Parents who fail to help an obese child eat and exercise properly, ignoring all advice and guidance, could be guilty of neglect, child health experts say today.
Dr Russell Viner and colleagues from the UCL Institute of Child Health in London say that the weight of a child by itself is not a reason for child protection staff to get involved.
But in an article on what they accept is a potentially contentious issue, published online today by the British Medical Journal, they suggest that it may be appropriate to consider the child protection register if the parents consistently fail to change the family's lifestyle and will not engage with outside help.
"Parental failure to provide their children with adequate treatment for a chronic illness (asthma, diabetes, epilepsy, etc) is a well accepted reason for a child protection registration for neglect," they write.
"We suggest that childhood obesity becomes a child protection concern when parents behave in a way that actively promotes treatment failure in a child who is at serious risk from obesity and when the parents or carers understand what is required, and are helped to engage with the treatment programme."
That might involve failing to keep appointments or get involved with healthcare staff or other professionals who want to help the child, they say, or "actively subverting weight management initiatives".
Viner said it was difficult to establish when obesity shaded into neglect and became an issue for child protection, because the pressure on everyone to eat too much and exercise too little were so powerful. These factors were so strong that "for some parents, it is very difficult to stop their child gaining weight".
He also pointed to the strong associations between food, feeding, caring and love. "And eating is a pleasure and you want to give your children pleasure."
Viner and his colleagues set out to review the evidence for any link between childhood obesity and neglect because there are no official guidelines for professionals. They discovered 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.
"Removing children from their parents may not help obesity. There are few data on the weight of children in public care," they say. A recent study found that 37% of children in care were overweight or obese – but almost all of them had put on weight after they were put into care.
Viner and his colleagues say in their paper that there will be particular concerns if obesity is putting a child at risk of disease, such as raised blood pressure or diabetes. Before such a child was put on the register, however, there would have to be clear, objective evidence over a sustained period that the parents were not complying with a treatment plan based on good evidence, they say.
Usually, obesity will be only one of a number of factors causing concern, they say, along with poor school attendance, exposure to violence or involvement in it, neglect, poor hygiene, mental health problems of parents and emotional or behavioural difficulties. They say a multidisciplinary assessment will be needed – including psychological wellbeing – to decide whether intervention is needed, and what sort. They add, though, that "a high index of suspicion is needed for children who are extremely obese". Among obese adults who have surgery to reduce the size of their stomach, up to a third report they were subjected to sexual abuse in childhood and a third report other forms of abuse.
"As 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 write. Guidelines for professionals and more research are urgently needed, they say.
