from families with obese parents. With 2/3 of adults now classified as obese, is it any wonder that the next generation of children is already doomed to become like that of their parents and that those numbers are expected to rise? While treatment and management of obesity at the population level has largely failed; prevention must become our top priority! We must adopt and pass on healthy lifestyle behaviours to our next generations. Admittingly this is no easy task, especially because so few of our current generation have adopted those behaviours themselves. Perhaps it is time to take a stand. Having children is a freedom (and a right) we all possess (?!); but it is also an immense many are not capable of (this is a topic for another day). As a society, we must ensure that children are provided with every opportunity to thrive and develop, and are protected from all unnecessary harm. The burden of childhood obesity is definitely unnecessary harm, and thus I feel it is our duty to protect children from this, whether from themselves, from their parents or from the environment that promotes it. How we do this is far from clear? Government intervention and public health/education seems to me, the most feasible and immediate solution and so I will conclude by endorsing the position of the JAMA authors who suggest that state/government regulation and intervention are a promising area for the prevention and management of childhood obesity (in the most extreme cases).

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