It's no secret that childhood obesity is a problem in the US.  Over 2 million American kids are considered "super obese." As a dietitian I have seen and counseled several severely obese children and their parents.  Over the past 20 years, I've only had to call child protective services once. The child in question was super obese and showed signs of neglect. Taking a child from the family home is traumatic to all involved so careful consideration of the root cause of the obesity is paramount to making the best decision for the child and family.  A parent-ectomy, as we say, may not be the remedy to a complex issue like childhood obesity.

Obesity is multi-factorial and obese kids are likely to grow up to be obese adults with a multitude of health problems.  However, government intervention isn't always the answer. Each obese child got that way for a number of reasons so a one-size-fits-all response isn't the solution. Genetics, lifestyle and environmental factors vie for priority in the development of childhood obesity. The key is to identify which factors have most profoundly influenced the child's obesity and address them head-on.

According to the CDC, 25% of US kids are overweight and 11% are obese.  In children, overweight is defined as a body mass index (BMI) at or above the 85th percentile, with obesity defined as a BMI at or above the 95th percentile. Super obese is a BMI at or above the 99th percentile. Childhood obesity rates are not exclusive to the US, with levels skyrocketing in other developed countries.

Research has shown that lifestyle factors such as calorie-packed diets and lack of activity have played a significant role in the modern obesity epidemic.  However, genetics contribute, too.  Kids born to obese parents are more likely to become obese.  If both biological parents are overweight, the child has a 60-70% chance of becoming obese, whereas if neither parent is obese, the chance is 10%.  Maternal obesity is a predictor of childhood obesity. Mom's weight has an impact on the number and size of fat cells that junior develops.  Fat cells never go away, unless they are removed by liposuction. Fat cells grow in size and number during key phases of growth, too; if overfeeding occurs during these phases, more and larger fat cells are created.  Children who overeat and are sedentary are at greatest risk for a lifelong battle with weight.

Other factors like certain diseases can contribute to weight gain including polycystic ovary syndrome (PCOS), hypothyroidism and Cushing's syndrome.  Slow metabolic rates may trigger weight gain particularly in those ethic groups with a genetic predisposition. Besides lifestyle factors, emotional cues can ignite the desire to over consume. Stress eating, constantly using food as a reward, and using food to cope are just some behaviors that are part of the emotional eating spectrum.

Childhood obesity presents differently in each kid that has it. In the late 1990s when I worked in Las Vegas as a dietitian in private practice I had a consultations with several super obese kids, but 3 come to mind immediately.  One was a 8-year old girl, about 5 feet tall and weighing 150 pounds, another was a 3-year old boy weighing 100 pounds and the third was a 9 year-old girl, about 5 feet tall weighing around 160 pounds.  I called child protective services about the toddler but not the girls.  Why? The 9 year-old girl had signs and symptoms of polycystic ovary syndrome (PCOS) and her rapid weight gain was due to a medical condition.  Granted her dietary habits weren't great, but her condition was one that wouldn't be solved by behavioral change. She received treatment for PCOS and dropped some weight. The other girl, the 8 year-old, was another story.  Her parents both worked long hours.  When she came to our consultation she complained of chronic stomachaches that could only be suppressed by consumption of milk shakes....6 a day.  Her parents, exhausted from working, gave in to their daughter's demands for sugar.  In this case, we provided counseling for the parents and educated them about healthier, low cost food choices.  The first few months were difficult as the child rebelled, but eventually she dropped about 30 pounds in 6 months.

The 3 year-old was a heartbreaker.  He arrived at the clinic wearing adult diapers and seemed to be a typical curious toddler.   His separated parents were normal weight. Mom worked long hours, often leaving the little boy in the care of relatives or by himself. The child's diet was loaded with sugary, high fat foods and, according to the mom, he was sometimes left alone in the apartment with snacks available.  I had to call child protective services, not because he was overweight, but because leaving a toddler home alone isn't ok.  While in foster care, the child was placed on a reasonable meal plan and mom got help so she wouldn't have to leave him home alone.  After about a year, mom was reunited with a child that was in the 80th percentile for BMI. 

So when the debate rages "should super obese children be separated from their parents?" I suggest that each case is unique.  The clinician needs to address the root cause of the obesity and treat it.  Government intervention and interference should be a last resort but considered if the child is being harmed.  If the child is removed from the home, weight management should be provided beyond foster care.  Further, the parents need some counseling to address lifestyle factors that contribute to their child's obesity.

Children are unique in that adults have control, or at least influence, on the food environment.  Younger children typically don't purchase food, make household decisions regarding food choices or have free will when it comes to buying or preparing their meals.  Adolescents have some control, but ultimately the adults in their lives assist with food purchases and decisions.  Children can be influenced by marketing ploys but it is the adult with the purchasing power.  Re-educating the adult(s) about optimal food choices while keeping economic and time factors in mind would do wonders to help combat childhood obesity.  There are no simple solutions but government involvement alone is not the answer. Recognizing that childhood obesity is caused by many factors, including some that can be controlled is critical to prevention and treatment.

The number one anti childhood obesity tip: Turn off the TV. TV is sedentary and can trigger mindless shut it off and get moving!

About the Author

Martina M. Cartwright

Martina M. Cartwright, Ph.D., R.D., is an adjunct professor of Nutritional Sciences at the University of Arizona and an independent biomedical consultant.

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