# AMA Journal: Foster Care for Selected Obese Children



## Cynthia (Jul 12, 2011)

Wow. That's quite a slippery slope.

http://www.ajc.com/health/should-parents-lose-custody-1012757.html


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## Fat Brian (Jul 12, 2011)

It seems like a lot of these families need help from family or friends, possibly even their church or a charitable organization. There also seems to be some margin of dysfunction in most of these situations. Maybe family counseling would be more beneficial than removing the child from their home.


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## loveembig (Jul 12, 2011)

This is NOT good. Giving the government legal authority like this is opening a door that can never be closed. This is just one more step in the governments never ending voracious need to undermine the lives and rights of its citizens. It's always the same rallying cry "it's for the welfare of the CHILL-dren, we need to protect the CHILL-dren. 

BULLSHIT! How many times are the CHILL-dren going to be used as pawns in their lust for control? It's just another big government power grab that will lead to more and more intrusive invasions into our lives.


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## Zoom (Jul 12, 2011)

The way I see it, there is no way that anyone in power should be allowed or able to know exactly what any child weighs. Certainly schools have no right to the information, despite the fact that some schools have been forcing kids to get weighed.

Of course, the problem then becomes one of a busybody seeing how big someone is in public and calling authorities even without taking one's statistic.

The article talks about the suggested new law applying to "the more extreme cases". But who has the right to decide when it becomes an extreme case? Certainly not the failiticians who spend more money than the gluttonous eat food.


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## HottiMegan (Jul 12, 2011)

My mom tried to control my food intake. I got really sneaky. By the time i could ride a bike and had money, i was out buying all the "forbidden" foods. It's not always the parents' fault. 

I've seen how my inlaws struggle with my defiant overweight niece. Kids can make your life a living hell when you're doing something to prevent them from eating. Her moms constant harping looks to be largely ignored. I figure her voice sounds like the Peanuts teacher to my niece.

I don't think losing custody is right. Maybe some intervention and educating or help but certainly not breaking up families. Besides, the foster care system is stressed enough to add more kids into this. 

The experts talk about how kids need to move more. In my oldest boys school he gets PE once a week. When i was in elementary school it was a daily 45 minute class. I'm not going to blame the schools but that's the place they spend most of their day and energy.


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## cinnamongirlky (Jul 13, 2011)

loveembig said:


> This is NOT good. Giving the government legal authority like this is opening a door that can never be closed. This is just one more step in the governments never ending voracious need to undermine the lives and rights of its citizens. It's always the same rallying cry "it's for the welfare of the CHILL-dren, we need to protect the CHILL-dren.
> 
> BULLSHIT! How many times are the CHILL-dren going to be used as pawns in their lust for control? It's just another big government power grab that will lead to more and more intrusive invasions into our lives.



*nodnod* You said everything I wanted to. I'm sick of the government trying to control our lives...


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## butch (Jul 13, 2011)

Perhaps the best known case of a fat child being taken from their parents (in the US) was Anamarie Regino, and the child ended up being given back to her parents after all the government intervention failed to make the child lose weight. What a shame the American Medical Association thinks splitting up families is the way to make children healthier. I would imagine the psychological trauma from such a removal would be immense, but then again, when it comes to the 'childhood obesity epidemic' , mental health always takes a back seat to slenderness.


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## Tracyarts (Jul 13, 2011)

I don't have a problem with it in certain cases. Just like I have no problem with children who are extremely underweight being removed from the home in certain cases. If the child's health and well-being is suffering due to their weight (on either side of the spectrum), and the parents are unable or unwilling to effectively address the problem (with medical or mental health care, nutrition and lifestyle changes, etc...) then something needs to be done before the child suffers permanent damage. And if placing them under supervision, and attempting to intervene by helping educate them and get them partnered up with different service providers doesn't address the issue, then more drastic measures need to be taken. 

IMHO, it's not a fat thing, it's a childrens' well-being thing.

And before anybody puts words into my mouth, I don't believe that this applies to otherwise healthy kids who just so happen to be fat (or thin). I'm talking extreme cases where children are truly suffering from their weight (on either side of the spectrum).

Tracy


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## Tad (Jul 13, 2011)

I guess I'd view it as: there should not be any policy that obese kids should be moved into foster care. However if there are cases of extreme obesity in kids, and the parents seem incapable or uninterested in taking steps to moderate it, then that could be _a_ factor that would lead to an investigation of the situation. Like Tracyarts said, like being extremely underweight, or really any other situation that appears to put the child at risk where the parents can't/won't do anything about it.

However, what is missing in that article is that I suspect that in most of those really extreme cases they talk about, there may well be underlying medical type conditions. There was no talk about helping parents with extremely obese kids get expert medical care to look at what might be underlying the situation :doh:


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## EtobicokeFA (Jul 13, 2011)

In general the idea of intervening in cases where the child is in extreme cases, however the problem is that how the medical industry relate weight and health. 

Would the officials recognize the difference between a child that obese but healthy and a kid that obese and not healthy?


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## Jes (Jul 13, 2011)

I would urge those of you interested in the discussion to read the commentary (and that's what it is--not a study, not a legislative bill, and not something coming from the AMA) in the journal. Ludwig's hope is that lots of other options be tried in the home before anything as extreme as foster care (which he sees as a last resort) be tried. He also feels trying changes in the home, and then foster care for rare exceptions, are much better options than using weight loss surgery on children. I don't know how I feel about the whole issue, but I know that reading the facts helps frame any discussion of what's being argued.


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## Keb (Jul 13, 2011)

EtobicokeFA said:


> In general the idea of intervening in cases where the child is in extreme cases, however the problem is that how the medical industry relate weight and health.
> 
> Would the officials recognize the difference between a child that obese but healthy and a kid that obese and not healthy?



The problem is that most of the world automatically assumes there is no distinction: Obese _is_ definitively unhealthy.


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## Miss Vickie (Jul 13, 2011)

From the article:



> Ludwig said he starting thinking about the issue after a 90-pound 3-year-old girl came to his obesity clinic several years ago. Her parents had physical disabilities, little money and difficulty controlling her weight. Last year, at age 12, she weighed 400 pounds and had developed diabetes, cholesterol problems, high blood pressure and sleep apnea.
> 
> "Out of medical concern, the state placed this girl in foster care, where she simply received three balanced meals a day and a snack or two and moderate physical activity," he said. After a year, she lost 130 pounds. Though she is still obese, her diabetes and apnea disappeared; she remains in foster care, he said.



Obviously, these parents were not in a position, due to their own disabilities and financial situation, to manage this child's health problems and encourage a healthy diet. So in this case, for the child's health, it was necessary to remove her from the home and get her help. Interestingly, she is still in foster care, which makes me wonder what else is going on with that family.

As Tracy said, in extreme situations where weight (whether it be too much or too little) is causing health problems and parents are unable to manage the issue, the child should be removed. None of us would complain of government interference if parents were starving a child; why get up in arms if parents are overfeeding a child to the point where the child is clearly ill and the state has to step in to safeguard the child's health and life? Does anyone really want a 12 year old to be a Type II diabetic, when it can easily be avoided by eating a reasonable diet?

OTOH, a fat healthy kid who can ride a bike, play with friends, go to school and whose parents are in a good position to at least try to get the kid to eat healthily should be left with parents. But this article isn't talking about removing fat and healthy children. It's talking about removing fat kids who are so overfed that they have a host of medical problems as a result, even before reaching adolescence.


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## Mathias (Jul 13, 2011)

The notion of "Lose weight and we'll let you go back to your parents." is very unsettling to me. I'll admit, I skimmed the article a bit, but there didn't seem to be any proposed solutions of the family working alongside the state to get the child's weight under control with the child still in the home. (Correct me if I'm wrong here) No mention of how the potential trauma of being taken from their parents homes could make the problem worse either.


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## Jes (Jul 13, 2011)

Miss Vickie said:


> OTOH, a fat healthy kid who can ride a bike, play with friends, go to school and whose parents are in a good position to at least try to get the kid to eat healthily should be left with parents. But this article isn't talking about removing fat and healthy children. It's talking about removing fat kids who are so overfed that they have a host of medical problems as a result, even before reaching adolescence.



Hmm. Anyone know the policy on how to handle a child with serious medical conditions for whom parents are unable to care (on their own)? Like a kid needing daily home-care with parents who are incapable of providing it for whatever reason? Are those kids also candidates for short-term foster care?


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## Jes (Jul 13, 2011)

Mathias said:


> I'll admit, I skimmed the article a bit.



Which article? The doctor's opinion piece or some secondary source? Are you debating points the doctor didn't actually even make? 

From the JAMA article I give you: "Most overweight and obese children have the opportunity to ameliorate these risks through behavior change and weight loss as adults. In this sense, poor parenting is analogous to secondhand smoke in the homea condition associated with adverse health consequences for the child, but not warranting legal intervention."

I honestly feel like a lot of Dimmers would agree with much of what Ludwig is talking about if they just read what he's actually talking about.


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## Miss Vickie (Jul 13, 2011)

It's addressed in the article, Mathias:



> Dr. David Ludwig, an obesity specialist at Harvard-affiliated Children's Hospital Boston, said the point isn't to blame parents, but rather to act in children's best interest and get them help that for whatever reason their parents can't provide.
> 
> State intervention "ideally will support not just the child but the whole family, with the goal of reuniting child and family as soon as possible. That may require instruction on parenting," said Ludwig, who wrote the article with Lindsey Murtagh, a lawyer and a researcher at Harvard's School of Public Health.
> 
> "Despite the discomfort posed by state intervention, it may sometimes be necessary to protect a child," Murtagh said.



I think the idea is to put the kid in foster to deal with the immediate health issues and get their diet under control, while educating the parents and getting them the help they need to be able to better meet the child's needs.

I heard of a child in our community who, as a preschooler, was so heavy he couldn't walk. He was pushed in a wheelchair, never learned to talk, would just gesture and grunt and his mom, who had her hands full, would give him whatever he wanted -- usually fast food, candy and soda. He wasn't toilet trained, had no friends and was never required to do anything that children his age should be doing to learn. A lot of people just assumed that he was developmentally delayed but he wasn't -- he just had had every single thing given to him, never encouraged to walk, and and missed many developmental milestones due to lack of opportunity. He had a host of health problems, any of which could have killed him. He was at immediate and long term risk.

They removed him to foster care (which was, yes, stressful but the mom had shown after numerous opportunities that she couldn't handle this child), changed his diet, started doing physical therapy and speech therapy. As a result of this "intervention by the government" he ended up being a normal and healthy child within months of being removed from her care. He walks, runs and bikes. He eats a wide variety of foods which includes fast food along with other, healthier choices. He is learning to reads and write. He's a little delayed but they expect that he'll catch up. He's lost a great deal of weight and is still fat, but he's at a weight that doesn't prevent him from being a kid, doesn't inhibit his mobility, and his risk for heart disease, arthritis and cancer are reduced significantly. I believe that he's been placed permanently with a family member due to concerns that his mom couldn't handle maintaining the changes.

So sometimes I do think the government needs to step in when parents and their families can't. I have a lot of involvement with social work and OCS when it comes to child custody and they are never rushed to take a child for no reason at all. Babies who end up in immediate OCS custody are there because the mom is currently using drugs and has no plan for rehab, or is returning to jail. They will bend over backwards with the family to find a family member who can take the child while the mom or parents get help to be safe parents. I think sometimes they don't take babies that they should, but the system usually errs on the side of keeping parents with kids, and sometimes that's to the child's detriment.

If the state truly wanted to step in and take fat kids, they'd be hard pressed to find enough foster parents to handle them. As it is, there is a critical shortage of foster care parents. I just don't see this happening unless, like the kid mentioned above, it's a medical and social emergency.


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## Miss Vickie (Jul 13, 2011)

Jes said:


> Hmm. Anyone know the policy on how to handle a child with serious medical conditions for whom parents are unable to care (on their own)? Like a kid needing daily home-care with parents who are incapable of providing it for whatever reason? Are those kids also candidates for short-term foster care?



It really depends on where they live. But I know that where I live, there are medical care foster parents who take a child for a few weeks or months to deal with immediate health problems that parents aren't in a condition to manage. We see this a lot with native kids, who have significant health problems including g tubes, complicated medication regimes, etc and their parents -- who are from a remote village in Alaska -- are in no condition to manage them. During this time they usually try to educate the parents to care for the problems, if they're likely to be long term, or arrange a family member who can handle this burden for the kid to live with.

A lot of times, kids can't go back to the village for weeks or months, and the parents can't stay in town because they have kids at home in the village. So they will pair up the kid with a medical foster parent until they can go back home.


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## Jes (Jul 13, 2011)

I'm cutting and pasting the whole shebang for those of you who feel invested enough to comment but haven't read the author's opinions:

JAMA. 2011;306(2):206-207.

State Intervention in Life-Threatening Childhood ObesityLindsey Murtagh, JD, MPH; David S. Ludwig, MD, PhD

Many biological, psychosocial, and behavioral factors affect energy balance and, therefore, childhood weight gain, with parents playing an important mediating role. Ubiquitous junk food marketing, lack of opportunities for physically active recreation, and other aspects of modern society promote unhealthful lifestyles in children. Inadequate or unskilled parental supervision can leave children vulnerable to these obesigenic environmental influences. Emotional distress and depression, or other psychological problems arising from abuse and neglect, may exacerbate this situation by leading to disordered eating and withdrawal from sports and other social activities. 

Even relatively mild parenting deficiencies, such as having excessive junk food in the home or failing to model a physically active lifestyle, may contribute to a child's weight problem. Typically, the potential harm involves an increased risk for obesity-related chronic disease later in life. Most overweight and obese children have the opportunity to ameliorate these risks through behavior change and weight loss as adults. In this sense, poor parenting is analogous to secondhand smoke in the homea condition associated with adverse health consequences for the child, but not warranting legal intervention. 

Severe obesity, characterized by a body mass index (BMI) at or beyond the 99th percentile, represents a fundamentally different situation. Whereas typical children consume about 100 kilocalories per day more than requirements state, the energy imbalance for severely obese children may exceed 1000 kilocalories per day,1&#8203; suggesting profoundly dysfunctional eating and activity habits. 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risk factors that together could rapidly accelerate development of macrovascular and microvascular diseases.

Without major weight loss, type 2 diabetes usually becomes permanent several years after onset due to irreversible pancreatic beta cell death, which decreases life expectancy significantly. Because of the poor outcome of conventional treatment for pediatric obesity, bariatric surgery has become increasingly considered for adolescents with type 2 diabetes.3&#8203; However, the long-term safety and effectiveness of this invasive procedure in adolescents remains unknown, and serious perioperative and long-term morbidity and mortality have been reported.4 As an alternative therapeutic approach, placement of the severely obese child under protective custody warrants discussion. 

Legal Considerations

Despite a well-established constitutional right of parents to raise their children as they choose, the state may intervene to protect the child's interests. Federal law, which establishes a minimum standard for states, 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.5&#8203; The seriousness of neglect is judged according to the magnitude or risk of harm and by its chronicity.6 Improper feeding practices, causing undernourishment and failure to thrive, have long been addressed through the child abuse and neglect framework. However, only a handful of states, including California, Indiana, Iowa, New Mexico, New York, Pennsylvania, and Texas, have legal precedent for applying this framework to overnourishment and severe obesity.7&#8203; Nevertheless, mandated reporter laws may obligate physicians to contact child protective services in the cases of children for whom chronic parental neglect has resulted in severe weight-related health complications. 

State intervention may serve the best interests of many children with life-threatening obesity, comprising the only realistic way to control harmful behaviors. Child protective services typically provide intermediate options such as in-home social supports, parenting training, counseling, and financial assistance, that may address underlying problems without resorting to removal. These less burdensome forms of legal intervention may be sufficient and therefore preferable in many cases. In some instances, support services may be insufficient to prevent severe harm, leaving foster care or bariatric surgery as the only alternatives. Although removal of the child from the home can cause families great emotional pain, this option lacks the physical risks of bariatric surgery. Moreover, family reunification can occur when conditions warrant, whereas the most common bariatric procedure (Roux-en-Y anastomosis [gastric bypass]) is generally irreversible. 

The possibility of an unrecognized genetic disease has made these removals especially controversial. A recent study found 5 of 300 severely obese children in the United Kingdom had a newly identified obesity-associated genetic deletion on chromosome 16p11.2; of these, 4 of 5 had received child protective services attention.8 Thus, a comparison may be made to osteogenesis imperfecta, a genetic cause of bone fractures often mistaken for physical abuse, resulting in unfair accusations against and stigmatization of the parents. However, a diagnosis of osteogenesis imperfecta provides a new management approach, such as physical therapy, measures to reduce fracture risk, and close fracture surveillance, that does not necessitate removal of the child from the home. In contrast, identifying a genetic cause of obesity (with the extremely rare exception of leptin deficiency) offers no new therapeutic options, requiring instead an intensification of the home-based behavioral interventions that have proven unsuccessful in these families. Psychosocial dwarfism, in which growth arrest results from a complex interplay of biological, psychological, and domestic environmental factors, provides a better comparison. For these children, removal from the home may be necessary to restore normal growth even without evidence of frank abuse and neglect. 

In severe instances of childhood obesity, removal from the home may be justifiable from a legal standpoint because of imminent health risks and the parents' chronic failure to address medical problems. Indeed, it may be unethical to subject such children to an invasive and irreversible procedure without first considering foster care. Nevertheless, state intervention would clearly not be desirable or practical, and probably not be legally justifiable, for most of the approximately 2 million children in the United States with a BMI at or beyond the 99th percentile.9&#8203; Moreover, the quality of foster care varies greatly; removal from the home does not guarantee improved physical health, and substantial psychosocial morbidity may ensue. Thus, the decision to pursue this option must be guided by carefully defined criteria such as those proposed by Varness et al,10 with less intrusive methods used whenever possible. 

Conclusions

An increasing proportion of US children are so severely obese as to be at immediate risk for life-threatening complications including type 2 diabetes. Some will become candidates for treatment at newly established pediatric surgical weight loss programs throughout the country. As an alternative approach, involvement of state protective services might be considered, including placement into foster care in carefully selected situations. 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.


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## butch (Jul 13, 2011)

After reading quite a bit about the Anamarie Regino case (which is the New Mexico case briefly mentioned in the text Jes shared), I stand by my statement. The fact that she is now 12 years old and 300 pounds, after medical intervention and foster care, shows that not every really fat child is living in a house of neglect. If there are no other signs of neglect and abysmal parenting, then I do think foster care would do more damage to a child's mental health then if they were left in the home unit.

Too bad the journalism about this that I've seen uses the too generic term 'obesity' when reporting it, since there is a world of difference between an 'obese' child and one who is 'super morbidly obese' (do they even classify children with the 'super morbidly obese' label, or is it only for adults?). Plus, how many of those very fat children are like Anamarie Regino, and suffering from an unknown condition that makes weight loss almost impossible?


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## Fat Brian (Jul 13, 2011)

Some overweight children are in danger and some are not. I was 300 lbs in the eighth grade but I rode my bike and walked with friends, I was just fat. On the other hand I'm sure for some extremely overweight kids their weight is just one sign of the poor environment they live in. I hope that government would try to determine the difference. I'm not opposed to removing a child who is in danger from their home, but hopefully their weight will not be the only factor considered.


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## Jes (Jul 13, 2011)

Fat Brian said:


> but hopefully their weight will not be the only factor considered.



has anyone suggested it will be in this discussion?


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## Fat Brian (Jul 13, 2011)

Jes said:


> has anyone suggested it will be in this discussion?



No, I was just expressing a hope. I understand what the opinion piece writer means, he's not suggesting a mass roundup of large children but overzealous government officials have ruined so many reasonable ideas. I'm actually sort of glad he's is saying that cutting open every fat kid and replumbing their guts might not be such a good idea.


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## bigmac (Jul 13, 2011)

Tad said:


> I guess I'd view it as: there should not be any policy that obese kids should be moved into foster care. However if there are cases of extreme obesity in kids, and the parents seem incapable or uninterested in taking steps to moderate it, then that could be _a_ factor that would lead to an investigation of the situation. Like Tracyarts said, like being extremely underweight, or really any other situation that appears to put the child at risk where the parents can't/won't do anything about it.
> 
> However, what is missing in that article is that I suspect that in most of those really extreme cases they talk about, there may well be underlying medical type conditions. There was no talk about helping parents with extremely obese kids get expert medical care to look at what might be underlying the situation :doh:



Yes!!!, good points.

Its never a good thing to base policy on extreme unusual cases. We don't need to add to the list of reasons that justify removal of children. Social workers may be well meaning but have a tendency to be over zealous (I know I'm married to one -- actually she's quite reasonable -- but some of her coworkers, not so much). If CPS social workers are given a training session that instructs them its OK to remove fat kids look out!

Indeed, this actually happened. One of my wife's coworkers removed a fat kid a few years ago after she had read about the fat Arizona girl who was removed. The family appealed to the agency ombudsmen who at the time was my wife -- the child was returned and the social worker scolded but it shows what can happen when people put ideas into the minds of front-line social workers.


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## Never2fat4me (Jul 17, 2011)

bigmac said:


> Its never a good thing to base policy on extreme unusual cases.



This is the key point. I think everyone would agree that if, for example, an 8-year old kid is so fat he/she is suffering from medical complications like Type 2 diabetes and high blood pressure and has mobility issues due to a parent overfeeding them, they need intervention. But to go from there to saying that fat kids should be put in foster families - with all the related psychological trauma that entails (not suggesting, btw, that foster families will cause this; taking away from parents the child loves is the problem) - is wrong. It's like saying because some parents do not provide enough food to their kids and they suffer from malnutrition, then skinny kids should be put in foster families. Everything depends on the individual situation.

I would also suggest that there be better resources available for parents to help them avoid these situations in the first place. Most families mentioned - such as that of Anamarie Regino - are poor and in jobs with lousy health plans. If they had regular access to good doctors (who are not fat-phobes themselves and don't automatically decide that eating less is the solution to every problem) and supportive nutritionists, then maybe these extreme situations could be avoided. Then again, that might involve - God forbid! - "bigger government" that would need to be paid with "tax increases"! (My apologies to those Teapartiers who may be offended by the utterance of those treasonous words. )

Chris


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## Charles (Jul 17, 2011)

Without fat kids, where will hte enxt generation of SSBBWs come from - so buy a chubby relative a Happy Meal ,and upgrade it with a milkshake and an apple pie or two--


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## Fat Brian (Jul 17, 2011)

Because of course we should introduce young girls to feeding as soon as possible.


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## Jes (Jul 17, 2011)

Charles said:


> Without fat kids, where will hte enxt generation of SSBBWs come from - so buy a chubby relative a Happy Meal ,and upgrade it with a milkshake and an apple pie or two--



haha. Oh, Charles, you crazy kid, you!


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## Mishty (Jul 17, 2011)

Charles said:


> Without fat kids, where will hte enxt generation of SSBBWs come from - so buy a chubby relative a Happy Meal ,and upgrade it with a milkshake and an apple pie or two--


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## GentleSavage (Jul 21, 2011)

I can see this being in appropriate in certain situations. But this is a wicked slippery slope. Like with everything, it will only be a good thing in moderation. If a child's health is at risk (at least to an extreme extent) and the parents would not/could not do anything to better it, then I feel like it would be okay. 

But the issue is having it stop with children being so overweight to a point where their health is at extreme risk, and with over weight kids. None of us wants a society where we are all forced to be the same. I've been overweight pretty much my whole life, but I've also been pretty healthy too. 

Just because someone is heavy doesn't mean that they're unhealthy, or that their parents aren't doing there job.


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## Dromond (Jul 22, 2011)

Charles said:


> Without fat kids, where will hte enxt generation of SSBBWs come from - so buy a chubby relative a Happy Meal ,and upgrade it with a milkshake and an apple pie or two--



If you are serious, you need therapy badly.


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## mossystate (Jul 23, 2011)

Charles said:


> Without fat kids, where will hte enxt generation of SSBBWs come from - so buy a chubby relative a Happy Meal ,and upgrade it with a milkshake and an apple pie or two--



Feeding girls to grow them fat so you can drool over them when they come of age ( I am giving benefit of the doubt ). This is really flying out here?


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## Fat Brian (Jul 23, 2011)

He's been roundly chastised and ridiculed as per board tradition, it should stay as an example to others.


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## TraciJo67 (Jul 24, 2011)

bigmac said:


> Yes!!!, good points.
> 
> Its never a good thing to base policy on extreme unusual cases. We don't need to add to the list of reasons that justify removal of children. Social workers may be well meaning but have a tendency to be over zealous (I know I'm married to one -- actually she's quite reasonable -- but some of her coworkers, not so much). If CPS social workers are given a training session that instructs them its OK to remove fat kids look out!
> 
> Indeed, this actually happened. One of my wife's coworkers removed a fat kid a few years ago after she had read about the fat Arizona girl who was removed. The family appealed to the agency ombudsmen who at the time was my wife -- the child was returned and the social worker scolded but it shows what can happen when people put ideas into the minds of front-line social workers.


 
A decision to remove a child from his/her home for placement is never -- NEVER -- made by an individual social worker. Such an important decision, with the implications for the well-being of the child AND of the family, is not one that any one individual (who carries his/her own set of biases) should ever make; in my agency, this never happens. I can't imagine a scenario in which a social worker responded to an investigation referral and then just yanked the child out of his/her home for being obese. Social Workers often get the blame for the decision because John Q. Public doesn't see all of the steps that go into the process of a removal -- including input from police officers, family members, pediatricians, other social workers, psychologists, etc. And we don't operate in these individual little vacuums of power and authority; we have peer reviews and panels and managers/investigators reviewing our work too (as well we should). Also, while in certain cases, including immediate and observable danger to the child's health and well-being, social workers can get a temporary order for removal ... the court system always gets involved and usually on the front end. 

I'm trying to imagine how your wife was the first to hear that an individual social worker removed a child from his/her home on her own biased authority; if this happened, then the lapse of judgment went quite far up the ladder and a number of other people should have been "scolded' as well.


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## Jes (Jul 24, 2011)

Charles said:


> Without fat kids, where will hte enxt generation of SSBBWs come from - so buy a chubby relative a Happy Meal ,and upgrade it with a milkshake and an apple pie or two--



According to a number of people at Dims, fat people are fat through no actions of their own (which includes eating), so in theory and practice, this shouldn't work.


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## bigmac (Jul 24, 2011)

TraciJo67 said:


> A decision to remove a child from his/her home for placement is never -- NEVER -- made by an individual social worker. Such an important decision, with the implications for the well-being of the child AND of the family, is not one that any one individual (who carries his/her own set of biases) should ever make; in my agency, this never happens. I can't imagine a scenario in which a social worker responded to an investigation referral and then just yanked the child out of his/her home for being obese. Social Workers often get the blame for the decision because John Q. Public doesn't see all of the steps that go into the process of a removal -- including input from police officers, family members, pediatricians, other social workers, psychologists, etc. And we don't operate in these individual little vacuums of power and authority; we have peer reviews and panels and managers/investigators reviewing our work too (as well we should). Also, while in certain cases, including immediate and observable danger to the child's health and well-being, social workers can get a temporary order for removal ... the court system always gets involved and usually on the front end.
> 
> I'm trying to imagine how your wife was the first to hear that an individual social worker removed a child from his/her home on her own biased authority; if this happened, then the lapse of judgment went quite far up the ladder and a number of other people should have been "scolded' as well.



I'm glad Minnesota has more checks and balances but here in California county social workers can and do remove kids without a warrant pending a court review that must be held within 48 hours (not including weekends or holidays). This is exactly what happened in the case I cited -- the children were removed by a social worker and returned by the court two days later.

My wife was the first person to deal with the parents' complaint because she was the social worker assigned to deal with parent complaints -- that simple -- when the parents showed up the morning after the removal they were directed to the person designated to deal with complaints (my wife).


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## TraciJo67 (Jul 24, 2011)

bigmac said:


> I'm glad Minnesota has more checks and balances but here in California county social workers can and do remove kids without a warrant pending a court review that must be held within 48 hours (not including weekends or holidays). This is exactly what happened in the case I cited -- the children were removed by a social worker and returned by the court two days later.
> 
> My wife was the first person to deal with the parents' complaint because she was the social worker assigned to deal with parent complaints -- that simple -- when the parents showed up the morning after the removal they were directed to the person designated to deal with complaints (my wife).


 
Bigmac, I'm sure that your wife knows (and probably you too, since you're part of the legal system) that all states are bound by CAPTA laws, subjected to review, and that removal of a child without a warrant requires that the social worker demonstrate that the health or safety of the child is in imminent danger. So it's not like one can stroll into a home, without discussion or review, and certainly not based on something as insubstantial as an anonymous tip, and remove an obese child. No reasonable judge would find that to meet the "imminent danger" requirement. 

I'm not doubting what you're telling me at all as I know that occassionally an ignorant or errant social worker will act beyond his/her authority, but such abuses, when discovered, are usually dealt with swiftly and harshly. You seem to be suggesting that this happens all the time, rather than as a very rare exception to well established rules.


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## bigmac (Jul 24, 2011)

TraciJo67 said:


> Bigmac, I'm sure that your wife knows (and probably you too, since you're part of the legal system) that all states are bound by CAPTA laws, subjected to review, and that removal of a child without a warrant requires that the social worker demonstrate that the health or safety of the child is in imminent danger. So it's not like one can stroll into a home, without discussion or review, and certainly not based on something as insubstantial as an anonymous tip, and remove an obese child. No reasonable judge would find that to meet the "imminent danger" requirement.
> 
> I'm not doubting what you're telling me at all as I know that occassionally an ignorant or errant social worker will act beyond his/her authority, but such abuses, when discovered, are usually dealt with swiftly and harshly. You seem to be suggesting that this happens all the time, rather than as a very rare exception to well established rules.



Actually walking into your house is exactly what happens if the child abuse hotline gets a complaint they take seriously. The social workers respond without a warrant -- if the parents deny entry they will get a warrant and return. In this case the complaint was from a physician's office so they took it seriously and responded within a couple of hours -- as it happens it was a night shift social worker who responded -- she took the fat kid into custody on her own authority (night-shift social workers can call the night-shift supervisors if they feel they need to -- just like cops can call their sergeant -- but they can remove on their own authority). She reasoned that it was medical neglect to let a kid get so fat, as well as to have failed to seek treatment for obesity that was clearly (in her opinion) impacting his health. As I said before the court disagreed strongly. The social worker subsequently disciplined by the Agency and also admonished by the court. The child was returned to the parents immediately. 

*My point in this thread is that if removing fat kids becomes normal or standard practice, courts and administrators will become much less willing to overturn overzealous social workers*. Also,my wife just informed me that the SW in question is no longer with the agency -- not sure if she quit or got fired.


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## bigmac (Jul 24, 2011)

TraciJo67 said:


> ... that all states are bound by CAPTA ...



Actually no. Child welfare is a core state responsibility and under the _Domestic Relations Abstention Doctrine_ federal laws regarding child welfare are strictly construed.

Furthermore, CAPTA only applies to states that have accepted federal grants. And even if they have accepted federal grants CAPTA does little more than set a minimal definition for child abuse and require social workers to tell parents why they're taking the kids.


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## TraciJo67 (Jul 24, 2011)

bigmac said:


> Actually no. Child welfare is a core state responsibility and under the _Domestic Relations Abstention Doctrine_ federal laws regarding child welfare are strictly construed.
> 
> Furthermore, CAPTA only applies to states that have accepted federal grants. And even if they have accepted federal grants CAPTA does little more than set a minimal definition for child abuse and require social workers to tell parents why they're taking the kids.


 
I wasn't aware that there were any states that didn't accept federal grants, Bigmac. Certainly, California is. 

I should add the caveat that I'm not a CPS worker, and never have been. But I am passingly familiar with CAPTA and it's a LOT more than minimum standards for informing parents of their rights.


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## bigmac (Jul 25, 2011)

TraciJo67 said:


> I wasn't aware that there were any states that didn't accept federal grants, Bigmac. Certainly, California is.
> 
> I should add the caveat that I'm not a CPS worker, and never have been. But I am passingly familiar with CAPTA and it's a LOT more than minimum standards for informing parents of their rights.




A lot of platitudes and apple pie statements. The act is a grant writers dream -- pretty much any existing program will qualify for a grant if the writer uses the right words.

What it doesn't do is tie the hands of local officials enforcing local laws (i.e. removing kids). For people keen on cutting federal red tape this act would be a good place to start.

Here are the actual program requirements (government argot at its finest):

*SEC. 206. LOCAL PROGRAM REQUIREMENTS.*

_IN GENERAL.-- Grants made under this title shall be used to develop, implement, operate, expand and enhance community-based, prevention-focused, family resource and support programs that--

assess community assets and needs through a planning process that involves parents and local public agencies, local nonprofit organizations, and private sector representatives;

develop a strategy to provide, over time, a continuum of preventive, family centered services to children and families, especially to young parents and parents with young children, through public-private partnerships;

provide--

core family resource and support services such as--

parent education, mutual support and self help, and leadership services;

outreach services;

community and social service referrals; and

follow-up services;

other core services, which must be provided or arranged for through contracts or agreements with other local agencies, including all forms of respite care services to the extent practicable; and

access to optional services, including--

referral to and counseling for adoption services for individuals interested in adopting a child or relinquishing their child for adoption;

child care, early childhood development and intervention services;

referral to services and supports to meet the additional needs of families with children with disabilities;

referral to job readiness services;

referral to educational services, such as scholastic tutoring, literacy training, and General Educational Degree services;

self-sufficiency and life management skills training;

community referral services, including early developmental screening of children; and

peer counseling;

develop leadership roles for the meaningful involvement of parents in the development, operation, evaluation, and oversight of the programs and services;

provide leadership in mobilizing local public and private resources to support the provision of needed family resource and support program services; and

participate with other community-based, prevention-focused, family resource and support program grantees in the development, operation and expansion of the Statewide network.

PRIORITY.-- In awarding local grants under this title, a lead entity shall give priority to effective community-based programs serving low income communities and those serving young parents or parents with young children, including community-based family resource and support programs._


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