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Foster care for obese children? Not a good idea

By Nazrat Mirza and Evan Nadler, Special to CNN
Obesity not only causes illnesses that can shorten lives, but it also has crippling psychosocial effects due to its visibility.
Obesity not only causes illnesses that can shorten lives, but it also has crippling psychosocial effects due to its visibility.
  • Obesity is dangerous and psychosocially crippling, say Nazrat Mirza and Evan Nadler
  • But separating extremely obese children from their families would be a mistake, they say
  • Weight loss is difficult but more likely when the entire family participates, they say
  • Mirza and Nadler: A second generation of obese individuals in the U.S. is beginning to appear

Editor's note: Dr. Nazrat Mirza is the medical director of the IDEAL Clinic, and Dr. Evan Nadler is the co-director of the Obesity Institute, both at Children's National Medical Center in Washington.

(CNN) -- We know smoking is bad, yet it seems far-fetched to suggest that parents who smoke should have their children put in foster care, doesn't it? Could you imagine if someone suggested that asthmatics who didn't take the appropriate medication be removed from their parents' home?

In last week's Journal of the American Medical Association, two writers suggested that in some cases extremely obese children should be placed in foster care. While there are certain instances where this should be considered -- when the parents consent to it and the environment at home is irreparable -- that separating children from their families would even be an option for discussion underscores the stigma associated with this devastating disease.

Obesity not only causes illnesses that eventually shorten a patient's life, but it has crippling psychosocial effects because of its visibility. We see this stigma with our patients and families every day.

As the JAMA authors suggest, childhood obesity is an incredibly complex problem. When seeking solutions, we have to look at multiple sources -- and we can't place the blame on one group or person.

The emotional and psychological harm that would come with forcibly removing a child from home may be severe and long-lasting and could result in other eating disorders later in life. We recommend a more inclusive approach that engages the entire family and helps them make healthy choices.

In our clinic at Children's National Medical Center, we treat the sickest of the sick. The clinic is limited to children who have a body mass index above the 99th percentile for their age and have an illness directly related to their weight. With the help of child psychologists and health educators, we've learned that building trust by avoiding blame is the key to success.

When patients and even parents feel threatened or unsure, they can close down, which is counterproductive to making any positive changes. Weight loss is difficult, but we have found more success when the entire family participates.

Setting goals -- small and incremental ones -- makes positive changes in building a healthy lifestyle more likely to occur. Switching from soda to water is one example in making a simple but significant change in calorie intake.

Further, we think resources would be better spent on efforts that could benefit entire communities. In Somerville, Massachusetts, in 2002, a community came together -- public health leaders, politicians, schools and families -- in a three-year program that had a positive impact. More people were riding bikes, and children gained less weight.

We are working toward the same goals through the DC Promise Neighborhood Initiative. From a public policy perspective, we have identified three areas where action would be effective:

Education. In many families, overindulging in food is a way to show love and affection. In some cultures, big children are admired. We need to change this paradigm through education and by building community awareness, especially now that a second generation of obese individuals in the United States is beginning to appear.

Developing practical tools that help change attitudes and behavior will help. The National Heart, Lung and Blood Institute's We Can! curriculum is one online resource available to community groups to help educate their families.

Medical procedures. Early results from across the country demonstrate that surgical procedures such as laparoscopic adjustable gastric banding and laparoscopic sleeve gastrectomy are safe and effective. Furthermore, long-term data from overseas shows positive results for laparoscopic adjustable gastric banding, although the Food and Drug Administration has yet to approve this option for children under 18 in the U.S.

Enhancing access to such surgical options after educating patients and their families seems a far more responsible and cost-effective approach than forcible removal of children from their homes. In our practice, we have had great success managing morbidly obese children by pairing inpatient weight-loss programs with surgery, while empowering and involving parents in the decision-making process the entire way.

Social policy. Taxation and regulation have been shown to be effective in changing incentives and opportunities for healthy living. Replacing sugar-sweetened beverages in vending machines in schools and improving access and affordability of fresh, healthy foods and safe play areas are good places to start.

Equally important are universal health coverage for all children and access to primary health care and community-based family activity and nutrition programs.

Engaging entire families, and working with parents instead of against them, are productive routes to reversing the obesity epidemic.

The opinions expressed in this commentary are solely those of Nazrat Mirza and Evan Nadler.