Suffer the children who don’t fit the mold

Imagine having a daughter with a rare condition that is poorly understood and health authorities seem disinterested in helping to diagnose. It’s not that girls and boys just like your daughter haven’t been seen throughout history, but today she’s mocked and viewed as a freak and everyone is pointing the blame at you — so much so, that government officials have taken your daughter away and made her a ward of the state.

An incredible story from Britain describes an eight-year old girl in West Cumbria removed from her home. Her transgression? She stands nearly a foot taller than other children her age — 5 feet! — and wears clothes six sizes larger.

First the news, as reported by the News & Star:

‘Too Fat’ Girl, 8 Taken Into Care

AN EIGHT-YEAR-OLD girl from west Cumbria became so fat she was taken from her parents and put into care. The girl is 5 feet tall and a size 16 – six sizes bigger than the average for her age. She has also suffered several health problems associated with her weight.

But her parents say they are devastated, claiming her size is due to a medical problem or genetics, not a poor diet. Her mother, who cannot be named for legal reasons, spoke to the News & Star from the family’s terraced home, which is plastered with photos and paintings of the girl. They spoke out just two months after research showed that west Cumbria is facing a health time bomb, with 40 per cent of its residents classified as overweight, and another 17 per cent obese. The girl’s mother said she and her partner will fight to get their daughter back.

She added: “Our world has fallen apart. Our daughter doesn’t over-eat and she’s active. I always put her first and I’d do anything to get her back. She’s always been chubby but she’s always out playing with other kids....”

It is the first time that Cumbria County Council has removed a child from its parents because of obesity....[Anne Ridgway] said “Parental behaviour that leads to childhood obesity can be a form of neglect.” ...It may not be an immediately life-threatening issue, but it can affect a child’s life chances, their potential and long-term health.

The Cumbria Primary Care Trust has started measuring children’s heights and weights.

There are numerous causes for extraordinarily tall and large children, including endocrine disorders, skeletal dysplasias, to genetics, according to a review by pediatricians at the University Calgary, who said “no treatment is usually necessary.” In past eras, she might have been described as having “gigantism,” first recognized in the 1800s, consisting of many conditions characterized by extreme physical size and height.

While there are multiple unexplained aspects to accelerated growth in size, according to Dr. Erica A. Eugster, M.D., Assistant Clinical Professor of Pediatrics, Pediatric Endocrinology/Diabetology, Riley Hospital in Indianapolis, Indiana, the most common conditions associated with it that have been identified in the medical literature include:

Normal variation

Genetic tall stature

Endocrine abnormalities

Precocious puberty

Hyperthyroidism

Gigantism

Exogenous obesity

Syndromes

Sotos

Beckwith-Wiedemann

Marfan

Homocystinuria

Fragile X

Sex chromosome aneuploidy

Klinefelter syndrome

47, XYY or 47, XXX

The most spurious is the term “exogenous obesity” — the idea that children grow exceedingly larger because they’re eating too much or too much bad foods. It was promoted by the pharmaceutical and weight loss industries which, back in the 1960s, was advocating putting children and adults on appetite suppressant drugs, like amphetamines and phentermine. Countless numbers of fat adults today recount being put on these drugs as kids. A 1970s review by the U.S. Food and Drug Administration of more than 200 clinical studies claiming effectiveness of amphetamine-like drugs for weight loss, however, found that all drug-related weight changes were small and short-term, losses that weren’t sustained. Nearly half a century later, the clinical evidence continues to show that no pharmacological treatment for obesity produces any lasting or notable effect on size. For example, researchers reported in the 2002 issue of the International Journal of Obesity, an examination of 108 randomized clinical trials and found modest short-term effects, never exceeding 4 kg over a placebo. Given the universal failure of diet drugs to produce longterm weight loss, the weight loss industry has moved to promoting obesity as a “disease” that requires life-long drug treatment or surgical interventions, despite the lack of evidence of long-term effectiveness or of any actual health benefits, especially over the side effects.

The Agency for Healthcare Research and Quality, in its 2004 Evidence Report/Technology Assessment report, “Pharmacological and Surgical Treatment of Obesity,” found no medical evidence exists in the medical literature to support “either pharmaceutical or surgical treatment of adolescent and pediatric patients.”

Similarly, the idea of “exogenous obesity” in children has led to inordinate volumes and varieties of dietary and lifestyle recommendations that have been popularized in consumer media, public policy and public health programs to address obesity. But, of course, as we’ve reviewed numerous times, no weight loss/management intervention in children has been able to provide evidence of effectiveness. The lack of evidence is a marked mismatch to the public’s focus on diets and comprehensive obesity preventive programs for children, according to researchers with the International Epidemiological Association.

But the key to leading readers to a more balanced perspective on this young girl’s situation is simply to note her height. It shows most clearly that this isn’t simply a matter of “obesity.” The belief that obesity in children leads to increases in their height has led to images that far exceed the evidence.

The increase in height of populations over generations is primarily a reflection of rising socioeconomic levels and the improved availability of food and healthcare, not obesity. In fact, it is short stature that’s long been recognized by healthcare professionals as being a sign of (besides family genes) poor diets and undernutrition, and lower socioeconomic status. Tallness generally indicates genetics, as well as lower levels of poverty, better nutritional status and healthcare.

The increase in the prevalence of fat children among the population stats for France between 1992 and 2000, for example, was linked to height increases of a mere 1.5cm in boys and 0.9cm in girls; and 1cm to 4cm among low-income children in Chile.

But it has been well-recognized in the medical literature for decades that obesity’s effect on the height of individual children is modest at best. In a 1979 issue of Annals of Human Biology, for example, researchers at the University of Pennsylvania examined 4,400 children between the ages of 9 and 15, and found that even the most obese girls “had not been significantly taller than their nonobese peers at any age.” They concluded:

In agreement with earlier reports, these longitudinal data indicate a consistent but minimal height advantage for youngsters with early onset obesity when compared to their age and sex-matched non-obese peers. The height advantage can be parcelled out almost equally to differences in length by one year of age and to differences in rate of skeletal maturation during adolescence. In our analyses, adolescent skinfold thickness, as an index of degree of “overnutrition", did not substitute for either of those variables or contribute more than a very small amount of additional information to the prediction of adolescent height.

“Overeating” might make a child a few pounds larger than they were genetically meant to be, but not significantly taller. And as medical professionals know, it’s biologically impossible for food alone to make a young 8-year old child an extraordinarily foot taller than her peers.

So, not surprisingly, the young girl’s mother in today’s news has said her daughter eats normally, is active and plays hard.

But no one believes her.

While we don’t know the full story or medical history of this young girl, clearly many are quick to jump to conclusions that since she is big, she must be “overeating” — while ignoring biological facts about weight and size, and her height. Her story sounds remarkably similar to the eight-year old boy in North Tyneside, reported in February.

This girl is being used in the political wrangling surrounding “childhood obesity” and being held up as an example of the “crisis” of children not eating “right.” As today’s news reports have illustrated, she’s being made the poster child of those hyping an obesity “health time bomb” to justify growing governmental interventions into our diets and lifestyles. The National Obesity Forum told the Times that she “was the latest in a significant but small number of children so obese they have been taken into care.” Anne Ridgway, chairman of the Cumbria Local Safeguarding Children Board, which coordinates multiple agencies to “safeguard and promote the welfare of children,” equated childhood obesity to a form of parental neglect.

This story comes fast on the heels of recent news stories reporting the public health director of Cumbria Primary Care trust, John Ashton, as saying West Cumbria’s obesity crisis will soon cripple the National Health Services. As the Times recently reported:

[T]he area has one of the highest concentrations of obese people in England. A report by researchers from Portsmouth and Southampton universities ranks West Cumbria as a blackspot because of the size of its fat population.... Professor John Ashton... warned that if the trend continued, the NHS would be unable to cope with the increase in weight-related illnesses.

“The prediction is that unless we do something drastic about trends in obesity and ‘couch-potatohood’ - that is people spending their time watching television rather than doing any physical activity - the number of people with diabetes will increase threefold in 10 years.”...

Dr Rebecca Wagstaff, consultant in public health for the Cumbria trust, said: “People in disadvantaged communities are more likely to be overweight because they tend to have a poorer diet. “Healthy foods can be seen as more expensive....”

Mike Graham, senior public health development specialist for Cumbria PCT, added: “Obesity is going to be the biggest risk to public health. The biggest risk was smoking and we are dealing with that now.... To help combat the problem, a £100,000 grant has been given by the national MEND initiative to West and North Cumbria, which will be used to help 588 families with obese and overweight children.... Carlisle United football club has also teamed up with a local teenager to start a club for overweight kids, while an American-style fat camp has been running at Newton Rigg, near Penrith.

Today’s news story of this little girl and her mother is another tragic example of exploiting extreme examples to exaggerate a crisis of childhood obesity... at the detriment of this child and her family, and all children and families, and at the expense of bringing better understanding of children’s natural diversities in size.

© 2007 Sandy Szwarc