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When does obesity become a child protection issue?

When does obesity become a child protection issue?

Childhood obesity alone is not a child protection concern, nor is failure to control weight. But consistent failure to change lifestyle and engage with outside support indicates neglect, particularly in younger children, say experts in a paper published on bmj.com today.

The suggestion that childhood obesity may raise child protection concerns is highly contentious, but there is little published evidence on the issue and no official guidelines for professionals.

So a group of child health experts, led by Dr Russell Viner at the UCL Institute of Child Health in London, set out to review existing evidence and propose a framework for practice.

They found increasing evidence linking adolescent and adult obesity with childhood sexual abuse, violence, and neglect, but found no studies examining the relation between child protection actions and childhood obesity. Data are also lacking on the long term outcomes of child protection strategies in relation to weight control, other metabolic disorders such as diabetes, and psychological health.

In the absence of evidence, the authors suggest that child protection actions are not warranted for childhood obesity alone or failure to control weight. "The aetiology of obesity is so complex that we believe it is untenable to institute child protection actions relating parental neglect to the cause of their child's obesity" or "to criticise parents for failing to treat it successfully, if they engage adequately with treatment," they write.

However, they do believe that consistent failure by parents to change lifestyle and engage with professionals or with weight management initiatives would constitute neglect. This is of particular concern if an obese child is at imminent risk of disorders like obstructive sleep apnoea, hypertension, type 2 diabetes or mobility restrictions, they say.

Where child protection concerns are raised, the authors suggest that obesity is likely to be one part of wider set of concerns about the child's welfare. It is therefore essential to evaluate other aspects of the child's health and wellbeing and determine if concerns are shared by other professionals, they say.

Finally, in cases of severe childhood obesity, they recommend a wider assessment of family and environmental factors.

"In all areas of child health, we have a duty to be open to the possibility of child neglect or abuse in any form," they conclude. "Guidelines for professionals are urgently needed, as is further research on the outcomes of child protection actions in obesity and links between early adversity and later obesity."

BMJ

Your comments (terms and conditions apply):

"I have lived in the UK for 8 years, married to a Brit and have a 4-year-old diabetic daughter. It is shameful that the UK does not have laws protecting and guaranteeing care for these vulnerable children. David Cameron, of all people, should be ashamed. In the US there is a law called IDEA (Individuals with Disabilities Education Act) that forbids any state institution, or institution receiving state funds from denying a child an equal education and states that it is the school's responsibility to administer insulin, do blood sugar tests, and protect these children (with adequate training provided from the state of course). We need to DEMAND this in this country!  No one is going to give this to us without a fight as it involves money everyone ... money they are all worried about spending and lip service is all we are getting.  We will continue to get lip service until we organize.  They debated this in parliament in 2009 and the bottom line was they did not want to come up with the funding to provide training for schools. We all need to organize. This is the only way. I've had to move my child's school as
they excluded her in a host of things. The current laws are rubbish and protect no one and require schools to do nothing" - Denise Hamilton, East Sussex

"There is some agreement amongst professionals and a growing body of evidence to support links between childhood weight issues and parenting skils and/or confidence, especially with regard to setting limits for appropriate behaviour. As with other child protection issues, obesity may be appropriately dealt with by providing support and/or skill development
opportunities to support behaviour change in the wider context, rather than specifically relating to weight loss or control. Programmes that include some psychological/behavioural aspect and demand participation from at least one parent/carer are increasingly demonstrating success in dealing with weight and other behaviour issues, including self-esteem. Programmes or advice that focus solely on weight and disregard wider familial issues are, unsurprisingly, rarely effective and can exacerbate already unfortunate and potentially dangerous situations" - Jo Smith, Wolverhampton

"I totally agree. I run a lifestyle advice clinic and I'm seeing patients under the age of 10 who are 70kg. In consultation I bring in advice and try and involve all the family. It is hard in the consultation not to accuse parents of bad lifestyle for the child. But hopefully the information and lifestyle changes will hopefully change the families life and review their diet and inactivity" - Name and address supplied

"As a 'long in the tooth HV' the report says nothing that has been already recognised. Childhood obesity is linked with poor parenting, social deprivation and other issues. Extra help to these families who are often difficult to engage with, is needed, however with the diminishing number of trained HVs it is an almost impossible task.I have done volunteer work in Africa where only 9hrs flight away the problems are often due to malnourisment and the breast feeding figures are almost 100%, the milk companies have not been able to make any impact due to the cost of their product" - Anne Evans, West Sussex

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