Published online December 29, 2008
PEDIATRICS Vol. 123 No. 1 January 2009, pp. 399-406 (doi:10.1542/peds.2008-0712)
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SPECIAL ARTICLE

Childhood Obesity and Medical Neglect

Todd Varness, MD, MPHa, David B. Allen, MDa, Aaron L. Carrel, MDa and Norman Fost, MD, MPHa,b

Departments of a Pediatrics
b Bioethics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin

The incidence of childhood obesity has increased dramatically, including severe childhood obesity and obesity-related comorbid conditions. Cases of severe childhood obesity have prompted the following question: does childhood obesity ever constitute medical neglect? In our opinion, removal of a child from the home is justified when all 3 of the following conditions are present: (1) a high likelihood that serious imminent harm will occur; (2) a reasonable likelihood that coercive state intervention will result in effective treatment; and (3) the absence of alternative options for addressing the problem. It is not the mere presence or degree of obesity but rather the presence of comorbid conditions that is critical for the determination of serious imminent harm. All 3 criteria are met in very limited cases, that is, the subset of obese children who have serious comorbid conditions and for whom all alternative options have been exhausted. In these limited cases, a trial of enforced treatment outside the home may be indicated, to protect the child from irreversible harm.

Key Words: obesity • ethics • child neglect • child abuse

Accepted May 2, 2008.


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