Letters
Metabolic diseases Child health
Volume 190 - Issue 11

When does severe childhood obesity become a child protection issue?

Authors:  Matthew A Sabin, Zoe McCallum, Kay Gibbons, George A Werther and Joseph Proietto

Med J Aust 2009; 190 (11): 653-655. || doi: 10.5694/j.1326-5377.2009.tb02609.x
Published online: 1 June 2009
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To the Editor: We read with interest the article by Alexander and colleagues on child protection issues in severe childhood obesity.1

With one quarter of Australian youth either overweight or obese, individual families (or the health care system) will not benefit from widespread involvement of child protection services in obesity. The authors are clear on this, and describe their case as “sufficiently extreme”. The difficulty lies in defining what is “extreme” and, as health professionals, we have a duty to the community to emphasise that these kinds of cases rarely occur. The illustrative case in the article by Alexander and colleagues required an amalgamation of details from several patients (for confidentiality purposes), and we believe it would be very unusual for a 40 kg 4-year-old girl to exhibit the degree of obesity-related comorbidity described.2,3 Such a degree of “medical urgency” is usually absent when managing young obese children and, in our experience, is thankfully very extreme and markedly different from the more usual scenario of discussions around potential long-term health problems.

Also, there are currently no fail-safe mechanisms in place to be 100% certain that there is not an underlying genetic, hormonal or metabolic reason for continuing weight gain in a young child. With the childhood obesity pandemic, it is impossible to routinely investigate all obese youth and, even if it were, research teams are continually finding new causes for why some children continue to gain weight irrespective of lifestyle change. Indeed, the more severe the obesity, the more likely for there to be an organic cause.4 It is not in anyone’s interests for child protection services to be automatically involved because of standard recommendations when, at a later date, an underlying medical cause is discovered.

Alexander and colleagues should be congratulated on re-igniting a public discussion on this highly emotive and difficult area of health care. We agree that parenting styles may influence weight regulation in young children5 but, for the above reasons, we would urge extreme caution when considering that parents may be “neglectful”. Within our obesogenic environment, perhaps (deliberate or intentional) non-compliance is an indication that society is neglecting parents, rather than that parents are medically neglecting their children?

We are concerned that the development of child protection guidelines will alienate parents and families, leading to a decline in the uptake of programs aimed at preventing and/or treating overweight and obesity. We would recommend that each case be taken on its individual merit and that primum non nocere is as important as Aristotle’s phrase of “practical wisdom”.

Authors

  • Matthew A Sabin1,2
  • Zoe McCallum1,2
  • Kay Gibbons1
  • George A Werther1,2
  • Joseph Proietto2,3
  • 1. Royal Children’s Hospital, Melbourne, VIC.
  • 2. University of Melbourne, VIC.
  • 3. Weight Control Clinic, Austin Health, Melbourne, VIC.

Correspondence: matt.sabin@rch.org.au

References

View this article on Wiley Online Library