JAMA report: Parents should lose custody of super obese kids

[OhioChick]

Posted: 07/12/2011

CHICAGO - Should parents of extremely obese children lose custody for not controlling their kids' weight? A provocative commentary in one of the nation's most distinguished medical journals argues yes, and its authors are joining a quiet chorus of advocates who say the government should be allowed to intervene in extreme cases.

It has happened a few times in the U.S., and the opinion piece in Wednesday's Journal of the American Medical Association says putting children temporarily in foster care is in some cases more ethical than obesity surgery.

Dr. David Ludwig, an obesity specialist at Harvard-affiliated Children's Hospital Boston, said the point isn't to blame parents, but rather to act in children's best interest and get them help that for whatever reason their parents can't provide.

State intervention "ideally will support not just the child but the whole family, with the goal of reuniting child and family as soon as possible. That may require instruction on parenting," said Ludwig, who wrote the article with Lindsey Murtagh, a lawyer and a researcher at Harvard's School of Public Health.

More: http://www.newsnet5.com/dpp/news/health/jama-report-parents-should-lose-custody-of-super-obese-kids

[MissB]

1. Why not intervention without removal?

[mzteris]

2. bullshit

Unless there is a clear-cut case of neglect or abuse - sometimes no matter WTF you do, your child has weight issues due to genetics.

[hedgehog]

3. I want to see a demonstrated program that gets the weight off and

keeps it off, first.

[Taitertots]

9. Diet and exercise n/t

[eridani]

17. Here's a clue for you. Diet and exercise rarely result in weigh reductions larger than

--about 10% of body weight. Do the math! 300 lbs - 30 lbs is STILL FAT!

[snooper2]

24. Oh bullshit...

[eridani]

31. Evidence for that assertion? n/t

[Lance_Boyle]

26. cite?

Or are these numbers entirely rectally-derived?

[eridani]

30. Study sponsored by Weight Watchers

Look up stats on any program you like. Weight lost almosta always occurs, but is pretty modest.

http://www.healthyweightforum.org/eng/articles/weight_watchers_points/

A study published in the Journal of the American Medical Association (JAMA), funded by Weight Watchers, found people who followed the Weight watchers Points program for two years lost an average of six pounds. Diligent participants - who attended at least 78 percent of the weekly meetings - lost an average of 11 pounds after two years on the program.

[Taitertots]

37. What source do you have to support your 10% claim? n/t

[eridani]

39. Weight Watchers and many others

Look up stats on any program you like. Weight lost almosta always occurs, but is pretty modest.

http://www.healthyweightforum.org/eng/articles/weight_watchers_points

A study published in the Journal of the American Medical Association (JAMA), funded by Weight Watchers, found people who followed the Weight watchers Points program for two years lost an average of six pounds. Diligent participants - who attended at least 78 percent of the weekly meetings - lost an average of 11 pounds after two years on the program.

[Taitertots]

41. That study only followed people who used weight watchers

and makes no mention of anything related to your 10% body weight claims
and doesn't contain anything about exercise

[eridani]

52. Google ANY diet + exercise program and you get similar results

Why is it that no shill for the magic of exercise plus dieting can produce a study showing better results? Yes, you can lose weight. And yes, you will still be fat.

http://www.sciencedaily.com/releases/2011/04/110414141449.htm

The majority of women in the study who both improved their diet and exercised regularly shed an average of nearly 11 percent of their starting weight, which exceeded the study's goal of a 10 percent or more reduction in body weight.


No weight loss of more than 13 lbs in any of the studies reviewed at the following link.
http://www.unm.edu/~lkravitz/Article%20folder/exandwtloss.html

However, Ross and colleagues and Sopko and associates also show the efficacy and worth of exercise only programs for promoting weight loss (in overweight and obese populations). Also, from a health perspective it is quite meaningful to emphasize that aerobic exercise independently decreases the risk of CAD and related comobidites. For health benefits, Ross et al. (2000) confirm established recommendations of regular, moderate-intensity physical activity, such as brisk walking, for 30 to 60 minutes on most days of the week.

[nadinbrzezinski]

73. Except that doctors are now happy if people lose

10% of body mass and chiefly KEEP IT... this has become practice.

I know... I lost a tad more since mine was a side effect of a medication... but as my doctor points out, I am not the average patient.

[eridani]

76. Right. Now let's get back to the math

300 lbs - 30 lbs is STILL FAT. Why is striving for the statistical weight modal value even worth attention if we are concerned about health?

[Iris]

4. Given the percentage of obese Americans grows annually, who, exactly, would be foster parenting

these children?

[Demeter]

5. This is why Doctors Should stick to Medicine

and get lawyers and insurance companies out of their offices....there's too many people thinking they know everything, due to their income levels, and exceeding their expertise in their arrogance.

[Mimosa]

57. AMEN.

My best bud is a family practice MD. Way before obsity became an 'issue' he had a big chip anti-fat on his shoulder. He despises fat people beyond reason.

[w8liftinglady]

6. I firmly believe they are blaming the wrong people...

something has changed over the last 30-40 years....I can't for the life of me believe that this many abusive,negligent parents exist.
My mom certainly wasn't.She did her best to feed me well.
I am a firm believer in additives placed in foods kids commonly eat these days...even things as seemingly harmless as cereal,contribute to this metabolic catastrophe.
It's also why we are seeing girls reach puberty at earlier and earlier ages.

but,let's not hold the multi-billion dollar cause responsible.
let's hold a well-meaning parent,doing whatever they are capable of doing with what little they have.

That'll teach them.

[nadinbrzezinski]

7. My brother is a GI specialists

and he agrees with you... Corn Syrup and all those lovely pesticides that work like hormones

There is more, he is a specialist in Chrons... like number three in the country. When he trained back in the pleistocene... Chrons, CELIACS? What are those? Again, he thinks these two (as well as a few others) are related.

By the way, so do I.

There are a FEW... perhaps in one hand, parents who use food to abuse kids and get into dependent relationships, but isn't that the case for everything else?

[REP]

35. Crohn's

Not Chrons. It IS chronic (well, relapsing/remittent to be really pedantic), but it's Crohn's disease. Celiac spue, while an inflammatory bowel disease like Crohn's, has such a different etiology though they can present with nearly identical symptoms - anecdotally, god knows how many times Celiac is still a suggested dx for me, when I a) have confirmed Crohn's and b) am biopsy-negative for celiac disease - but celiac symptoms can be stopped with a simple elimination diet; Crohn's symptoms persist even after eliminating all food!

[KittyWampus]

8. So many culprits- chemicals in environs, additives in food, little sunlight or exercise.

Break down of family and community support systems contributing to stress and depression.

Over-reliance on carbs, sugar, food w/ little prana left in it.

[eridani]

18. You're only talking about garden variety obesity here

What's the difference between fat kids and superfat kids?

[snooper2]

25. Escalators, driving the car quarter mile to 7-11 for a slurpee

sitting around playing video games,

Stupid fucking assholes taking away playground equipment because somebody might get "hurt"

Can't do things like "dodgeball", might get hurt or hurt someones feelings...

Sitting around posting on the Intertubes all day..

Paying people to cut your grass

To lazy to cook dinner so eat fast food, or pre-made dinners.. (Oh, and don't give me that bullshit that it costs more to eat healthy. it doesn't...) I can get a bag of potatoes and whip them up, but most people are lazy so they get pre-packaged "fries/tots". But it's so easy, I just pop them in the oven :eyes:

Too lazy to do some situps every morning...

[w8liftinglady]

38. I invite you to show me anywhere within walking distance of Dallas Housing authority.

where a family can buy healthy food.

Thank you for justifying the right-wing meme that cuts spending on nutritional support for children and families...kind of like the "ghetto queen" meme.
I work in Dallas as a nurse.My partner is a teacher in the DISD. I see what these kids endure on a daily basis.Thanks for laying more crap on their parents working 2 minimum wage jobs while they babysit their younger siblings.

[eridani]

56. This is the American norm. So why aren't 70% ot the population super-fat?

Meaning 400+ lbs for average height.

[anneboleyn]

70. Exactly. This bias against the obese (that they are lazy and stupid) is medieval, literally.

I know this from studying early conceptions of the obese in Western culture (after the arrival of Christianity). The perceptions of the obese persist, despite the obvious problem that many obese people do not stuff their faces with nearly enough food to weigh 350 or 400 pounds. There are clearly complex genetic factors at work. But it's easier to condemn and judge rather than accept this as a complex medical problem.

[Manifestor_of_Light]

69. autoimmune and metabolic problems.

HFCS as nadin keeps pointing out, which is like sugar on crack.

Diabetes, hypothyroidism, adrenal exhaustion, other such autoimmune diseases.

More people have thyroid problems than have diabetes, yet you see NO national organization raising awareness of hypothyroidism and Hashimoto's disease (an autoimmune disease my mother had and I have that kills your thyroid in pre-adolescense).

Doctors don'twant to test thyroids, don't want to give patients thyroid hormone because they think it's dangerous (wrong) and think all fat middle aged grumpy infertile women need anti-depressants. Thyroid supplementation could fix all these problems.

I didn;t get fat until I was middle aged and it just came on gradually. This was after being nagged all my life to eat more by my screaming grandmother until I went nuts. I was a bad kid because I only ate what I could tolerate, only ate when I was hungry and stopped when I was full. So that was bad.

I don't have anorexia nor am I a compulsive over eater. As I said, I only eat when I'm hungry,not when I am bored.

[Name removed]

10. Deleted message

Sub-thread removed by moderator. Click here to review the message board rules.

[Marblehead]

11. The food we eat is killing us

or some of it is and throw in some BPA and a dash of HFC and voila, a 300 lb kid

[eridani]

33. It's killing even those who don't gain as much weight

Weight is irrelevant to the harm caused by poor diet.

[Horse with no Name]

12. How about we make fresh fruit and vegetables (that we subsidize anyway) cheaper

than high carb cheap filler food that most people have to use to fill the gaps on groceries?

[eridani]

13. And just WTF do they plan to do with Prader-Willi kids?

http://www.pwsausa.org/faq.htm

Q: What is Prader-Willi syndrome (PWS)?
A: PWS is a complex genetic disorder that typically causes low muscle tone, short stature, incomplete sexual development, cognitive disabilities, problem behaviors, and a chronic feeling of hunger that can lead to excessive eating and life-threatening obesity.

Q: Is PWS inherited?
A: Most cases of PWS are attributed to a spontaneous genetic error that occurs at or near the time of conception for unknown reasons. In a very small percentage of cases (2 percent or less), a genetic mutation that does not affect the parent is passed on to the child, and in these families more than one child may be affected. A PWS-like disorder can also be acquired after birth if the hypothalamic portion of the brain is damaged through injury or surgery. All families with a child diagnosed with PWS should see a geneticist for genetic counseling in order to fully understand their chances of having another child with PWS.

Q: How common is PWS?
A: It is estimated that one in 12,000 to 15,000 people has PWS. Although considered a "rare" disorder, Prader-Willi syndrome is one of the most common conditions seen in genetics clinics and is the most common genetic cause of obesity that has been identified. PWS is found in people of both sexes and all races.

[eridani]

34. [crickets] n/t

[xmas74]

36. I've worked with Prader-Willi.

It's pretty rare but they are out there. I worked in a state hospital and we had one family with three children all with Prader-Willi.

[eridani]

40. Rare only in the genreal population. Pretty common among the super-fat n/t

[xmas74]

49. I don't know about that.

We had morbidly obese on grounds yet there were few that had Prader-Willi. There's more to P-W than just the eating-lots more. P-W can be disturbing to work with at times.

There are many reasons for obesity and not all of them are from laziness/poor diet. There's always genetics (besides P-W), diseases and disorders, medications, environmental issues, etc. Prader-Willi is so much more involved than any of that. Most of the morbidly obese I know wouldn't dig in a trash can for a used med cup to lick. P-W patients have done so, among many other things.

[eridani]

58. It pretty much has to be genetics, Prader-Willi and other things

If it is inevitable that people with crappy diets and no physical activity eventually weigh 400+ lbs, 70% of the population would weigh that much. Why don't they?

[xmas74]

64. You tell me.

From what I've been told there usually isn't just one factor. It's multiple factors.

My argument is that P-W isn't all that common and that it's definitely not common even in the morbidly obese. There are many other things that it could be besides P-W. What I'd hate to see is people latch on to something and use it improperly. Prader-Willi isn't common, even among the morbidly obese. It's something far worse.
I've seen Prader-Willi and I know what it does. If it were so common it would have been a recurring diagnosis among the obese on grounds. It wasn't, not by a long shot.

There's a reason for the increase in weight gain in our society. I'd look at the other possible causes first instead of blaming it mostly on genetics. The majority of Prader-Willi also have an additional diagnosis of some form of mental handicap. They also tend to be very short in stature (the patients I worked with were both well under five foot), and have a "stubbier" appearance. Their facial features also have a different appearance than the average person. (Don't ask me to explain it-I can just picture their faces in my mind and it's not the same.)

[eridani]

65. Again, if the difference is lifestyle, 70% of Americans would be super fat

Why isn't that the case?

[xmas74]

67. Yet you keep blaming Prader-Willi.

Sorry, Prader-Willi isn't it.

Ever been around someone with P-W? You'd know the difference immediately.

Look further down the page you've given

"Q: What does the future hold for people with PWS?

A: With help, people with PWS can expect to accomplish many of the things their "normal" peers do—complete school, achieve in their outside areas of interest, be successfully employed, even move away from their family home. They do, however, need a significant amount of support from their families and from school, work, and residential service providers to both achieve these goals and avoid obesity and the serious health consequences that accompany it. Even those with IQs in the normal range need lifelong diet supervision and protection from food availability. "

Most with Prader-Willi have low IQ. As I stated before, it's usually associated with the disorder.

Prader-Willi is in a whole new ballpark. It's nothing like the average overweight person in the crowd.

This link has more info about Prader-Willi, along with a few pictures of young children with it.

http://atlasgeneticsoncology.org/Kprones/PraderWilliID10114.html

Look at the face shape. You know the average obese child doesn't have this disorder.

[eridani]

68. I'm blaming genetics. That is the reason why the near universality of crappy diets +

--inactivity in this country does not result in most people weighing 400 lbs. Also, the OP seemed to think that just putting Prader-Willi kids in foster care was a great idea. Do you agres.

[xmas74]

74. Prader-Willi kids might already be in foster care.

It's extremely difficult to take care of a P-W child in a regular home. They need 24 hour supervision due to the nature of the disorder. (Stealing food is very common so most households have to lock up all food. Pica, the ingestion of inedible objects, is also common with P-W. SIB (self injurious behavior) is also common.) Most households find that, unless the symptoms of P-W are mild, they cannot take care of them at home. It's not uncommon to see a child with this disorder handed over voluntarily by parents to the state and placed in a 24 hour group home. In other words, P-W is already in foster care.

Maybe the crappy diets and inactivity in this country does not result in most people weighing 400 lbs, but it might result in them weighing 20% or more over their projected healthy weight. Take an individual who is already predisposed to heaviness and give them a crappy diet then eliminate their exercise. What would happen? They'd gain even more weight.

Oh, and as to Prader-Willi: they will always be heavier than projected healthy weights but if they are under constant supervision they do not reach 400+ pound ranges. The right diet and good exercise does quite a bit to keep their weight down and keep them healthier.

[eridani]

75. Yes, people inclined to be heavy would gain more weight, but this still

--doesn't necessarily result in becoming super fat. People with BMIs above 35 will never be normal weight, except for the 1% or so who are willing to make that the main purpose of their lives for the rest of their lives.

[flvegan]

14. Are these "medical journals" and their resident "experts"

training parents in nutrition?

I'm betting...no.

[JonTheGreat]

15. Stupid. Why not address the issures making kids fat? Protip: It's not always the parents fault.

For example the fact bad food is insanly cheaper then good food in most places so poor families have no real choice.

[eridani]

16. Sol, what's the difference between kids that are superfat--

--and those who are just fat?

[Iris]

20. If that's not common knowledge, then extreme measures like breaking apart families should not be the

first solution.

[Liquorice]

19. I agree with that. Any parent who would let a normal child become

"super" obese is definitely not a competent parent. There is almost certainly mental illness of the parent(s) in a situation where the child is morbidly obese. I base my viewpoint on direct personal observation.

Normal healthy children from normal healthy families do NOT become obese.

[Iris]

21. Have you been studying this for a while?Can you point to some links to reasearch that backs this up?

[Liquorice]

46. Studying? I saw it happen! And the mother was mentally ill.

**editing to add that it's obvious neglect when a parent allows a child to become severely obese. Parents are responsible for feeding their kids nutritious food, and they are also clearly responsible if their otherwise healthy 10 year old is 250 lbs. You don't need a link to figure that out.

In the situation I saw, the mother was told repeatedly to put the child on a diet, and she lied to the doctors and said the kid was on a diet, but was "sneaking" food. The doctors kept lecturing the poor kid. However, her home was actually filled with snack cakes, cookies, potato chips, etc., everywhere, and no healthy food in sight. She was feeding the kid cookies for breakfast. She was crippling her child with severe obesity and the kid should have been removed from the home.

[eridani]

54. Why is it that fewer than 1% of kids whose mothers feed them crap--

--end up as super fat? Shitty diets are the American norm. If that is the case, the super fat ought to be 70% of the population. Why isn't that the case?

[Liquorice]

59. If you feed all of your kids crap, and only one of them gets super obese, you

are still responsible for your obese child. People have different propensities, but that doesn't negate the responsibility of the parent. And no healthy child becomes 450 lbs without major parental incompetency/abuse/neglect.

[eridani]

60. I think it does. If you feed them all well and lead them in reqular exercise--

--the fat one is still going to be far heavier than average.

[Liquorice]

62. Yeah, but heavier than average is not 450 lbs. nt

[eridani]

71. No, more like 350 lbs, which is may be different in effects on health, but which

--is not the slightest bit more protection against bullying and general social contempt.

[eridani]

29. What's genetically normal?

If genetics makes no difference, then every single person who ate exactly 2500 calories a day and was on the same exercise program would have exactly the same BMI. why do you think they don't?

[Liquorice]

47. There's a difference between a kid being a little overweight and being

"super" obese, the latter being what the JAMA report is talking about. A super obese kid, like the 440-pound 16-year-old girl they write about in the report, does not happen from a little overeating and no amount of genetics makes an otherwise healthy teenager 440 lbs. That is a case of severe neglect on the part of the parents, and the child should be removed from the home in those extreme cases.

[eridani]

50. 100% crap. Please google" Prader-Willi syndrome" n/t

[Liquorice]

51. Reading comprehension! I wrote an otherwise healthy teenager, not a teenager

with a serious medical condition. Reading skills can go a long way in situations like these.

[eridani]

53. Prader/Willi kids, while a small percentage of the general population, are--

--quite a large percent of super-fat kids.

[Liquorice]

61. Ok, but that has nothing to do with otherwise healthy children who are severely obese which

was what my comment was solely about.

[eridani]

66. There is no evidence that severely obese people are "otherwise healthy" n/t

[nadinbrzezinski]

72. There are several metabolic diseases

that will also lead to super obese kids.

Also England tried this little thing with a kid... the kid GAINED weight under State Custody... leading to them finally testing the kid for all kinds of things.

Yes, kids are fed crap, yes some parents are bad... I am willing to bet that most superobese kids are not normal... whether it was diagnosed already or not

[Name removed]

55. Deleted message

Message removed by moderator. Click here to review the message board rules.

[Liquorice]

63. Yeah, I just saw it happen, so of course I'm completely

clueless. You're right, I am shamelessly against neglectful parents who let healthy children become morbidly obese and suffer with type 2 diabetes and heart disease before they are even out of elementary school. I'm crazy like that. After all, parents shouldn't be responsible for their own kids' nutritional needs and caloric requirements! Shame on me indeed!

[Lone_Star_Dem]

22. If a parent were underfeeding a child would that child be taken away?

How malnourished would a child have to be before the state would intervene?

It's the responsibility of child services to make sure children are taken care of in a way which is healthy to them. This includes dietary education for families when they're not providing it on their own. Or so I believe.

[Dappleganger]

43. An excellent question.

[Liquorice]

48. Exactly. nt

[MicaelS]

23. What next..removing kids from the homes of parents who smoke?

Removing kids from the homes of parents who dip tobacco or use cannabis? Removing kids from the parents who own guns? Who have ATVs or motorcycles? Drowning kills more kids than anything so I guess all the kids who live in homes who have swimming pools will be removed.

Just how fucking far is the medical community going to try to force their way into people's lives?

[eridani]

32. Kids are already removed if their parents don't have much money.

There was a well publicized case in my community about 15 years ago. A man was convicted of murdering his wife, and custody of the two kids was contested between the maternal grandmother and the dead woman's sister versus the paternal grandparents. Mom and sis lived in public housing and were low income. They argued that they were the best choice because no one in their family was a convicted murderer. The affluent paternal grandparents asserted that they could provide more material advantages. Custody went to them.

[Dappleganger]

44. This, too.

[AngryAmish]

27. THis is a necessity

PArents who mistreat their children should be punished by taking away their children. And, remember, being a Republikan near children is a form of child abuse.

[Scout]

28. leave the fat kids alone; take the BULLIES away from their parents! n/t

[Dappleganger]

42. I'm not really comfortable with JAMA declaring if parents should lose custody

of their children. That's a moral decision and not a scientific one.

Also, what happens if the child put into foster care does not lose weight, will they then be returned to their natural parent(s)? Will that child blame himself/herself for the split of the family, because after all it wouldn't have occurred had the child not been overweight (and I'm not blaming the child at all, only speculating how a child may think--they blame themselves and think in concrete ways).

Also, that opinion is based on the assumption that a foster situation is better than a family with obese children. Who is to say that is actually healthier?

*Former guardian ad litem here, just thinking aloud.

[ecstatic]

45. Right. Because their lives would be so much better in the foster care system

:eyes: :eyes: :eyes:

Why not? I'm sure there's a long line of parents waiting to adopt "super obese kids!"