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15 July 2011

The JAMA Blames Parents for Their Obese Children

The Journal of the American Medical Association (JAMA) just published a commentary titled "State Intervention in Life-Threatening Childhood Obesity." Here's a selection to give you the gist:
Many biological, psychosocial, and behavioral factors affect energy balance and, therefore, childhood weight gain, with parents playing an important mediating role. Ubiquitous junk food marketing, lack of opportunities for physically active recreation, and other aspects of modern society promote unhealthful lifestyles in children. Inadequate or unskilled parental supervision can leave children vulnerable to these obesigenic environmental influences.

State intervention may serve the best interests of many children with life-threatening obesity....
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. Indeed, it may be unethical to subject such children to an invasive and irreversible procedure without first considering foster care.
Ultimately, government can reduce the need for such interventions through investments in the social infrastructure and policies to improve diet and promote physical activity among children.
Here is the problem: the authors acknowledge that obesity is a social problem, caused in part by cultural and structural contraints on healthy behavior. They even conclude by stating that the government should intervene in order to help kids eat better and exercise more. The bulk of the piece, however, is aimed at blaming parents for a social problem that is largely out of their control and of which they are also likely to be victims. In short, the authors admit that this is a societal-level problem but prescribe an individual-level solution.

This issue is not unique in its capacity to incite error in the level of analysis. Indeed, virtually every governmental response to social problems makes this mistake. Take the criminal justice system. We know that crime is a social thing caused in part by issues that are economic and structural, but we futily try to solve it by prosecuting and locking up individuals. Take welfare. We know that poverty is a social thing caused by the way that we have organized our economy, but we try in vain to eliminate it by giving individuals food stamps, subsidized housing, and Medicaid.

The solution to social problems like obesity, crime, and poverty must be themselves social. Even just talking about taking kids away from their parents because they are obese is cruel and needlessly contentious. We must dig deep and look to the root of these problems if we hope to solve them.

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