Obesity Surgery or Removing Kids from Home: What’s Better?

Should we blame his weight on his parents?

A recent Journal of the American Medical Association piece is questioning whether it's better for a super obese child to go through obesity surgery or to be removed from the home, at least temporarily, until their weight can be stabilized.  In some cases, they think taking custody is better.  I agree. Our government has done things such as remove vending machines from school grounds, revamp the food pyramid to a plate (one reason was so kids can understand it more easily), and several municipalities have passed ordinances requiring calorie counts on menus.  The idea here is to get people the best information so they can make smart choices and, yes, in a Big Brother sort of way, to remove temptations. But what happens, most likely from lack of knowledge, if parents raise super obese kids? Barring medical reasons, I'm sure it's not on purpose.  I'm sure the parent or parents are either working so hard they barely have time to breathe, let alone cook a healthy dinner, or they have no idea how to prepare healthy foods because they were never taught themselves. The first step should be intervention; the school system should flag kids with extreme obesity issues (I'm talking morbidly obese, not the merely plump) and have the parents in for a talk.  Lots and lots of information should be made available to them: cooking classes, how to eat well on a budget, shopping lists, maybe coupons geared towards healthy food, a support group with other parents, even psychological support if needed.  Everything we can think of to keep the child in the home, but healthy. But if that doesn't work, yes, I think taking children from the home is a whole lot better than putting them under the knife. A child who is super obese, who doesn't improve with intervention, and is looking at surgery to repair the damage is a kid with a shortened lifespan.  I want to be super clear here.  In my opinion, going in for bariatric or similar surgeries is literally maiming the body, and long-term studies suggest it doesn't always work.  Many adults getting the procedure have found their stomach will stretch again over time and fall back to their calorie chugging ways.  Why do that to a kid? But don't just put the child in any random home.  I've worked in the department of social services system and I've seen the gamut of people in the system.  Some are a bit lost, in need of guidance, and some with maybe not the best intentions.  Just stowing a kid in any random environment isn't going to work.  You need to develop a system of foster homes geared towards working with obese kids, or work with existing in-treatment hospital programs (my preference) that can work with and help these kids. And you should never give up on the parents.  Keep trying to educate them and get them to see what damage they're doing to their kids.  I guarantee you the parents are most likely obese too and need just as much, if not more, help than their children.  Plus, removing one's child from one's care is a very radical and punitive action to take, and just might be enough of a deterrent to get a parent to take action where other methods failed. So that's a pretty strong opinion and I'm right there with JAMA.  What do you think?  Should we look at taking kids out of the home or do you think surgery is the better option?  This is by no means the first option we look at, but the absolute last ... if we can stop a kid's obesity when they're young, we can give them a chance at a long, healthy life.  If we don't, we're condemning them to medical problems and very possibly an early death.  Don't they deserve a better chance than that? Lisa

About Lisa Johnson

Lisa Johnson here. I've been a personal trainer since 1997, a Pilates instructor since 1998 and the owner of Modern Pilates since 1999. I'm hoping to give you some good ideas to get or stay in shape with a healthy dose of humor and reality. Thanks for joining me.

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14 Responses to Obesity Surgery or Removing Kids from Home: What’s Better?

  1. Bodynsoil July 13, 2011 at 8:19 am #

    I agree that bariatric surgery isn’t the answer when children are morbidly obese. One responsibility, in the medical practice I work for, is gathering health history information. Almost all of the patients I interview who have had bariatric surgery are unhappy with their quality of life and still obese, why subject a child to that before they are old enough to understand the ramifications.

    While taking the child out of the home might help them reach a healthier weight,eventually they would return to the parental home to start the cycle again. Perhaps a whole home treatment plan would would best, bring in a health and nutrition counselor to work with the family group. Create a situation where the whole family can get healthier and not only will the child’s future improve but perhaps so will the family unit.

    Also, budget tightening measures have seen physical education cut in many schools. Perhaps we should go back to the family living classes that were available when I was younger. Teaching not only nutrition but all aspects of family life from healthy living/cooking to balancing a budget even minor home repairs.

  2. Sonia Simone July 13, 2011 at 8:21 am #

    Social services seems to have enough problems helping kids who are being beaten, raped, exposed to drugs, recruited into gangs, etc. There are some real heroes in the foster system (I know a couple), but not enough, it seems, to go around.

    There’s so much that could be done in the way of education before we started taking kids out of homes. I would love to see this as more of a priority, but everything in the U.S. seems to be going in the opposite direction — less money available for critical services.

  3. Marialexandra July 13, 2011 at 8:25 am #

    I think surgery is covering the problem up, not solving it, and I think taking a child away must be the very last resort, but I do believe it is the parents fault, consiously or unconsiously. The lack of education regarding proper calorie intakes and what is healthy, is extremely poor and that is where the real problem lies. As a daughter of an over weight person, I have experienced the lack of knowledge regarding food and because of it, I found myself with an eating disorder as a teen. Because of a small health scare at age 15 I began to educate myself on how to eat right and become a healthy person. My mother, on the other hand, had her stomach stapled when no one even knew that was possible. I learned how to eat, she still considers chocolate a meal. Education, it can solve all of the worlds problems. Problem is, would anyone go out and buy Doritos or McDonalds then?

  4. Lisa Johnson July 13, 2011 at 8:32 am #

    Bodynsoil, all very good points. I definitely only agree with removal if it’s an extreme case and all that you’re talking about has already been tried. To Sonia’s point (and I’ve seen it with my own eyes) the social services department are generally extremely overwhelmed and suffering budget cutbacks. They are more worried about kids who’s parents are drug dealers than a Mom who doesn’t know to hold the fries.

    That said, if you’re between a rock and a hard place taking the kid could help two ways. 1. Give them some education to help them start to make their own decisions (even if they go back to the home they can choose to eat smaller portions) and 2. It could be the wakeup call the parents need to pay attention and do right by their kids.

    I think it’s worth a shot anyway, and I do think it’s a better option than surgery.


  5. Lisa Johnson July 13, 2011 at 8:33 am #

    Maria, excellent points and thanks for talking about your family. You’re a perfect example of how education can save a kid even if the parents don’t have the proper information. :-)

  6. gene @boutdrz July 13, 2011 at 8:50 am #

    hey! bodynsoil! way to represent VT! woot~!
    IMHO, creating obese kids is borderline abuse. should social services be involved? i think yes. I also think that parental counselling and classes (as mentioned in the article) should be mandatory, especially for kids/families on public assistance/welfare. But that’s almost a different arguement….
    As for the surgery? No way. Obesisty isn’t an acute condition; it happens over time, because of behaviours, choices, and (in)actions. ANY time you put someone under sedation you are putting them at risk of DEATH. It says it right there on the consent form. So….would I want to put kids at risk of dying for a procedure that isn’t guaranteed to work? Nope.

  7. Cindy July 13, 2011 at 9:16 am #

    I agree that an entire whole family intervention needs to occur first. And the child needs to be evaluated physically and psychologically. Even if the parents are cooking non-healthy foods, for a child to be morbidly obese he or she has to be eating other foods, either snacks in the home or outside of the home. As an educator I have seen the kinds of snacks kids bring to school, especially in low income areas. In fact I had several kids have Doritos and Mountain Dew be their breakfast of champions.

    The one question I have is, who pays for this? If the family is low income they probably can’t afford it, and unfortunately social services that would/should be in place for things like this are underfunded or non-existent.

  8. Lisa Johnson July 13, 2011 at 10:22 am #

    Well put Gene. :-)

    Cindy, good point about the psychology, so many abused girls turn to food for solace, I saw it a lot in DSS, to the point where (when I worked there) we would gently prod for possible sexual abuse if a girl was very heavy. Yes, we’d pay for it, but it’s way cheaper to pay for intervention than to pay for bariatric surgery which I believe runs about $100K per procedure. That’s a LOT of intervention.

  9. TraceyJoy July 14, 2011 at 12:50 am #

    I have strong mixed feelings on this…Surgery = non negotiable, ain’t gonna happen. NEXT!!! I was an overweight child, now I’m an overweight adult!! However I would have been so upset being removed from my home until I would have eaten more and tripled in size. = FAIL

    ITA w/Bodyandsoil. I feel family preservation is a major step in the right direction, teach them together how to be healthy. Many have no idea. You are only going to do what you know how to do. Parents cooked this way, that’s how I learned, that is how they learned and so on. I’m learning a new way to eat now in adulthood, mom still thinks I’m crazy. That said willing, allowing your child to do something that is so harmful to their bodies that it will ultimately kill them far too soon can fall under the category of child abuse and or neglect. So in that light if a child is being neglected does the state have the right to come in? HMMMM

    This is not a cut and dry issue. There is not one fix for this frightening epidemic. A parent has $10 for food. Are they going to Whole Foods or Traders Joes, heck are they going to the grocery store at all…$10 in the stores get you what???? Not much but you can rack up at Dollar menu at the fast food chains that seems like a better deal. So you have to re-educate, re-train the entire family including their taste buds. Eating out used to be a treat, now it’s all meals eaten in the car…So this seems to be a product of our environment/lifestyle/culture. How to you flip the masses around when dinner options are Taco Bell, BK, Mickey D’s or Wendy’s?? This is a major tough issue. I don’t know what the clear answer is.

  10. Lisa Johnson July 14, 2011 at 7:34 am #

    Tracey, I agree this is very much not a cut and dry issue. Some people in the twitter stream were quite harsh and I think they don’t understand the whole issue. The American obesity epidemic has so many moving parts to it you can’t just fix “one aspect” of it and everything starts working again, there’s DNA, lobbyists, government policies, marketing, chemical manipulation of foods, GMOs, big food, big agra, it’s just not that easy.

    Thank you for sharing your thoughts I truly appreciate it. L–

  11. DMA July 17, 2011 at 9:44 am #

    My understanding of the JAMA article is that it is a commentary piece by Harvard doctors based on a premise that childhood morbid obesity is a form of parental “abuse and neglect”. This premise is disturbing on so many levels because obesity is a much more complicated issue than media would lead us to believe. One could argue that we have a “blame the victim” scenario here. And while yes, we are complicit in the obesity problem of our county-this is only part of the story. Our food supply is ridiculously low in nutrition. And while the answers seem simple enough, whole foods, water instead of soft drinks, movement, and healthy coping skills, our society does not support these answers. Our society supports work, money, stuff, power, more money and more stuff. The idea that removing a child from their home would be an appropriate alternative to weight loss surgery is to me a classic metaphor for the general black and white, sound bite society we live in now. There is a lot of grey, but we as a society don’t find grey valuable, satisfying, or speedy enough. Having worked in WLS for many years, I believe people have a right to do with their bodies as they see fit under informed consent. I have always believed and continue to believe that children are incapable of informed consent. I am not a proponent of WLS for adults and definitely not with children. But I also know it saves lives. Children however do not need WLS they need an entire life style change. But a trauma based change-the removal of a child from their home-for the crime of overeating and under exercising seems an equally devastating option to surgery.

  12. Lisa Johnson July 17, 2011 at 11:46 am #

    DMA, thank you so much for a well-written contribution. I do hope I made it clear that lots and lots of steps would be taken with the parents and the child (and the school system too!) before the child is removed from the home. I also advocated for a situation where the child can be removed to an environment specifically for the purpose of re-educating the child and his parents but in a way that’s more supportive to the child.

    I agree just grabbing a “fat kid” and ripping him out of their home while saying tsk, tsk to the parents is completely ineffective and detrimental to everyone especially the child.

    What would you suggest as an alternative? Have a weight loss chef move in with the family? (I chuckled when I first thought of this but actually …)


  13. Tara Burner July 19, 2011 at 7:43 am #

    I have strong feelings on this but rather than write an entire book I’ll just post a link to an interesting viewpoint on the same topic from “The Health Ranger” and leave my thoughts to myself http://www.naturalnews.com/033046_obese_children_government_intervention.html

  14. Lisa Johnson July 19, 2011 at 10:46 am #

    Thanks Tara :-)

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