Public Health Ethics: Case 4
Childhood Obesity and Parental Responsibility
(From BH509: When Life Makes You Sick: Ethics and the Social Determinants of Health, Erika Blacksher, instructor)
Joe lives with his mother and aunt and her two children, both under age 6, in a small duplex south of Seattle. Average height for his age, Joe is 9 years old and weighs 184 pounds. His two cousins are not obese, but they are overweight. The mothers of the family work a number of jobs to make ends meet. They do not have much money for material things or extra curricular activities, and increasing gang activity in the area has made them reluctant to let the children play on their own in the nearby park and soccer field. What the family does not do in the way of ‘fun’, they make up for with food. The school nurse has brought Joe’s obesity to his mother’s attention twice, each time suggesting several approaches to helping him lose weight. They include buying healthier foods and healthier cooking. Joe’s mom has been slow to take up these practices because the foods are more expensive than what she usually buys, the recipes seem strange to her, and she suspects they will not taste very good to Joe or her niece and nephew, who she often also cooks for. At a recent pediatric check up Joe’s physician cautions the mother that she really needs to get Joe’s weight under control. He is developing elevated blood sugar and has experienced difficulty breathing in his sleep. If she does not take action, he says he might be obligated to alert child protective services.
As childhood obesity has become an epidemic problem in the United States, such cases increasingly are being reported. The rate of childhood obesity has more than tripled in the last three decades with serious short- and long-term health consequences. Obese children are significantly more likely to experience a wide range of poor health outcomes, including type II diabetes, cardiovascular conditions, asthma, sleep disordered breathing, anomalies in foot structure, low self-esteem, depression, and high-risk behaviors. Studies suggest that as many as half of all obese children remain obese as adults, leading to further health risks-elevated risk of heart disease, stroke, diabetes, osteoporosis, lower-body disability, some types of cancer, and premature mortality in general.
Public health leaders emphasize structural and environmental interventions to remedy the U.S. obesity epidemic, but even they acknowledge the role parents play in contributing to children’s healthfulness, including normal weight (Frieden et al. 2010). Increasingly, state intervention in severe cases of childhood obesity is being called for under certain circumstances (Murtagh, Ludwig 2011).
Are clinicians obligated to report parents of obese children to child protective services?
Although parents have significant discretion to rear their children according to their own values and practices, society may justifiably intervene when it deems parental behaviors expose their children to serious harm. This “harm principle,” discussed above, is often appealed to as the basis for intervention (Murtagh, Ludwig2011). There have been legal cases in which a child has been removed from the home in cases where parental practices are judged to have contributed severe morbid obesity, in states that include California, Indiana, Iowa, New Mexico, and New York. Similar cases have also been reported in the United Kingdom. Commentators on the subject, however, urge caution, as removing a child from the home can seriously harm a child in other ways (Black et al. 2011). Commentators encourage using intermediate options, such as in home support services, parent training, and financial assistance, and seeking a second medical opinion before any action is taken.