Date Published: 1 February 2009

Childhood obesity and abuse

When does severe childhood obesity become a child protection issue? This is just one of the ethical, medical and legal questions confronting doctors as they deal with increasing rates of childhood obesity, according to a series of articles in the latest Medical Journal of Australia.

Dr Shirley Alexander from Westmead Children’s Hospital and her colleagues say severe childhood obesity is a common problem that can result in acute and chronic life-threatening complications. Their article examines the case of a severely obese child whose parents were unwilling or unable to adhere to management programs aimed at helping her lose weight.

“We argue that in a sufficiently extreme case, notification of child protection services may be an appropriate professional response,” the report says.

According to the report, parental neglect can be a causative factor in ongoing obesity and related medical problems including sleep apnoea.

The case described in the article, an amalgamation of real issues from a number of actual cases, described a four-year-old girl who was 110cm tall and weighed in at a hefty 40kg. The child watched TV for six hours a day and had temper tantrums when denied food. A family-focused multidisciplinary approach failed to stop or reverse the child’s weight gain. Child protection authorities were finally notified when the child’s health continued to deteriorate. She was introduced to a program of physical activity and reduced dietary intake that soon had her losing weight.

The report concludes that a doctor is duty bound to report severe cases of inadequately managed paediatric obesity to the authorities.

A related article by Joanne Stubbs and Helen Achat says that collecting accurate data is essential in the fight against obesity. The article says monitoring and reporting on childhood obesity provide information on which to base, and subsequently evaluate, our efforts and are dependent on ‘opt out’ consent to minimise problems of inadequate participation.

“Ongoing population-based anthropometric measurement is fundamental to such efforts (early intervention in weight problems). We argue this is only possible with ‘opt out’ consent.”

‘Opt out’ consent facilitates the recruitment of a representative sample of the population for valid and meaningful anthropometric information and, at the same time, leaves the individual with the right to decline participation. The article calls on ethics committees to support endeavours to confront the challenges of childhood obesity by allowing opt-out consent for anthropometric measurement studies.

The final article in the series written by nutritionalist Dr Tim Gill and a diverse group of experts in paediatrics, public health, nutrition and endocrinology from the University of Sydney, refutes recent commentary downplaying the prevalence of childhood obesity saying it remains a widespread health concern that warrants population-wide prevention programs.

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