Childhood obesity is an increasing problem in England, with 1 in 4 children (aged 10-11 years) leaving primary school with obesity (including over 4% (26,000) who are severely obese ). Yet, despite this frequency, there is little consensus among health, social care, and education professionals as to whether child obesity should be considered a child protection concern, according to new research combining results from interviews with key professionals from one local authority in the UK.
Moreover, the findings being presented at The European and International Congress on Obesity (ECOICO), held online this year, and published at the same time in the British Journal of Social Work, suggest that threshold judgements about whether obesity amounts to 'significant harm' and warrants intervention are inconsistent and may be limiting the support services being offered to and accepted by children and their families.
"Our study offers a unique insight into current multi-agency practice on child obesity and child protection", says Dr Peter Nelson from Sheffield Hallam University, UK, who led the research. "We're seeing that thresholds do not operate simply as a line to be crossed for a referral to be accepted by social services, but they are nuanced and complex, with personal values and beliefs about obesity influencing individual decision making, and different agency thresholds."
Children who are obese experience low self-esteem and bullying and are at risk of serious long-term health problems including type 2 diabetes, heart problems, cancer, and even premature death. But whether childhood obesity is a consequence of neglect, and obese children should potentially be removed from parents who do not try to reduce their child's weight, is a question that has divided opinion.
This divide is reflected in the health and social care professions where there is resistance to "bodily surveillance", whilst acknowledging the need to investigate neglect where evidence exists of clear parental failure to manage a child's diet, health, and fitness.
Currently, practice varies across the UK with childhood obesity incorporated in some multi-agency child protection procedures but with no mention in others, and little research to explain these variations.
To provide more evidence, researchers interviewed 23 health and social care professionals and conducted focus groups with 24 health and social care professionals working in child protection and obesity services for a local authority in the north of England. They conducted semi-structured interviews and focus groups to explore their decision making, views, and experiences of working with obesity and the child protection system. All responses were anonymised.
Analysis of responses indicated that 10 out of 23 interview participants believed that child obesity is a child protection issue, with a further three agreeing if obesity was also associated with wider concerns about neglect. Seven interviewees thought obesity was not a child protection concern, and three considered the problem was too complex to have a view either way.
Generally speaking, obesity was more likely to be seen as a child protection issue when families did not engage with the support offered and make lifestyle changes.
In addition, the research found that personal beliefs and values about obesity and parenting skills were affecting threshold judgements and referral decisions, while assumptions that social work thresholds were high, and differing agency thresholds, also impacted subsequent actions and interventions.
"The questions we should be asking are whether by taking a child protection approach we are passing the problem of child obesity onto families and then blaming them when they fail to help their child lose weight, and in so doing, ignore the clear links between obesity and disadvantage. Or could a child protection approach act as a catalyst for families who fail to engage to take up support as well as a gateway to more intensive support", says co-author Dr Catherine Homer from Sheffield Hallam University in the UK.
"There's a real opportunity to address these issues now. Failure to do so will lead to potentially lasting damage to each child's health and well-being."
The authors highlight several limitations of their study, including the small sample size and the absence of perspectives of children and their parents/carers. They also note that the study was based in one geographical area, which could limit the generalisability of the findings, and the potential for researcher bias.