Wow, didn't realize the thread was so long when I posted -- I lost all the page links under that long list of "related threads." And as it was, I replied hastily.
However, I do read the JAMA article as advocating consideration of foster care as a last resort, and not as a blanket solution for all at-risk children. By definition, they are talking about 1% of children -- by identifying as those most at risk as the 99th-and-above percentile of kids. My initial response based on reading the first page and having as yet only glanced at the JAMA article was based on the erroneous assumption (shared, I suspect, by others) that the idea was to consider state intervention simply for children who fit the definition of obese -- which is to say, nearly a third of US children, according to the statistics here.
If that were the case, we'd clearly be talking about a problem of epidemiology -- one far outside the scope of the state to address on an individual basis, and one that the article states does not warrant state intervention.
So, my bad for not doing my homework and realizing what the proposed scope of proposed intervention is, as it is stated in the linked article but not in the original post (or anywhere else in the body of the thread that I have seen).
Still, even for the limited number of children under consideration, as the article itself states:
[S]tate 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 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.
The proposal by Varness et al is stated as follows:
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.
Like other conditions with a spectrum of severity (eg, substance abuse), it is difficult to determine when a sufficiently high likelihood of serious imminent harm is present. Another variable to be considered is the potential for reversing or reducing the risk of harm. Several conditions associated with obesity (eg, impaired glucose tolerance) are serious but not imminent, and the risk can be reduced when the child becomes an adult. However, some conditions (eg, advanced hepatic fibrosis) lead to harm that cannot be reversed when the child becomes an adult and can make autonomous decisions. In these cases, a stronger argument for removal from the home can be made, even if the harm is not technically imminent.
The same article goes on to state that it is the comorbidity factors, and not the severity of obesity itself, that are likely to be deteriminant in the future risk of the child.
How, then, to screen for these risk factors? Or is it simply a fact of requiring physicians to report any children with x number of y risk factors to the state so that CPS can get involved? If so, I think the notion that children are obese becomes secondary to the fact that they have been identified as medically at-risk, which I suspect affects such a small proportion of the population as to become a largely impractical philosophical argument.
However, what I read the original article as really pushing for -- in a roundabout way, because it is not structurally the article's primary focus -- is for the state to engage in population-level intervention.
The thread's original question, which triggered my own knee-jerk response, was...
Severe obesity in children -- is that a form of child abuse? Should the state step in and save these kids from their parents?
... to which my answer was and would remain an emphatic, "No," on the face of it.
If the question is amended to, "Should obsese children identified by a physician as displaying a well-defined syndrome of obesity-associated illness and a very high likelihood of developing severe irreversible metabolic disease but for whom intervention might conceivably still reduce that risk be subjected to state intervention, possibly to include placement in foster care?"
I don't have much of an opinion, and I suspect canvassing wouldn't result in much in the way of consensus.