Table of Contents
The incidence of childhood obesity has increased drastically, including severe childhood obesity and obesity related comorbid conditions in the United States. When parents will not or cannot follow through with steps needed to decrease the impact of their child’s obesity, the following question arises: does such noncompliance constitute reportable child neglect and consideration of coercive state intervention? This paper will examine whether childhood obesity is a reflection of negligence.
The American Obesity Epidemic
In the United States childhood obesity has become a serious problem putting children at risk for poor health. Over the past couple decades, childhood obesity rates have steadily increased. According to the Centers for Disease Control and Prevention, the prevalence of obesity was 18.5% and affected about 13.7 million children and adolescents. The Centers for Disease Control and Prevention also reports, obesity prevalence was 13.9% among two to five-year-olds, 18.4% among six to eleven-year-olds, and 20.6% among twelve to nineteen-year-olds.
According to Hruby and Hu (2015), if secular trends continue, by 2030 an estimated 38% of the world’s adult population will be overweight and another 20% will be obese.
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Serious short-term and long-term health issues can arise in children whom are classified as obese. There are multiple significant health consequences of childhood obesity that can arise but may not become apparent until adulthood. To be more specific cardiovascular disease, diabetes, musculoskeletal disorders, and even certain types of cancer can become more apparent in the child’s adult years. Along with physical concerns of childhood obesity, there are also mental and emotional effects that should be taken into consideration, such as low self-esteem which can arise from being bullied in school or in the community. There is a growing consensus that multiple factors are contributing to childhood obesity disparities among racial/ethnic minorities. Such factors include cultural, family, community/environmental and psychological factors in addition to socioeconomic status.
Causes of Obesity
The mechanism of obesity development is not fully understood, and it is believed to be a disorder with multiple causes. Causes that play a pivotal role in the rising prevalence of obesity worldwide include environmental factors, lifestyle preferences, and cultural environment.
Research has examined how genetics can play a role in the development of obesity, however it was found to not be the cause of the dramatic increase of childhood obesity. According to Sahoo, Sahoo, Choudbury, Sufi, Kumar, and Bhadoria (2015), some studies have found that body mass index (BMI) is 25 – 40% heritable but genetic susceptibility often needs to be coupled with contributing environmental and behavioral factors in order to affect weight. One factor that significantly plays a role in obesity is a sedentary lifestyle. Television viewing and other electronic media use among children and adolescents has increased in the past recent years. According to Sahoo et al, (2015), research suggests the number of hours children spend watching television correlates with their consumption of the most advertised goods, including sweetened cereals, sweets, sweetened beverages, and salty snacks.
Apart from sedentary lifestyles, other environmental factors have reduced physical activity opportunities. In the recent years’ physical activity and safe environments to be active in have taken a decrease.
Children in the past would either walk or ride their bicycle to school. Now days, parents are the ones transporting their children to school. According to Sahoo et. al, (2015), parents said they drove their children to school since their homes were too far away from the school along with there being no safe walking route to school, fear of child predators, and out of convenience for the child. Another environmental factor is children who live in unsafe areas or who do not have access to safe, well-lit walking routes have fewer opportunities to be physically active.
Socio-cultural factors have also been found to influence the development of obesity. As a society, food tends to be used as a reward, as a means to control others, and as part of socializing. With the above factors listed, it can encourage the development of unhealthy relationships with food and thereby increase the risk of obesity developing. It is also important to consider the family factor in association with the increase of childhood obesity cases. According to Sahoo et. al. (2015), studies have shown that having an overweight mother and living in a single parent household are associated with overweight and childhood obesity. Food preferences of the family and the types of food available in the house can influence what the children eat. Family mealtimes can have an influence of the type of food consumed and the portion size of that food. Lastly, family habits have influence on children whether they are sedentary or active.
Beauchamp and Childress: Four Ethical Principles
Thomas L Beauchamp and James F Childress are best known for their work in medical ethics. These American philosophers published a book, Principles of Biomedical Ethics, which became a must-read for researchers, academics, and medical students. These renowned gentlemen developed the four ethical principles. The four ethical principles are respect for autonomy, beneficence, nonmaleficence, and justice. These four ethical principles provide healthcare workers with a direction to estimate the significance of the ethical decision in a clinical setting.
The principle of autonomy emphasizes patients have the right to make decisions about their medical treatment. Healthcare providers are obligated to be truthful to their patients and respect the choices that are made by the patients. The ethical principle of beneficence requires healthcare professionals to treat patients in a way that provides maximum benefit to that specific patient. On the other hand, the ethical principle nonmaleficence assures the duty of healthcare staff to avoid causing any harm to the patient. In other words, healthcare professionals have the responsibility to protect their patients. The last ethical principle, justice, has the meaning of equality and fairness. In the healthcare industry, all individuals have equal rights in terms of seeking healthcare and to participate in their individualized plan of care.
Support of Childhood Obesity as Medical Neglect
According to Dominquez (2014), a proposal by some members of the pediatric medical community recommends classifying childhood obesity as neglect when the parents or guardians of the child fail to seek medical care, provide recommended medical care, or control their child’s behavior so that the child is not at risk of serious harm or death.
In the scenario provided for this essay, four-year-old Samantha weighs one-hundred and twenty pounds and her parents have been educated on how to improve her diet and increase her activity level. However, the child continues to gain weight and has also been diagnosed with diabetes mellitus type two, sleep apnea, and hyperlipidemia. The four ethical principles defined previously in this paper can be applied to this situation as follows:
- Beneficence requires nurses and physicians to seek interventions to reverse the physical and psychological derangements that interfere with the child’s well-being. According to Perryman and Sidoti (2015), when pediatric patients are not given the opportunity to explore less aggressive means to lose weight and reduce comorbid conditions through dietary and exercise changes, and not well-informed of long-term follow up required by surgery or undesirable side effects of medications, beneficence is violated.
- Nonmaleficence, or do no harm, is another obligation for helping professionals have to refrain from actions that risk hurting their patients. In this case, it is important for the healthcare team to consider this ethical principle when contemplating treatment options for Samantha and which interventions have the potential to do harm. Although Samantha’s physicians have educated the parents about lifestyle modifications for their child, they have failed to implement them into her daily routine. This placed harm on Samantha with the new diagnosis of several comorbidities of obesity at such a young age.
- According to Perryman and Sidoti (2015), autotomy, or the right patient’s right to independently self-govern and select options based on their own wishes, is forfeited as children are not able to make health-related choices. However, autonomy would allow the child to participate in the creation and implementation of a plan, as well as actively pursue that chosen destiny; however, legally and ethically, that responsibility falls to the parent which Samantha’s parents were noncompliant with the recommendations for their daughter that the healthcare team recommended.
- Justice demands that all patients have to right of equality and fairness with the care they receive. Samantha has received fair care from her healthcare team as the providers have been diligently working with her family to help improve her overall health, but it unfortunately has not benefited Samantha because of her parent’s noncompliance with the education and instruction given by the team.
Healthcare providers are mandated to report medical neglect when a child’s health and safety is at risk due to failure or refusal on the family’s part to provide treatment or provide access to treatment. However, before a referral for medical neglect is reported, healthcare providers must assess for the presence of medical comorbidities and the potential for those comorbidities to cause imminent harm. Identified comorbidities to childhood obesity include diabetes, hypertension, sleep apnea, uncontrolled asthma, orthopedic concerns, and/or psychological comorbidities.
Against of Childhood Obesity as Medical Neglect
Within legal boundaries, parents have the right to raise their children as they wish, and they have the responsibility to protect their children from harm. This creates an ethical dilemma when children become obese. On the opposing side, the four ethical principles can be applied to Samantha’s scenario as follows:
- Beneficence was applied in Samantha’s scenario by the healthcare providers informing the parents about lifestyle changes that need to occur in their daughter’s life. However, more intervention could have been done to try and help Samantha prevent her new diagnosis.
- Nonmaleficence was applied by the healthcare provides working with Samantha and her family. Although, the only intervention the parents were informed on was changing her lifestyle and diet habits. Other interventions could have been offered and implemented to help prevent one, if not all of, the child’s new diagnosis of diabetes mellitus type two, hyperlipidemia, and sleep apnea.
- Autonomy was previously defined as the right to make his or her own decisions regarding the patient’s medical care. Ultimately the parents of Samantha act as the decision makers for their child in the areas of nutrition and activity because according to the CDC, children do not yet possess the maturity and capacity needed to make health-related choices.
- Justice was applied to the case scenario, however there could have been more implementation presented by Samantha’s healthcare team. This team has been working this case for the past couple years and there has been no shown compliance to that recommendation. The team should have went more in depth about how serious Samantha’s condition is, what she is at risk of being diagnosed with, and the potential risks that could develop in adulthood.
Personal Stance
Personally, I do believe childhood obesity is a form and should be recognized as child neglect. Each generation of children is becoming heavier and, as a result, contracting serious health conditions. Parents have a responsibility to recognize when their child is developing an unhealthy weight pattern and take steps to curb their weight gain.
Children do not become obese overnight. Parents of a child who is obese contribute to the issue by allowing or failing to recognize their child’s overindulgence in unhealthy food. However, it is understandable that parents are unable to monitor all aspects of their child’s food consumption, as the child is at school or daycare during the day and the parents are not always present when the child is eating. Although parents are not always there to monitor their child’s eating habits, they should be able to recognize their child’s unhealthy weight gain and lack of exercise.
Taking a step back and looking at this from a parent’s point of view, my opinion really does not change. As a parent it is your duty to look out for your child. The development of obesity in your own child is the failure on the parent’s part because they were unable to recognize and reverse the situation by implementing new lifestyle modifications for their child. Children are not capable to know the impact of eating sugary and fatty food but rather need guidance from their parents to provide them with the education of what is healthy and unhealthy. However, I am not saying the child cannot indulge in a few sugary foods but rather indulge in moderation.
Personal Reflection
This ethical essay assignment was a benefit to my nursing school education. Reviewing the four ethical principles again this semester was beneficial but the application of them was the most beneficial. Knowing how to apply these principles to a scenario will be helpful in my future practice if I were to ever encounter an ethical situation similar to this or a completely different ethical situation. Thinking about this case and the ethical principles, it was hard to develop the opposing side of childhood obesity as medical neglect. The reason being is it was difficult to put my personal views aside in the beginning. Once I was able to fully disregard my personal thoughts, I was able to complete that section. This put it in perspective how hard it may be in practice to disregard strong personal views or biases on an ethical topic like this, but it is always important to look at both sides of a dilemma such as childhood obesity.
Conclusion
Unfortunately, childhood obesity is increasing at an alarming rate, and efforts to curb this epidemic and its consequences are being pursued appropriately. Family dynamics play a critical role in childhood obesity. Although parents have the right to make their children’s health decisions, including diet and exercise, when does it reach a point where enough is enough. Through ethical family-based interventions focused on nutrition and physical activity, the entire family can create and maintain a health lifestyle, which is essential in preventing and treating the childhood obesity epidemic. The question still is, will the family follow through with the plan and if they do not, will anything arise from their chosen actions.
