July 13, 2011 -- Parents, in some cases, should lose custody of their severely obese children, argued Dr. David Ludwig, an obesity expert at Children's Hospital Boston, in an opinion piece that ran in the Journal of the American Medical Association Wednesday.

"State intervention may serve the best interests of many children with life-threatening obesity, comprising the only realistic way to control harmful behaviors," Ludwig said in the editorial, which he co-wrote with Lindsey Murtagh, a lawyer and researcher at Harvard's School of Public Health.

"In severe instances of childhood obesity, removal from the home may be justifiable, from a legal standpoint because of imminent health risks and the parents' chronic failure to address medical problems," the authors wrote

The editorial has, unsurprisingly, set off an explosive debate, but it took care to point out that removal from the home was not necessarily the solution for all obese children and should be considered only as a last option in the most extreme of cases.

As an example, the authors cited the case of a 90-pound, 3-year-old girl who came to Ludwig's clinic several years ago. By age 12, she weighed 400 pounds and had developed diabetes, cholesterol problems, high blood pressure and sleep apnea.

Ludwig and Murtagh wrote that state intervention may have been an appropriate response here.

According to the Centers for Disease Control and Prevention, approximately 17 percent, or 12.5 million, children and teens are obese. Since 1980, these obesity rates have tripled.

"State 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," Ludwig and Murtagh state.

But for kids like Ludwig's 400-pound, 12-year-old patient, or those who have developed life-threatening conditions such as type 2 diabetes, and breathing and liver problems that could kill before the age of 30, temporary foster care may be an appropriate solution, said the authors.

"Initially reading media reports, this sounds like a horror story, where the government would be kicking down doors and taking kids from their homes, but that's not what he's saying," said James Zervios, communications director at the Obesity Action Coalition.

"When a child is being put in harm's way, he may benefit from some type of intervention to teach the child and parents how to exercise and eat healthy," said Zervios. "There's no blanket approach to this situation."

Therapy and education programs should be a first line of offense in treating obese children, Zervios said. But when a parent repeatedly ignores advice and guidance for the child's well-being, government intervention may be an appropriate next step.

"If we give government the option of removing obese children from the home, we know from our experience with child abuse and neglect cases that many child protective service agencies will be too quick to place overweight children in foster care," said Dr. David Orentlicher, co-director of Hall Center for Law and Health at Indiana University of School Law, who disagreed with the idea of state intervention.

"Sometimes it is easier to take a child out of the home than take the time and resources to provide the right solution to the problem."

Should Parents Lose Custody of Severely Obese Kids?

While Dr. David Katz, founder of the Yale Prevention Center, praised Ludwig as a physician, and found the editorial to be balanced and reasonable, he said there was not enough evidence that the state would do a better job of feeding children than their parents.

"There is no doubt that, whereas starving a child Is an obvious example of abuse, in an age of epidemic childhood obesity, it may be time to look at willful overfeeding in a similar light," said Katz.

But without having evidence that foster care would benefit a morbidly obese child more than his original caregivers and without knowing cost and benefit tradeoffs when the state takes children from their parents, it's too early to say whether this is an appropriate response, said Katz.

"I do believe that severe obesity in a child is a serious problem," Katz said. "The best approach to it is to prevent it rather than fix it. But when we need to fix it, for now, the state should identify the problem and offer solutions, but not impose them."