Foster care is not the solution for providing much needed health care services to the 2 million children suffering from extreme obesity in the US. However, even though I agree with Dr. Ludwig in his recent article published in JAMA that under certain conditions removing an extremely obese child from the home may be a physicians duty and in the best interests of the child, it is, as most experts agree, a very slippery slope. The idea of sending extremely obese children into an already underfunded, stressed foster care system is to deny those children their just due. This is a matter of social justice, and the ever-widening gap between rich and poor. Many obese children live in poverty, and thus lack access to affordable and effective obesity treatment programs. In order to provide care for these children, health care organizations must provide access to obesity prevention and treatment services where they are most needed, and must do so earlier.
We also know that many physicians do not have the tools or resources to adequately care for extremely obese children, and that there are many ethical considerations when faced with caregivers who are complicit, if not outright responsible for their child’s life threatening condition. However, trapping potentially 2M children with acute medical needs in an already stressed and underfunded system will only lower the quality care for all children.
The question is not whether foster care is the answer to the obesity epidemic. The real question is: Will all seriously ill children and their families have access to affordable, safe, and effective obesity treatment?