Child Abuse by Any Other Name

"We knew that early childhood is the critical time for obesity prevention strategies. If we intervene earlier, it's easier to change the trajectory of weight gain."
Suzanne Biro, (former) research associate, department of family medicine, Queen's University, Kingston, Ontario

"Data speaks. I see these children in my clinical practice. So yes, it's a problem."
Dr. Catherine Birken, Hospital for Sick Children, obesity treatment program, Toronto

"[Despite the rarity of serious health risks in obese toddlers] ...certainly we have five- and six-year-olds who have life-threatening conditions [like severe sleep apnea or uncontrolled diabetes. With toddlers] we certainly see more subtle stuff where heavy toddlers experience difficulty reaching developmental milestones. It's harder to stand up, harder to walk, harder to run."
"Probably by age two or three they might start to feel some of the shaming that people deliver to obese people -- jokes that might be told about them by daycare providers, or their parents. So there's some psychological risk there."
"It's really not an issue of parents not caring or being lazy. They're just navigating a world where the odds are stacked against them [with the ubiquitousness of] cheap, crappy foods [marketed to parents."
"Imagine how challenging it would be for a single mom who's barely making it to serve fresh steamed vegetables and lean meat and a freshly cut salad. Our environment isn't designed in a way to make that realistic, and helpful or easy. It makes more sense to stop at the drive-thru and get your kinds fed so they stop whining."
Dr. Dan Flanders, pediatrician, North York General Hospital

"[In instances where guiding/counselling of parents fails] placement of the severely obese child under protective custody warrants discussion."
"Despite a well-established constitutional right of parents to raise their children as they choose, the state may intervene to protect the child's interest."
2011 commentary, respected medical journal

"[Over-feeding a toddler does not constitute parental negligence until] you're into extreme morbid obesity [and a threat to life is immediate]."
"But we do have an obligation to step in and try to help this child."
Arthur Caplan, bioethicist, director, division of medical ethics, New York University Langone Medical Centre

Getty Images   As well as possible health issues, heavy toddlers may have trouble reaching their “developmental milestones,” one pediatrician says. “It’s harder to stand up, harder to walk, harder to run.”

A Canadian research team's conclusion led by Suzanne Biro was recently published in the latest issue of CMAJ Open, representing the first study in Canada to examine serious weight issues in toddlers. The research concludes that one in four 18-month-olds presents at that young age as overweight, obese or at overweight risk. Experts examining the study results consider it to be "alarming" in its verification of the extension from older age groups of obesity in children leaning further down the age demographic to children two and under.

And the question looms large: just who is it that is responsible for the situation, when a very young child has become so grossly weighted with extra fat that the child is unable to move with comfort? Certainly not everyone will agree with Dr. Flanders' generous view of parents' lack of time and knowledge, overwhelmed by the constant pressure of marketing, to make the effort to ensure their children eat wholesome, nutritious food in appropriate quantities to help them grow normally.

It is the most fundamental of issues that parents have a profound obligation to their young; to make certain that, through their efforts and their dedication to the well-being of their children, their early years are the time to set patterns of lifestyle that will stand the children in good stead throughout their lives, beginning when they are first exposed to expectations that their diet will represent  a wide array of whole foods, not junk food representing their daily fare, resulting in harm to their immediate and future health prospects.

The study examined weight and height (or length) measures for over eight thousand children under 20 years of age, constructed from electronic medical records obtained through family doctors and pediatricians in Ontario to discover that, in 2013, overall, 28 percent of children ages five to 19 were categorized as overweight or as obese. Over 1,400 billing codes for 18-month "well baby visits" (routine checkups) were extracted as well, over the period 2008 to 2013.

Of this group, roughly seven percent were categorized as overweight or obese; 19 percent were considered at risk of becoming overweight. The sample size represented one considerably larger than the national survey last undertaken, estimating overweight and obesity rates in children and teens through the 2009 to 2011 Statistics Canada's Canadian health measures survey which included only those children aged three or older.

According to Dr. Flanders, a specialist in obesity and nutrition, the average height of a two-year-old is 86 centimetres (2-feet-8-inches) and the normal weight for a child of this height would be about 11.5 kilograms (25 pounds). So any child that weighs in above 29 pounds (13 kg) is considered overweight, while above 32 pounds "which is about 40 percent additional body weight composed of extra fat tissue" would be considered obese.

Dr. Flanders lingers on "figuring out what's the most effective and humane way to approach this problem", and he posits more social services for families, as well as considering the manner in which to regulate how high-fat, sugary foods are marketed to parents and children. Put into perspective; the marketing targeting children on television appeals to a child's view of what looks like fun and promises to taste yummy, while the marketing focus aimed at generating acceptance from parents isn't that far off the message children lap up.

"Conveying a message to parents that it's their personal responsibility and they need to 'get it together and become better parents' isn't fair", contends Dr. Flanders. The question here is why is it not fair, since it is the parents' obligation as loving and concerned parents, to recognize and act upon that responsibility, to guide their children in the appropriate direction in such a fraught landscape as nutrition and health?

Other jurisdictions act upon the neglect by parents of children's guidance and concern, by acting to remove children from the care of neglectful or abusive parents, as a last resort. In the U.S. in 2011, an eight-year-old boy weighing 200 pounds was placed by child welfare workers in foster care. Several years ago in Britain, police arrested the parents of an 11-year-old child weighing 210 pounds, on suspicion of neglect.