By Meg Rayner-ThomasThe article “Obese kids to be sent to CYF if parents fail to help them lose weight’’ (New Zealand Herald, 1 April 2015) engages in sensationalistic reporting that contributes to dangerous stigma and misunderstanding of obesity. In addition, the radical practice of referring children to child protection services for obesity does nothing to improve health or wellbeing and fails families.Obesity is not synonymous with child abuse and should not be lumped in the same category as other child protection issues such as drugs or domestic violence. Neither is obesity in and of itself an illness. This is because a substantial number of people who are obese actually have completely healthy cardio-metabolic profiles and have no co-morbid health issues stemming from obesity (1). By Dr. Johnson’s own admission, it has been only a very tiny minority of children with severe obesity who also have complicated co-morbidities and additional family issues who were referred to CYF. Furthermore, Dr. Johnson also admits that most of the children for whom interventions were put in place either failed to lose weight or regained it.It is unsurprising that the interventions put in place to cause the children to lose weight didn’t work. Many people on diets do see weight loss initially, however as their bodies work to conserve energy their metabolisms slow and the majority of people fail to maintain any significant change in size (2). Diets are extremely ineffective at creating long term weight loss and have actually been shown to ultimately cause weight gain for a lot of people (3). The children Dr. Johnson worked with had a completely normal and predictable response to the weight loss efforts imposed upon them. This begs the question of whether the emphasis placed on the children’s obesity is misplaced and if perhaps it might be more effective and appropriate to focus on other measures of the children’s health. It would likely be more successful to discuss support to alleviate the family issues and focus on solving the disparities affecting the children’s overall wellbeing.There are a multitude of determinants contributing to obesity. These determinants range from environmental factors (such as the availability of nutritious foods, a safe home, a place to cook, etc.) to medical issues, to genetic influence, among many others. They do not include moral failing, weakness, or even an unwillingness to lose weight. Furthermore, obesity alone does not create an impending danger to a child and unequivocally does not by itself constitute as abuse. Simply removing a child from their home and loved ones does nothing to address the structural inequalities or underlying health issues that may be at play. What it does do is disrupt the family and create a lot of trauma for the child and their parents. It also contributes to a perception that the most important thing about a person is their size, rather than their health, their family, their happiness or any other intrinsic quality.There is no question that young people are feeling immense pressure to be thin (4). One study has found that young women fear being fat more than cancer or the death of their parents. Approximately a third of young women and one out of ten young men report being unhappy about their weight. Substantial numbers of young people also report worrying about gaining weight and they report attempting to lose weight within the last year. Equally as startling is that weight based bullying is experienced by over a third of young women and a quarter of young men from their peers and, sadly, a third of young women and 16% of young men report experiencing weight based bullying from their families.Here is where the real disconnect exists. While the negative health impacts of obesity receive a lot of attention and are frequently misunderstood, the impacts of the stigma, discrimination, and panic being communicated to young people about obesity go largely ignored. Research has shown a link between poor body image and eating disorders, depression, anxiety, and even suicide (5). The dehumanising message that obese bodies are wrong bodies, that they are bodies that can be bullied, bodies that are diseased, and ultimately bodies that can be removed from their homes and their families is very loud and very damaging. Perhaps the focus should be less on obesity and more on trying to ensure that all people, regardless of their size, are given the respect, support, and resources they inherently deserve. These are the radical actions that would likely improve children’s health and help families.
References1. Fabbrini, E., et al. (2015). Metabolically normal obese people are protected from adverse effects following weight gain. The Journal of clinical investigation, 125(125 (2)), 787-795.Hamer, M., & Stamatakis, E. (2012). Metabolically healthy obesity and risk of all-cause and cardiovascular disease mortality. The Journal of Clinical Endocrinology & Metabolism, 97(7), 2482-2488.Ortega, F. B., Lee, D. C., Katzmarzyk, P. T., Ruiz, J. R., Sui, X., Church, T. S., & Blair, S. N. (2012). The intriguing metabolically healthy but obese phenotype: cardiovascular prognosis and role of fitness. European Heart Journal, ehs174.2. Sumithran, P., & Proietto, J. (2013). The defence of body weight: a physiological basis for weight regain after weight loss. Clinical Science, 124(4), 231-241.3. Mann, T., Tomiyama, A. J., Westling, E., Lew, A. M., Samuels, B., & Chatman, J. (2007). Medicare’s search for effective obesity treatments: diets are not the answer. American Psychologist, 62(3), 220.4. Clark, T.C., Fleming, T., Bullen, P., Crengle, S., Denny, S., Dyson, B., Fortune, S., Peiris-John, R., Robinson, E., Rossen, F., Sheridan, J., Teevale, T., Utter, J., & The Adolescent Health Research Group (2013). Youth’12 Prevalence Tables: The health and wellbeing of New Zealand secondary school students in 2012. The University of Auckland, New Zealand5. Brausch, A. M., & Muehlenkamp, J. J. (2007). Body image and suicidal ideation in adolescents. Body Image, 4(2), 207-212.