Obesity: parental support, education initiatives must start early

Recently the Journal of the American Medical Association published a controversial article regarding the status of the approximately two million super-obese children in this country (“State intervention in life-threatening childhood obesity”, Murtagh & Ludwig). Citing the urgency of the severe medical complications facing these children at or exceeding the 99th percentile for Body Mass Index, the authors advocate for the state to intervene in order to correct neglectful or irresponsible parenting. While interventions such as in-home support and parent training are preferred, the authors conclude that some cases will warrant more severe action, specifically gastric bypass surgery or foster care. While both of these options are unpleasant, the authors opt for foster care as the less invasive option. The authors of the article caution against the unknown risks of surgery and the ethical considerations of putting children through “irreversible and invasive” surgery. Option B is no better. Even under the most justified circumstances, removing a child from his or her family causes devastating and inevitable emotional trauma. There is no action more invasive than to uproot a child from his home, separating him from his attachment figure for an unknown length of time. Removal of a child should be reserved for the most extreme cases of child safety, only after all other efforts have been exhausted. Unfortunately, the dangers of childhood obesity are very real, and there may be cases in which one of these crucial options will be selected. Sadly, if nothing is done to prevent obesity, cases like these will no longer be rare. With two million severely obese children and growing, the solution cannot be to increase the capacity of foster care or to open new hospitals to operate on our kids. These options are too costly, in more ways than one. Instead, the focus should be on ways to prevent childhood obesity, to save children from suffering either of these traumatic experiences. A new nutrition agenda, going beyond diet and physical activity to decrease childhood obesity and focus on prevention, should be implemented. The best approach is one that is multidisciplinary with successful linkages among the private and public sectors, the entertainment industry, agriculture, nutrition, and health. Proactive strategies are necessary to prevent obesity. Research has shown that the risk for childhood overweight and obesity begins in the womb. The first 1,000 days of a child’s life, from conception to two years of age, are a critical developmental period. It is within this time span that first steps to prevent childhood obesity can and should be taken. In fact, the mother’s diet both before and during pregnancy can have a lifelong impact on her child’s health. Therefore, interventions that begin during pregnancy can shape the earliest childhood experiences and place children on a trajectory for improved health outcomes. Twenty-five years of research supports successful and creative programs that include parents in the solution. There currently are many programs in New Jersey that support children and families, recognizing that children need their parents and caregivers and that parents and caregivers also need support. Parents generally want the best for their children, and, when properly nurtured and supported, will act in their children’s best interests. Just as parents play a role in the negative behaviors that lead to obesity, parents must be at the center of efforts to prevent childhood obesity. Through home visiting, parent support, and parent education programs that target pregnant women and families with very young children, parents can be equipped with information they need to properly nourish their children and set them on a path for improved health outcomes. Investment in prevention efforts, in programs that educate parents long before obesity becomes a problem, is the most effective, ethical, and respectful approach. Prevention programming can keep kids healthy and keep families together.