Now that the battle against the bulge in the U.S. has reached the grade school level, plenty of efforts have begun to fight childhood obesity and its dangers. They range from educational efforts, such as First Lady Michelle Obama's Let's Move! campaign, to new pediatric surgical programs nationwide. Now two researchers float a legal approach: make severe obesity a crime. 

Lindsey Murtagh of the Harvard School of Public Health and David S. Ludwig of the Children's Hospital in Boston present their case in the July 13 issue of JAMA, The Journal of the American Medical Association. Their commentary, "State Intervention in Life-Threatening Childhood Obesity," makes the point that kids with a body-mass index in the 99th percentile face serious health threats: 

Obesity of this magnitude can cause immediate and potentially irreversible consequences, most notably type 2 diabetes. This complication, reflecting years of progressive metabolic deterioration, carries a dire prognosis. In addition to hyperglycemia, youth with type 2 diabetes typically have severe insulin resistance, low diet quality, sedentary lifestyle, and poor adherence to medical treatment.

 Allowing your kids to develop such a condition, which leads to severe cardiovascular damage on all levels and a shortened life, could be seen as bad parenting. Although the authors also point out the existence of other "obesigenic" factors, such as the marketing of unhealthy foods, the primary responsibility falls on the parents. And as such, existing laws could be applied: 

Federal law…defines child abuse and neglect as “any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm…or an act or failure to act which presents an imminent risk of serious harm.” The seriousness of neglect is judged according to the magnitude or risk of harm and by its chronicity. Improper feeding practices, causing undernourishment and failure to thrive, have long been addressed through the child abuse and neglect framework.

As a result, Murtagh and Ludwig argue, state intervention "may serve the best interests of many children with life-threatening obesity, comprising the only realistic way to control harmful behaviors." (The American Medical Association press office was quick to note in an email to reporters that the commentary does not reflect the position of the AMA or JAMA.)

The emotional devastation of separating a family, the authors say, could be ameliorated by the prospect of return if the parents presumably get their act together. And the emotional pain may be less severe than the physical pain and risk of gastric bypass surgery—a serious procedure for adults, let alone kids.

Defining childhood obesity as abuse would place a tremendous burden on parents—and an unfair one. Considering the marketing and low cost of sweetened cereals, high-fat fast-food meals and other treats aimed squarely at kids, others also bear responsibility for our childhood obesity epidemic. Even the U.S. government could be blamed, considering that the Department of Agriculture promotes the consumption of U.S. foods.

In writing their thought-provoking essay, Murtagh and Ludwig recognize the real long-term solution, at least as far as government's role in it. "Ultimately, government can reduce the need for such interventions through investments in the social infrastructure and policies to improve diet and promote physical activity among children," they conclude.

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