Roughly 2 million U.S. children are extremely obese -- weighing significantly more than what's considered healthy.
A Cleveland Heights boy was taken from his family and was placed in foster care in October after county case workers said his mother wasn't doing enough to control his weight. The boy, at his weight, is considered at risk for developing such diseases as diabetes and high blood pressure. Government growth charts say most boys his age weigh about 60 pounds.
Cuyahoga County removed the boy because case workers considered the mother's inability to get his weight down a form of medical neglect. The county's Children and Family Services agency said Monday it stood by its custody move, which was approved by a judge.
"We have worked very hard with this family for 20 months before it got to this point," agency Administrator Patricia Rideout said.
Rideout said the issue has created a buzz among agency staff members and she has heard it was a popular Internet item. She said she was following state law in withholding the boy's name in his best interest.
There's no easy answer when it comes to determining who's to blame in such obesity cases, said Dr. Naim Alkhouri, who works with overweight children and their families at Cleveland Clinic Children's Hospital and leads its pediatric metabolic clinic.
"It's not only the parents or the child," he said. "Obesity is an epidemic in the United States. As a society we're all responsible."
It's not enough to just encourage some children to eat healthier and exercise, he said, because there's also "a big psychological component."
"When it comes to involving the authorities, I don't think we have clear guidelines," he said. "Starting the debate is a good thing. We need more guidance on how to react to the issue."
The Centers for Disease Control and Prevention's Division of Nutrition, Physical Activity and Obesity tries to address the roles of nutrition and physical activity in improving public health and preventing and controlling chronic diseases. It says achieving and maintaining a healthy weight is part of an ongoing lifestyle that can be adopted. It offers resources to help people determine which foods are needed for a healthy diet and promotes regular physical activity to reduce the risk for diseases and control weight.
County workers were alerted to the boy's weight early last year after his mother took him to a hospital for breathing problems. He was diagnosed with sleep apnea, which is characterized by pauses in breathing during sleep and can be weight-related, and he was given a breathing machine.
Parents have lost custody of obese children a few times in the United States, and an opinion piece in the Journal of the American Medical Association in July said putting children temporarily in foster care is in some cases more ethical than obesity surgery, which can involve removing part of the stomach.
Dr. David Ludwig, an obesity specialist at Harvard-affiliated Children's Hospital Boston, said the point isn't to blame parents but rather to act in children's best interest and get them help their parents can't provide.
Dr. Norman Fost, a medical ethicist at the University of Wisconsin's Madison campus, said Monday that foster care wouldn't cure the Ohio boy's obesity but might help.
"The goal is to make him less obese," he said.
Fost said the boy's sleep apnea could be related to his weight and could be imminently dangerous. A target weight of 150 pounds might improve the apnea problem, he said.
The boy's mother said she has worked on the weight issue.
"They are trying to make it seem like I am unfit, like I don't love my child," she told The Plain Dealer newspaper, which didn't reveal her identity because the case could involve abuse.
A public defender, Sam Amata, said Monday the custody removal would be challenged based on the contention that the boy is not in imminent danger.
"We don't feel there's that kind of requisite danger," he said.
While experts say childhood obesity is a growing problem around the country, it's worse than average in the Chicago area.
"A lack of access to healthy food and easy access to unhealthy food, lack of safe places to play, lack of gym in school," said Dr. Dan Felten, pediatrician, Rush University Medical Center.
Dr. Felten says parents have to take responsibility for providing healthy food choices and encouraging exercise.
According to the DCFS, there have been no similar cases where they have taken custody of an obese child in Illinois. If they did, it would be based on a doctor's opinion that the child must be in imminent danger because of parental neglect.
"We should start right away educating parents before they have children...how to make sure their children are healthy," said Dr. Mary Mullen, pediatrician/dietician, Rush University Medical Center, who has co-authored a book on healthy eating for kids.
The Associated Press contributed to this report