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Thursday, July 21, 2011

Foster Care for Fat Children? Gastric Bypass Surgery? Two Wrongs Call for a Fight

Posted By on Thu, Jul 21, 2011 at 1:00 PM

Marilyn Wann - MARK RICHARDS
  • Mark Richards
  • Marilyn Wann

Last week, major news outlets seemed pleased to report that a Harvard public health expert wants Child Protective Services officials to take fat children from their families.

As scary as that sounds, what David Ludwig advised, in the pages of the Journal of the American Medical Association -- one of the world's foremost medical journals -- is far more terrifying: "It may be unethical to subject such children to an invasive and irreversible procedure [gastric bypass] without first considering foster care."

Finally! An "obesity" fearmonger admits that weight-loss surgery -- aka stomach amputation, digestive bonsai, gut lobotomy, gastric guillotine, and having your esophagus stretched to your anus (slight exaggeration) -- is dangerous. Or, in Ludwig's own words, its "long-term safety and effectiveness ... remains unknown, and serious perioperative and long-term morbidity and mortality have been reported." (Translation: You could get very sick or die, for little or no lasting weight loss.)

What kind of choice is this for kids? We cut off your stomach or we cut you off from your family? That's the best advice a Harvard public health expert can offer?

I imagine this backward warning is a response to pharmaceutical company Allergan Inc.'s bid to persuade the U.S. Food and Drug Administration to allow stomach binding (aka lap-band surgery) on teens. (In Finland, lap-band is banned, based on data that 39 percent of survivors have major complications and nearly half have to have the band taken out.)

I agree we should protect children (and all humans) from these surgeries. I also refuse to believe that Child Protective Services is the next best delivery system for health information.

I want to see healthful eating and exercise habits and respect for families with fat children. In the (thankfully few) cases I've been involved in or watched with dread as CPS has taken fat children from their families, foster care has not been able to bring about permanent weight loss. Families are reunited only after traumatic months of separation. (I applaud the family members of Anamarie Regino for their bravery in speaking out last week.) We should recognize that families targeted by CPS in this manner are usually poor and often people of color; weight discrimination readily links up with other common prejudices.

The leading U.S. fat civil rights group, the National Association to Advance Fat Acceptance, issued a statement rightly decrying state-sponsored kidnapping as a new diet fad.

I saw a physician last week, not because I'm ill, but because I now have reliable access to health insurance for the first time in my adult life, thanks to a state program for people with so-called "pre-existing conditions." (Fat people like me aren't allowed to buy regular insurance. Fat = pre-existing condition.) I asked her what she thought of the kidnapping policy.

"Scientifically speaking, all obesity, including childhood obesity, is multifactorial and complex. To try to address it in this way is both punitive and nonrational," Lisa Capaldini says. Happily, there's a better option. NAAFA offers a child advocacy toolkit and strongly allies with a growing list of experts who promote an approach called Health at Every Size. Experts behind this method focus on safe, effective, data-based treatments with a goal of overall health. They don't focus on weight or weight loss.

Health at Every Size pioneer and Michigan health educator Jon Robison was invited to guest-edit a wellness journal's issue on children, weight, and health -- a much-needed antidote to Ludwig's editorial. In it, Robison cites data from the U.S. government and from the Journal of the American Medical Association (the same journal that published Ludwig) to put things in perspective: For every 100,000 children, 11.8 have Type 2 diabetes. Adds Linda Bacon, another health educator associated with Health at Every Size, 2,700 have diagnosed eating disorders. Should our first priority really be to scare children about food and weight?

Unlike the "obesity" fearmonger approach, the Health at Every Size approach has not only proven safe and effective in promoting good health for people of all sizes, it also reduces weight-based discrimination rather than encouraging villagers to grab their pitchforks.

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Marilyn Wann

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