Obesity — not a child protection issue

The return to school after the summer holidays has already produced the first request from the child protection authorities for information about an overweight 15-year old boy, whose family is now threatened with statutory proceedings.

It is only a few weeks since David Rogers, public health spokesman for the Local Government Association, declared that ‘parents who allow their children to eat too much could be as guilty of neglect as those who did not feed their children at all’.1 The LGA's conviction that overweight children should become the subject of child protection procedures was reported under the headline ‘Fat children “should be taken from parents” to curb obesity epidemic’. It seems that the Fat police are already on the rampage.

I first encountered the facile presentation of obesity as a form of child abuse at a case conference about a teenage girl some years ago. Social workers accepted that her parents were devoted and there was no hint of neglect. Nevertheless, they cited a recent case in the US in which authorities had been blamed over the death of a morbidly obese young woman and insisted that drastic action had to be taken.

I pointed out the inappropriateness of the parallel between the situation of an under-nourished and neglected infant and an over-weight and pampered adolescent. In the former case, actual bodily harm is the direct result of parental abuse and is, at least in physical terms, readily susceptible to intervention. The dramatically improving growth chart of the ‘failing-to-thrive’ infant following admission to hospital can be found in every child health textbook. In the latter case, long-term risks to health are the result of a complex (and poorly understood) combination of factors, including the wider ‘obesogenic’ environment (of cheap, fast and fattening food, sedentary lifestyles and leisure activities) as well as the behaviour of both the young person and her parents.

A paediatrician told the case conference that there was only weak and contradictory evidence supporting the efficacy of any particular treatment for childhood obesity.2 She argued against the proposal for coercive action, putting the view, recently restated by the Royal College of Paediatricians, that obesity is ‘a public health problem, not a child protection issue’.3 I was concerned that imposing stigmatising statutory measures on the family would alienate them from both health and social services without providing any benefit for the child. However, it seemed that the anxieties of the child protection authorities to avert blame outweighed their concerns for the welfare of the child, who was duly placed on the ‘at risk’ register.

‘Did it do any good?’ I recently inquired of the subject of these proceedings. ‘No’ was her candid response. The only benefit of being on the register was that she was enrolled in an exercise course at the local swimming pool. But, as she recalled with some bitterness, this ceased on her 16th birthday when she was no longer the responsibility of the child protection authorities. However, since enrolling on a college course and joining a local gym, she had managed to lose several stones in weight.

Apart from being threatened with legal action, parents will shortly be receiving official warnings if their children are overweight and instructions from the government about healthy eating and physical activity (despite the abundant evidence that such exhortations are utterly useless). In their crusade against childhood obesity, public health zealots would do well to heed the wise words of paediatric experts in this field, who recently observed that ‘it is also important to remember that obesity remains extremely difficult for professionals to treat, thus criticising parents for what professionals are frequently unable to do smacks of hypocrisy.’4

• © British Journal of General Practice, 2008.