This has happened a few times in the United States, and the opinion piece published Wednesday in the Journal of the American Medical Association indicates that the temporary placement of children in foster care is in some cases more ethical than obesity surgery.

Dr David Ludwig, an obesity specialist at Harvard-affiliated Children’s Hospital Boston, said it’s not about blaming parents, but rather acting in the best interests of children and getting them to help. for some reason their parents can’t provide.

State intervention “will ideally support not only the child but the whole family, with the aim of reuniting the child and the family as soon as possible. It may require parenting instructions, ”said Ludwig, who wrote the article with Lindsey Murtagh, attorney and attorney. researcher at Harvard School of Public Health.

“Despite the discomfort posed by state intervention, it may sometimes be necessary to protect a child,” Murtagh said.

But University of Pennsylvania bioethicist Art Caplan said he feared the debate was blaming parents too much. Obese children fall victim to advertising, marketing, peer pressure and bullying – things a parent cannot control, he said.

“If you want to change a child’s weight, you’ll have to change them all,” Caplan said.

About 2 million American children are extremely obese. Most are not in imminent danger, Ludwig said. But some have obesity-related issues such as type 2 diabetes, difficulty breathing, and liver problems that could kill them before they are 30. , should be taken into consideration, said Ludwig.

While some doctors are promoting weight loss surgery for severely obese teens, Ludwig said it hasn’t been used for a very long time in teens and can lead to serious and sometimes fatal complications.

“We don’t know the long-term safety and effectiveness of these procedures performed at an early age,” he said.

Ludwig said he began to think about the matter after a 90-pound 3-year-old girl came to his obesity clinic several years ago. Her parents had physical disabilities, little money, and difficulty controlling her weight. Last year, at the age of 12, she weighed 400 pounds and developed diabetes, cholesterol problems, high blood pressure and sleep apnea.

“For medical reasons, the state placed this girl in foster care, where she was simply given three balanced meals a day and a snack or two and moderate physical activity,” he said. After a year, she lost 130 pounds. Although she is still obese, her diabetes and apnea have disappeared; she is staying with a foster family, he said.

In a comment published last year in the medical journal BMJ, London pediatrician Dr Russell Viner and colleagues said obesity was a factor in several child protection cases in Britain. They argued that child protection services should be considered if parents are negligent or actively reject efforts to control the weight of an extremely obese child.

A 2009 opinion piece in Pediatrics made similar arguments. Its authors stated that the temporary removal from the home would be justified “when all reasonable alternative options have been exhausted”.

This article was about a 440-pound 16-year-old girl who developed breathing problems from being overweight and nearly died in a University of Wisconsin hospital. Doctors have discussed whether to report her family for negligence. But they didn’t need it, as her medical crisis “was a wake-up call” to her family, and the girl ended up losing around 100 pounds, co-author Dr Norman Fost said. medical ethicist at Madison University. Campus.

State intervention in obesity “does not necessarily imply new legal requirements,” Ludwig said. Health care providers are required to report children who are at immediate risk, and this can be due to a variety of reasons, including neglect, abuse and what doctors call “stunting”. This is when children are severely underweight.

Jerri Gray, a single mother from Greenville, SC, who lost custody of her 14-year-old 555-pound son two years ago, said authorities did not understand the challenges families may face in trying to control the weight of their children.

“I’ve always had two jobs so we didn’t end up living in ghettos,” Gray said. She said she often didn’t have time to cook, so she would buy fast food for her son. She said she asked doctors for help with her son’s big appetite, but was charged with negligence.

His sister has custody of the boy, now 16. The sister has the money to help him diet and exercise, and the boy has lost over 200 pounds, Gray said.

“Even though it turned out to be some good in terms of his weight loss, he said to me last week, ‘Mom, I want to be back with you so badly.’ They did havoc by separating us, ”Gray said.

Stormy Bradley, an Atlanta mother whose overweight 14-year-old daughter participates in a Georgia advocacy group’s “Stop Childhood Obesity” campaign, said she sympathized with families facing lawsuits due to the weight of their children.

Healthier food often costs more, and trying to monitor children’s weight can be difficult, especially as they reach their teens and avoid parental controls, Bradley said. But keeping young people away from their parents “definitely seems too extreme,” she said.

Dr. Lainie Ross, medical ethicist at the University of Chicago, said: “There is a stigma with state intervention. We just need to do it with caution and humility and make sure that we can truly say that our interventions are going to do more good. that bad. “