If a child becomes morbidly obese under their parents' care, should the child then be removed from the family home and looked after elsewhere? Is categorising clinical obesity as a child protection issue yet another example of meddling bureaucrats in our nanny state exercising control, or should a child's physical health take utmost precedence regardless of the consequences?
The latest published statistics do make for depressing reading: 32 per cent of children (aged 2-15) in the UK in 2012 are classed as obese. A child dying before their parent is sadly not an alarmist hypothesis, but a grim reality. However, winching out vulnerable children from the environment they regard as safe and secure feels like an extremity that would surely rip the heart and soul out of any family.
There are no reliable figures that show just how many children in the UK are morbidly obese, as according to the National Obesity Observatory "there is no agreed standard definition of morbid obesity for children". However, NHS guidelines for adults state if your body mass index (BMI) is between 30 and 40 you would be considered obese, but if your BMI is over 40 you would be considered morbidly obese.
Natalia, 10, is described by her mother Susan as "the biggest girl at her school, and really struggles to control her weight". Susan and Natalia (not their real names) decline to have Natalia's BMI or weight published, but Susan says Natalia is between two to three times heavier than other girls her age. Susan talks me through her daughter's daily diet:
"Natalia isn't fed junk food by me all day, I know the right foods to give her, but she's always had a big appetite and loves food that isn't good for her. Breakfast is cereal, followed by toast and juice. Lunch is a sandwich, crisps, fruit, maybe a sausage roll and yoghurt. The problem is after school, she does have biscuits or a bit of cake or some treats, but I can't stop her eating it. I've tried in the past, but she just goes to the shop to buy it with her pocket money. Dinner we all eat together as a family and is normally something like lasagne, pasta or a roast. Natalia will also have a bowl of cereal or toast most nights as well before bed."
Susan explains how Natalia feels judged and stared at when she goes out which makes her very self-conscious about socialising with others:
"It's really hard for her. She can't wear the same clothes as the other girls and makes excuses not to go out and play, which results in a vicious cycle of her staying at home, not exercising and eating more. We've been to the doctors, but the healthy eating plan hasn't worked, so our next step is a different kind of specialist support that can successfully change Natalia's eating habits."
I ask Susan whether she thinks overfeeding children is an issue of abuse and neglect, which has in cases resulted in clinically and morbidly obese children being taken away from their families:
"I think it depends on the severity of the obesity. It's difficult for parents, if you have a child that wants to eat, they will, regardless of whether food is in the house or not. However, if the parents are consistently feeding them rubbish all day and don't serve anything but junk food, that is different. We're responsible for our children, so intentionally not giving them healthy food, yes, is neglecting them. I remember that poor child in Wales who got so big she couldn't walk, in cases like that, you have to ask why did no one else intervene?"
The devastatingly sad story of morbidly obese 19 year-old Georgia Davis from Aberdare, South Wales, dominated headlines again earlier this year after Georgia fell ill. It was reported that Georgia was bed bound and weighed more than 60 stone when emergency services arrived at the home she shares with her mother and step father. Emergency services knocked down a wall, removed windows and erected scaffolding so she could be transferred safely to hospital.
Dr Matt Capehorn, Clinical Manager for the Rotheram Institute for Obesity, cites the case of Georgia Davis as an example of the importance of specialist intervention at an early stage of morbid obesity.
"If as reported Georgia was bed bound because of her weight, then who was controlling her diet? A strict food management programme should have been implemented and intense specialist support in place. If home wasn't the right environment for that to be supported, that should have been clearly identified and Georgia removed from that environment. Her welfare and safety above all else should and needs to come first."
Dr Capehorn and fellow colleagues have proposed a motion to the British Medical Association that child obesity in under-12s should be regarded as neglect and as a child protection issue.
"This is not a blanket proposal that every parent who has an obese child should have them removed from their care. If parents come to us and say I am desperately worried about my child's weight, please help me, then they are clearly accessing the support and services available to them. However, in cases that we deal with, where the parents are repeatedly warned about the consequences of what they are feeding their children and take no steps to change this, that absolutely is a matter of neglect. Social services should then take the necessary steps to protect that child and if necessary remove them from that environment."
Dr Capehorn goes on to describe that because obesity is "so socially accepted" by society, it makes it an even more complex condition for professionals to treat:
"If a child goes to school and is evidently excessively malnourished, immediate steps are taken as a matter of urgency by school and social services. However, if a child goes into school excessively over nourished (which is the reality in many towns and cities in the UK) nothing happens. We are betraying and neglecting thousands of children because of fear of upsetting people. I've had parents whose children are morbidly obese brandishing letters at me from their school stating that little Peter is 'just overweight'. Many schools refuse to use the word obese in fear of upsetting the parents. They prefer to be politically correct tentatively describing little Peter as 'overweight', but this politeness is literally killing our future generations."
This isn't the first time health and social care professionals have argued to make child obesity part of a statutory child protection framework. The British Medical Journal published "Childhood protection and obesity: framework for practice" - compiled by academics at University College London - which asks, "Childhood obesity is an increasing problem, but when does it constitute grounds for a charge of neglect?" The editorial warns that increasing child protection action related to childhood obesity will be a future cost pressure for local councils. The report also claims similar concerns are evident internationally, citing reports of US courts acting to remove obese children from their parents.
There are no statistics in the public domain that show how many children in the UK have been removed from the family home because of social workers concerns over obesity. Even if the figures were published, they would not be reported by the media, because of strict reporting restrictions put in place to protect minors.
Joanna Nicolas is a Child Protection Consultant and Trainer who says clinical obesity in children needs to be considered as a child protection issue, unless there is a medical reason why that child has become so obese:
"Sadly, a happy, clinically obese child doesn't exist. We already know about the huge impact obesity has on a child's physical and emotional wellbeing and development. It's a very difficult, sensitive subject as there are no statutory guidelines or published data, which makes it even harder for social workers to decide at what point an obese child should be subject to a child protection plan. In the majority of cases, concerns about a child's weight and their welfare will be referred to social services by health visitors, schools or medical professionals. It is also highly probable there will be other issues that also need investigating within the family unit."
Ms Nicolas, who was a front line social worker for 17 years, references the framework "Working Together to Safeguard Children" on how children's services, local authorities, key statutory agencies and schools are expected to safeguard and promote the welfare of children referred to them. Ms Nicolas also reveals she has been involved in eight cases where a child's obesity was subject to a child protection plan:
"Social workers are not in the habit of taking children away from their families for no reason. As soon as a child's weight starts impacting on how they are able to function in normal circumstances and compromises their welfare and safety, then there is unfortunately no alternative but for the child to be subject to a protection plan. There are lots of inconsistencies so one local authority will refer at one level; another authority will take action at a different stage. It is so important for agencies to have some concise guidelines leading to legislation as the definitions of neglect and abuse are so broad."
Who really does care?
In 2007, the Government published the Foresight Report, billed as "part of the Government's own efforts to understand more fully the potential scale and complexity of obesity". Key findings warned that by 2050, two-thirds of children in the UK will be above a healthy weight and 60 per cent of men and 50 per cent of women will be clinically obese. The report concluded that without action, obesity-related diseases will cost the UK an extra £45.5 billion per year.
Five years on, the British Government is evidently still thinking just how to tackle this 21st century disease. The obligatory campaigns have been, as expected, rolled out, such as Change4Life which tells you nothing different from reading a free leaflet at your doctors surgery or a quick google search. On the Department of Health's website, press releases regarding initiatives such as the Public Health Responsibility Deal (simply a PR opportunity for Britain's biggest food companies to work in partnership with the coalition), the brainchild of the now axed Health Minister Andrew Lansley, mention nothing about proposed legislation, investment and most importantly, planned action.
Also proudly highlighted by the DofH is the National Child Measurement Programme, where schools measure the weight and height of children starting in reception (aged 4-5) and then again in year 6 (aged 10-11). The 2010/11 NCMP results found that in reception, over a fifth (22.6 per cent) of the children measured were either overweight or obese. In Year 6, this rate was one in three (33.4 per cent).
However, Al Jazeera understands from senior healthcare professionals that the results of the NCMP are distorted, and do not depict an accurate record of how many children fall into each category. This is because as it is not compulsory to have their child weighed, many parents choose to opt out of the programme. Moreover, as children grow and change so quickly depending on their ever changing lifestyle and eating habits, the reliability of the results can vary greatly in a very short space of time. There are also concerns, according to senior sources, that after the results are sent home, the responsibility is re-directed and pressure placed on the parents to seek the relevant support and services if their child is not measuring at a healthy weight.
The Department of Health says the report provides high-level analysis of the prevalence of "underweight", "healthy weight", "overweight", "obese" and "overweight and obese combined" children in reception (aged 4-5 years) and Year 6 (aged 10-11 years), measured in state schools in England. They also say information is used to help the NHS and local authorities plan and provide better health services for children.
Children in the UK today are being abused and neglected first and foremost by the British government and Britain's biggest food companies. The blame for childhood obesity is directed at parents, schools, lack of discipline, sedate lifestyles - anyone and everything but them. The culpable, corporate driven monsters that tantalise and tempt through aggressive marketing and clever manipulation succeed in convincing our future generations they need additives and sugar pumped through their veins. Where's their morality, their sense of conscience? Do the executives controlling these corporations happily feed their children their processed products saturated in trans-fat and artificial sweeteners that are netting them huge bonuses every year?
The highly influential celebrities promoting crisps, fizzy drinks, chocolate and fast food, whilst decked out in their sport kits, should also hang their heads in shame. Beckham and co should be content with their already inflated salaries and profiles, rather than endorsing all the wrong kind of messages to our highly impressionable children.
And the British Government - who have the power to make a difference - to not make junk food so readily available and accessible to our children, to not let advertising dominate our children's lives, but don't. Who could have excluded McDonalds, Coca Cola and Cadbury's from sponsoring the 2012 Olympics, and championed a truly healthy, positive legacy, but didn't. Who need to support and educate those who need guidance and support the most, but haven't. We are waiting and watching, before it really does becomes too late.
Siobhan Courtney is a British freelance broadcast journalist and writer. She is a former BBC World News presenter and BBC News journalist who has reported and written for BBC Newsnight.
The views expressed in this article are the author's own and do not necessarily reflect Al Jazeera's editorial policy.