Blame the Mothers: Fat Children Equals Child Abuse?

I thought these research abstracts, published recently, deserved to be displayed together for sheer irony.

The first shows the parent-blaming inherent in the "childhood obesity epidemic" public health campaigns.

The second points out the unfair nature of this parent-blaming and the sexist, mother-blaming nature of most of the media messages around public health campaigns against child obesity.

The third helps refute the common idea that fat kids eat excessively and that fatness is always related to the amount of calories consumed.

Unfortunately, it is only the first message only that is being communicated to the public these days. Here's the typical take-away message that many people get from childhood obesity public health campaigns:

If a child is fat, it's THE PARENTS' FAULT, and they are bad parents to have "let" their child get that way (and it's especially the mother's fault because it's her job to see that everyone is healthy).   

Parents of fat children have failed in their duties as a parent, and perhaps their child should even be taken from them. 

If a child is "morbidly obese," then the parent has allowed him to become that way, and that is a form of child abuse. 

Like the attitudes behind this lawyer's comment:

The idea here is that a minor who is morbidly obese has an unacceptable amount of health risks due to, basically, the gross negligence of their parents...they have to be taught to lead a healthy lifestyle, which they obviously haven’t been taught yet thus far.

"Gross negligence of their parents"?  Because no child could possibly be morbidly obese unless their parent was force-feeding them huge amounts of junk, right?

The state will step in and stop parents who won’t feed their kids. Why shouldn't the state step in and stop parents who keep shoveling food down their kids’ throats?

"Shoveling food down their kids' throats"? Really?  Because children can only be obese if they are consuming huge amounts of calories?  Because their parents are lazy or ignorant and don't know anything about feeding "healthy" food?  Because all that's needed for fat kids to slim down is to unplug the TV/computer and exercise a little restraint at the dinner table, right?

The societal pressure on parents of fat children is tremendous.  Look at some of these quotes from people about the stories on removing fat children from parental custody.

-I get extremely frustrated when I see an obese child. I mean, REALLY frustrated. I immediately look to the parent to see why this child is overweight. Is the parent obese as well? Is it just carelessness? Does the parent not see it? Does the child have a thyroid problem? Can they not afford healthier food? All these questions run through my mind, and yes, in that very moment I do want to snatch the child away from the parent. I want to bring the child into my home and introduce them to REAL food, that nourishes their growing body....

-I get sooooo angry when I see obese kids too. I literally want to punch the parents in the face and tell them to wake up!!   

This idea that parents are solely responsible for making a child fat and that this is tantamount to bad parenting and child abuse drives so much of the discussion around "childhood obesity" hysteria these days, yet this perception is fundamentally flawed.

A fat child does not equal child abuse.

Let's say it again:

A FAT CHILD DOES NOT EQUAL CHILD ABUSE.  

Yet there are a number of health and social care professionals that seem to believe it does:

Does allowing a child to become morbidly obese qualify as child abuse? Some health and social care professionals believe it is a question that needs to be considered more seriously... 

"It is my view that child obesity should be treated as a form of child mistreatment, as any type of under-feeding is," says Joanna Nicolas, a child protection consultant who has been a social worker for 17 years. 

"If a child is obese it is a form of abuse because of the physical impact on the child, the implications for their future health and the psychological impact," she told Radio 4's The Report.

This is parent-blaming at its worst. It is a reflection of negative public health discussion that views obesity as a entirely voluntary state, caused by bad habits, laziness, and/or ignorance about nutrition, and a condition that is supposedly easily modifiable by reasonable behavior.

Yet if obesity were so easy to prevent and/or treat, why hasn't been it taken care of by now? Why don't the many obesity intervention programs out there result in more permanent weight loss? Why do most weight loss intervention studies tellingly not include long-term follow-up? Why do study after study show only a small number of people losing weight and keeping it off long-term? Why do many people who initially lose weight end up heavier in the long-term after dieting? Are that many people really that weak-willed and ignorant?

Why do many super-obese people who have SURGERY to restrict their stomachs and re-route their intestines still remain clinically obese, even after losing lots of weight? Why do they often remain fat to some degree (and even regain lots of weight after a couple of years) despite being unable to eat a lot of food or absorb many nutrients from the food they do eat?

Could it be that fatness is related to factors other than just intake and output?

The only way healthcare and social professionals can explain the tremendous statistical failure of diet programs is by blaming fat people themselves.  In their view, it can't be the fault of the diet/lifestyle programs, it can't possibly be from some metabolic difference, nor can it be because there are strong biological mechanisms for defense of body weight.

No, it must be fat people's own intransigence, laziness, ignorance, lack of self-discipline, or unwillingness to change habits that is behind their continued fatness.

In other words, it has to be fat people's fault because these healthcare folks NEED it to be their fault.  They need to believe in a paradigm where it's fat people's fault because otherwise, it questions everything they believe in and the very nature of their own body privilege.

And because this is the narrative that society wants to hear, this is the message they are given, over and over again in the media.  Read the stories featured in the media and see how rare it is to see a message that doesn't conform to this paradigm. As Abigail Saguy discussed in her excellent article for the Washington Post:

The way we talk about fatness as a medical issue and a public health crisis brought on largely by reckless personal choices may be worsening anti-fat prejudice and related health problems.

Well, it certainly is worsening the prejudice and pressure that parents of fat children experience.  If the trend keeps going the way that it is in some areas, there will be more and more blame put onto the parents of fat children, and more efforts to take fat children away from their parents in order to "save" them.

And that is just incredibly frustrating and alarming to the parents of fat children everywhere.


References

J Law Med. 2012 Sep;20(1):124-51. Childhood obesity, parental duties of care and strategies for intervention. Nolan EJ.   PMID: 23156652

Childhood obesity is an increasingly serious issue which causes significant health problems among children. There are numerous causes of childhood obesity. However, the ultimate responsibility for the problems and costs associated with an obese child should be attributed to that child's parents. Parents owe a duty of care to their child and, when their child is obese, have arguably breached that duty. However, if parents were required to pay their child damages, this would arguably be problematic and of little utility. Rather, intervention strategies should be implemented which seek to treat and prevent childhood obesity and to address the identified causes of childhood obesity.

Appetite. 2012 Nov 24. pii: S0195-6663(12)00448-5. doi: 10.1016/j.appet.2012.11.005. [Epub ahead of print] "Fat is your fault": Gatekeepers to health, attributions of responsibility and the portrayal of gender in the Irish media representation of obesity. Brún AD, McCarthy M, McKenzie K, McGloin A.  PMID: 23186694

We investigated the representation of obesity in the Irish media by conducting an inductive thematic analysis on newspaper articles (n=346) published in 2005, 2007 and 2009 sampled from six major publications. The study analysed the media's construction of gender in discussions of obesity and associated attributions of blame. Three dominant themes are discussed: the caricatured portrayal of gender, women as caregivers for others, and emotive parent-blaming for childhood obesity. Men were portrayed as a homogenous group; unaware and unconcerned about weight and health issues. Dieting and engaging in preventative health behaviours were portrayed as activities exclusively within the female domain and women were depicted as responsible for encouraging men to be healthy. Parents, specifically mothers, attracted much blame for childhood obesity and media messages aimed to shame and disgrace parents of obese children through use of emotive and evocative language. This portrayal was broadly consistent across media types and served to reinforce traditional gender roles by positioning women as primarily responsible for health. This analysis offers the first qualitative investigation into the Irish media discourse on obesity and indicates a rather traditional take on gender roles in diet and nutrition.

Pediatrics. 2012 Oct;130(4):e936-42. doi: 10.1542/peds.2012-0605. Epub 2012 Sep 10.
Self-reported energy intake by age in overweight and healthy-weight children in NHANES, 2001-2008. Skinner AC, Steiner MJ, Perrin EM.  PMID: 22966024

...METHODS: We examined dietary reports of children ages 1 to 17 years by using the National Health and Nutrition Examination Survey, 2001-2008 (N=12648)... CONCLUSIONS: In a nationally representative cross-sectional sample, overweight and obese girls older than 7 years and boys older than 10 years reported consuming fewer daily calories than their healthy-weight peers....

"Elective" Cesareans? Hardly

I have to do a follow-up to my recent blog entry on timing of planned cesareans. I need to comment further on this idea of "elective" cesareans.

Jennifer Block, author of Pushed: The Painful Truth About Childbirth and Modern Maternity Care, has an awesome article about "elective" cesareans on her blog, which I will quote from at the end of this blog entry.

It's called, "Can We Please Stop Blaming Women for C-Sections?" Her points reiterate a really hot button for me, the blaming of mothers for everything that's wrong with our modern maternal care system.

The press releases that accompanied release of the New England Journal of Medicine article often implied that the main factor driving 38-week cesareans was maternal request, that women were behind all these irresponsible early cesareans simply for the sake of convenience or because they were tired of being pregnant.

In fact, it is doctors who are usually pushing the 38-week timing. Often, they want to avoid any chance of the woman going into labor before the cesarean because they have an exaggerated sense of risk around labor after prior cesarean (or with a breech baby), or simply because they simply want to be done with this patient that much sooner.

Blaming the Mothers

I can't emphasize how much it infuriates me to see these press releases blaming women for the epidemic of too-early cesareans or the high cesarean rate, but it fits the typical pattern these days.....blaming mothers for all the problems.

High cesarean rate? Well it's because of all the older moms, all the fat moms, all the high-risk moms getting fertility treatments now, blah blah blah.

Of course, the high cesarean rate couldn't possibly be because doctors induce women at SUCH high rates now, could it? Couldn't possibly be because doctors no longer attend vaginal breech births, could it?

Nor could it possibly be influenced by the fact that cesareans make the hospitals so much more money, could it? Or the fact that doctors find "scheduled" births so much more time-efficient for their own needs, could it?

Nope, it's all about blaming the mothers.

"Elective" Cesareans

High "elective" cesarean rate? Well, if you believe the media and doctors, it's because there are all these irresponsible mothers demanding unnecessary patient-choice cesareans, you see.

But the reality is completely different. That NEJM study, for example, only looked at "elective" cesareans......cesareans planned before labor, simply because the mother had had a previous cesarean. No good medical reason, just the fact of a prior cesarean.

But is that really an "elective" cesarean? Is it really a maternal-choice cesarean?

Sometimes the mom is totally on board and wants another cesarean. That's okay, as long as she understands the risks of multiple repeat cesareans. Often, women don't understand just how many risks that entails, but if she has been given full informed consent and still wants another cesarean, that's her choice.

But often, the mother would really like to have a chance at a vaginal birth again, only to be told (falsely) that Vaginal Birth After Cesarean (VBAC) would be far too risky, that VBACs are "illegal" now (no, they are not!), or that she HAS to have another cesarean because her hospital won't "allow" VBACs anymore.

Alas, more and more hospitals are banning VBACs these days. In some states, half of the hospitals with Labor and Delivery wards do not "permit" women to have a VBAC. That means a whole lot of women are being pushed into cesareans they don't want and DON'T NEED.

What it boils down to is a de facto FORCING of women into surgery. This is a gross violation of human rights and basic reproductive rights. No one should be forced to undergo surgery they don't want or need, and yet hospitals all over the country are, in effect, doing just this.

Childbirth Is A Feminist Issue

This is something we as women should really be getting fired up about....someone ELSE is determining what we can do with our bodies, someone ELSE is taking our bodily autonomy away from us. Childbirth issues are very much on the forefront of the women's rights battlegrounds these days, but alas, not everyone understands this yet.

About a third of all childbearing women today have their children surgically; in some hospitals the c-section rate is 40-50% or even more. Some of these are necessary and life-saving....but many are not.

And once they have that first cesarean on board, about 90% of women now have all their future children surgically too. (It used to be much lower but the VBAC bans have changed that.)

Some women have a repeat cesarean truly voluntarily, and if they choose that knowing all the pros and cons, it's fine.......but a LOT more women are doing it simply because they have no choice.

Either their hospital/doctors won't "let" them birth vaginally anymore (since when do you have to ask permission for the right to use your vagina?), or they have been unreasonably scared or even bullied into it.

Some doctors use completely distorted facts to try and scare women out of a VBAC, or they pretend to go along with a VBAC until the last minute when the old bait-and-switch is pulled ("your baby is too big," or "you have to go into labor by 40 weeks or schedule the cesarean," etc.).

Fat women in particular are being talked into planned cesareans and out of VBACs at record rates. Even practices that do still support VBAC often do so only for women of average size, refusing the choice of a VBAC to "morbidly obese" women. Once again, bodily autonomy and childbirth choices are particularly threatened for fat women.

Women forced into or scared into a repeat cesarean are NOT having "elective" cesareans. The high cesarean rate in this country is not being driven by maternal-request cesareans, and the timing of 38-week planned cesareans is not being driven by women either.

It's not about women "choosing" these procedures (or their timing), it's about women's choices being taken away from them.

As Jennifer Block writes on her blog:

Elective implies freely chosen, life-enhancing. Laser eye surgery is elective. Tattoos are elective. But the vast majority of so-called "elective" cesarean sections are not, and it is inappropriate and disingenuous to call them so in the medical literature....

[I]n spite of the true risk, VBACs are often vehemently discouraged. In fact, many obstetricians now refuse to attend them, and hundreds of hospitals have officially banned them. And malpractice liability fears are a strong motivation to schedule the surgery early, so as to avoid the possibility of labor—and vaginal birth. The fact is that VBAC is inaccessible to most women.

So, if a woman with a scar from a previous cesarean goes to her OB and is recommended to schedule a repeat cesarean—and is told that a vaginal birth would be risky, and that anyway it won't be done by this doctor, this practice, or this hospital—can the surgery possibly be called "elective?"