Severe childhood obesity and its associated comorbidities are increasing in prevalence.

Extreme childhood obesity may be viewed as a mirror image of severe non-organic failure to thrive. Parental neglect may be a causative factor in both circumstances.

When suspicion of parental neglect arises, health care professionals may have both an ethical obligation and a statutory duty to notify child protection services.

Guidelines on the point at which medical practitioners should seek state assistance in cases of severe childhood obesity would be helpful, not only for medical practitioners, but also for child protection services.