Thursday, July 14, 2011

The Parenting Fallacy: Why Taking Fat Kids From Their Parents Will Only Make Things Worse

The latest controversy about childhood obesity centers around whether obese children should be removed from their parents care.  The argument is as follows: "Obese children are obese because they don't exercise enough or eat too much, so taking them away from their parents and putting them in a different family environment with healthier role models should help them lose weight."

This argument makes two major assumptions that I take issue with, so I'm going to address them one at a time.

Fallacy 1: Obese Kids are Obese Because they Eat Too Much
While eating a lot of calories definitely contributes to weight gain in people of all ages, it's hard for a child to become truly, morbidly obese without other factors being involved.  While many more children are overweight these days than once were, severe obesity still isn't common.  Severe obesity effects roughly 2.5% of affluent children and over 4% of lower income children in the US (Reuters, 2009).  While that's a sharp rise from previous years, its still a smaller number than it would be if every child who ate too much fast food became severely obese.

Children who (as I was) are severely obese are usually that way in some part because of health problems and genetic predispositions.  Simply eating more vegetables and walking more, while not a bad thing, will not solve their problems.  The difference in obesity rates between affluent and poor families is particularly telling; it's true that cheap food is generally less healthy, but even more so that poor people are overwhelmingly more likely to lack health insurance, or not have enough money for necessary medications.  Thus, in poor families, health problems may go undiagnosed.  Even if they are diagnosed, if regular medication or some other treatment is necessary, it may well be beyond what the family can afford.   

For example, I have Hypothyroidism.  This was diagnosed with a blood test, admittedly one of the cheaper diagnostic tools available in our society.  Still, that test costs around $100 when I get it done today.  That much money is at least a week's groceries for a poor family.  Once my problem was diagnosed, I discovered that I needed to take one or more pills every day in order to replace the hormone my body was failing to produce.  At the moment, those pills are available through Target's generic program for $4-$8 a month, but before that they cost around $30, which is a non-trivial monthly sum if you're poor.  However, my body chemistry varies (as does everyone's) based on the time of year, my age, my weight, and other factors, so I have to have my thyroid levels retested once every 3 months or so at the cost of $100.  If I don't get it retested, my doctor often won't refill my prescription.  Even if she would, though, my dosage might have become incorrect.

That means a poor family's paying an average of $496 a year to properly treat a child (or adult) with my condition.  That might not sound like much, but it's more than a lot of families have.  That's assuming they have a primary care doctor at all, and that he bothers to test for the illness in the first place; mine thought it was overdiagnosed, and he was less harried than many modern pediatricians.

It's just as likely that the child's symptoms - sadness, exhaustion, weight gain - will go overlooked by their parents due to a perceived lack of seriousness.  When you barely have the money to take your child  to the doctor for a fever or a broken bone, taking them because they're tired and out of sorts can seem like an outrageous extravagance.

Thyroid disease is one of the more common and easy to test for causes of obesity.  Less common illnesses would be even more likely to go undiagnosed, especially in a child whose parents couldn't afford extensive testing.  Even children whose parents have health insurance face the same prejudice that adults do.  Medical professionals tend to blithely assume that obesity is wholly a "lifestyle" issue, and to reject data that contradicts their assumptions.

As I've stated before, it took four years for one of the doctors in my pediatrician's office to realize that it would be a good idea to test me for a disease that was known to run in my family, and which I was exhibiting classic symptoms of.  It was easier for the fine medical professionals in question to send me off to another nutritionist and assume my mother and I were lying when we said I was following their instructions.

The bottom line is that severely obese children get that way for complex reasons, and diet and exercise alone have been proven to be ineffective at addressing those issues.  A change of household isn't going to cure obesity any more than a change of climate used to cure Tuberculosis in the 19th century; in fact it's likely to be less effective, since climate can mitigate TB, but depression and anxiety make obesity worse.

Fallacy 2: Other Families Will do a Better Job

Ok, I barely know where to start here.  Fat kids face a ton of prejudice every day.  Their fellow students, teachers, and playmates all treat them differently.  Sometimes that difference is subtle and well meaning, but more often it is cruel, malicious and destructive.  Every fat kid can tell you the names they had on the schoolyard.  Mine was Flabby Abby.  I remember kids chanting it.  By the time I turned nine, I hated school so much that I never talked to other students at all; I just wanted to go home where I was safe.

Let me reiterate that:  Home was Where I Was Safe.

My Mom was at home, and while she and I didn't always get along, I knew that she loved me and wanted me to be ok.  Often my Grandmother was there too, and I loved her fiercely.  My brother was there, and he never treated me like I was anything other than his annoying older sister.  Home was the place where I could be alone with my books and my drawings and my dolls.  Home was where I could sit in my mother's garden and make necklaces out of flowers.  When I was a kid, home was a mostly good place in a world where everything else was bad.

I suspect that experience is one that a lot of fat kids are familiar with.  While I'm sure some parents mistreat their fat children, call them names, are mean to them "for their own good" a la Biggest Loser (which is another post in and of itself), I suspect most love their children and try to make them feel safe and comfortable.  Their love for their child is larger than their preconceptions about fat people.  They may be prejudiced towards fat people in general, but it doesn't get directed towards their child; he or she is different.  Because of this, fat children can generally go home and find shelter from the ridicule and hostility they encounter elsewhere in the world.

Imagine that being stripped from a child.  Imagine that child being sent away from the one safe place she has, and having it happen because she's fat.  How is that child not supposed to feel like she is being punished for her weight?  And then, imagine her being brought into an environment where her weight is constantly monitored and emphasized, where she's pressured and pushed to lose weight while in a place where she's alone and scared.  Imagine the feeling of being constantly judged, of having no place to go that is free of scrutiny or prejudice.

I'm sure that there are some good, well meaning foster parents out there, and I don't claim that this would happen in every case.  That said, even kind, well intentioned people have their prejudices, and prejudice against fat people is incredibly common in our culture.  Unlike natural or adoptive parents, who have had many years to bond with their child, and who presumably love her irrespective of her weight, foster parents are experiencing her for the first time as a fat child.  The assumptions and prejudgements they have about fat people will inevitably color how they treat her.

Even assuming the foster parents are sympathetic and kind, if they have other children (foster or otherwise), those children are likely to be a source of abuse.  Thin children are notoriously cruel to their fat peers, and even heavy children can be mean to other fat kids they perceive to be more vulnerable than themselves.  A foster child in a new environment is automatically at the bottom of the social food chain, and thus a target for all manner of mistreatment by other children. I can't see how a child in this situation wouldn't be miserable, even above and beyond the more general misery of being separated from her home and family.

That being the case, while another family may indeed feed a child more broccoli and take her on more walks, being put in such a situation is more likely to engender depression and self-loathing (since the child is likely to blame herself for the situation) than a renewed desire to be healthy.  As anyone who's ever tried dieting can tell you, a diet started under such conditions is highly unlikely to work unless administered forcibly and coercively.  With this in mind, I see two potential end results.

1.  The child is not forced into dieting, and loses very little weight.  She likely remains depressed and obese even after she returns home, and other aspects of her life - schoolwork, friends, family ties - are adversely effected by the experience.

2.  The child is forced into dieting.  She loses some weight (although a limited amount unless medical issues are dealt with), but her self image is brutalized in the process.  She either takes on the values of those who coerced her, or she rejects them and deeply resents all attempts to make her lose weight.  In either case, serious body image issues are likely to become a problem.

In the former case, the child is likely to be incredibly self-critical, and may face issues with anorexia or bulimia later on as she tries to conform to the expectations of those who pushed her onto this course.

In the latter case, the child is likely to hate and resent dieting and all things associated with it, while at the same time feeling that her size makes her fundamentally unloveable.  This can lead to any of the many problems generally associated with depression and low self-esteem.

The latter scenario is not entirely hypothetical.  Because my untreated thyroid disorder led to a period of severe depression, I was in an inpatient treatment center for about a year as a young teen.  While there, I was pushed to diet and exercise, while dealing with the (sometimes violent) abuse of the other students and the more subtle prejudice of the staff.  I deeply resented this, and for over a decade afterwards had difficulty dealing with diets.  At the same time, the sense of inadequacy that the experience confirmed in me lingered into adulthood.  It factored into many of my bad choices, including staying in an abusive relationship, and until recently made me feel like I could never succeed in the creative fields I love most.  It had a major negative impact on my life, and that was without the additional burden these children will have of being told they've been taken away from their homes because they're fat.

I'm not saying that childhood obesity isn't a problem; it is.  If I had my way, no child would ever have to go through what I went through, both physically and socially.  However, that problem is not merely a matter of lifestyle, and treating it as if it is will only lead to more miserable children.  Indeed, the problem is not even simply a physical one, although good, cheap medical care would do more to help it than any amount of coercive intervention.

If we want to truly help obese kids, we need to fight the prejudices that harm them emotionally, even as we try to find ways to help them get more physically fit.  When fat kids are treated like any other kids, are protected from bullying by peers and teachers, are treated respectfully and taken seriously by health professionals, and are as safe at school as they are at home, I suspect we'll find addressing their weight issues simpler and more straightforward; after all, good healthcare can treat most medical problems, while depression, loneliness and self-hatred are notoriously bad motivators.