Posts tagged with Obesity

Governor’s ambitious plans to improve the health of Michigan residents

By Kathy Barks Hoffman/ Associated Press

Gov. Rick Snyder included himself Wednesday when he laid out goals to make Michigan a healthier state by getting more people into wellness programs, setting up an exchange where citizens can buy health insurance and dealing with residents' expanding waistlines.

During his special message to the Legislature on health and wellness delivered at the Heart of the City Health Center in Grand Rapids, the Republican governor announced he weighed 194 pounds after stepping on a scale. He also disclosed his body mass index — or BMI, which uses height and weight to estimate body fat — is 26.8, putting him in the overweight category.

"I've got a few pounds to lose, folks," the 5'11" governor told dozens of health care advocates gathered at the newly opened clinic.

With a goal of losing 10 pounds by the end of the year, Snyder quipped to reporters that there would be plenty of peer pressure since he plans to post his weight, BMI, blood pressure and cholesterol and blood sugar counts on a state government website where everyone can see how he's doing.

Dealing with Michigan's obesity problem — it ranks 8th nationally among the fattest states — is a priority for Snyder, who said flatly, "We're not healthy." [According to the "F as in Fat" annual report, Kansas ranks 16th in adult obesity, but 18th in childhood obesity. Michigan is actually doing better there at No. 41.]

He wants to give children better access to healthier foods and exercise, and track pediatric obesity by asking doctors to add the BMI measurements of patients under 18 to a state registry.

That emphasis won wide praise from doctors, insurers and consumers.

"Michigan ranks above the national average, with a full 11 percent of our state's children considered overweight," Michigan State Medical Society President Steven Newman said in a statement. "That's not good news for Michigan, and it's even worse news for our kids. ... The governor's focus on nutrition and fitness is a great first step in a better direction."

The governor also wants to get a lot more veterans enrolled in health care offered by the Veterans Administration and outlaw smoking on state beaches. He said it's important to ensure that young pregnant women get prenatal care and that he'll try to expand the state's Health Kids Dental program to more children. Currently only a third of Medicaid-eligible children are covered by the program, and few in the state's largest cities.

One goal that might run into opposition is requiring insurers to cover treatments for autism. One of Lt. Gov. Brian Calley's children suffers from autism, but his efforts to push through legislation requiring the coverage have failed in the Senate. Snyder said "it's time" for Michigan to join the 27 states that require insurers to cover the disorder, brushing aside criticism from business groups that it's a costly mandate they can't afford.

Even as he was laying out ways for the state to better serve residents' health care needs, Snyder called on individuals to take more responsibility for their own health and wellness through what he referred to as the Michigan 4X4 plan. Under the plan, everyone should maintain a healthy diet, engage in regular exercise, get an annual physical exam and avoid all tobacco use, and must have regular checks of their body mass index, blood pressure, cholesterol level and blood sugar level measurements.

As with other initiatives the governor has introduced this year on education and government services, the Snyder administration has created a health dashboard to measure statewide progress on reaching his goals. He urged local communities to identify their own local health priorities, find ways to address them and evaluate their success.

He praised the Marquette community for increasing physical activity by making walking and biking more accessible, planting community gardens, adding farmers markets and developing workplace wellness policies. And he said the state will draw on experts from all communities when it holds an obesity summit in Lansing on Sept. 21 and an infant mortality summit in Ypsilanti on Oct. 17.

Although Republican Attorney General Bill Schuette has joined more than a dozen other attorneys general in a lawsuit challenging federal health care changes, Snyder said he wants the GOP-controlled Legislature to begin implementing requirements in the federal law this fall.

That includes passing legislation setting up Michigan's version of a health insurance exchange called the MI Health Marketplace. Snyder wants to give a nonprofit company the authority to set up the exchange, and warned the federal government will step in with its own plan if Michigan doesn't have plans for an exchange in place by January 2013. More than half a million consumers are expected to purchase a policy through the exchange once its running in 2014.

Snyder urged lawmakers to pass the necessary legislation by Thanksgiving so the state can use federal funding to set up the exchange and meet the requirements in the federal law.

The governor also said he wants to take a "fresh look" at how the state regulates Blue Cross and Blue Shield of Michigan, a nonprofit company that insures 4.3 million state residents and must by law agree to insure anyone who wants coverage.

The Michigan Association of Health Plans, which represents Blue Cross competitors, said it's time to look at what it calls "significant advantages" Blue Cross holds under existing laws. Blue Cross said in a statement that agreed "Michigan's antiquated regulator system" needs change and said it looked forward to helping update the system through new legislation.

"It's going to be a complex discussion, and it's a changing discussion," Senate Majority Leader Randy Richardville, R- Monroe, said of the Blue Cross-related proposals. "We're not going to hurry to do anything."

Snyder also wants to overhaul the 33-year-old state public health code, which doesn't mention electronic records or address many of the changes in medical services over recent decades.

"Health is the foundation for Michigan's economic transformation," Snyder said. "In order to see real improvement in our public health, and to make rising health care costs as manageable as possible, all levels of government, the private sector and individual Michiganders have a part to play."


Half of Americans down a sugar drink every day


By Mike Stobbe/Associated Press

Half of Americans drink a soda or sugary beverage each day — and some are downing a lot.

One in 20 people drinks the equivalent of more than four cans of soda each day, even though health officials say sweetened beverages should be limited to less than half a can.

The Centers for Disease Control and Prevention in Atlanta released the figures Wednesday in a report said to be the government's first to offer national statistics for both adults and kids.

Sweetened drinks have been linked to the U.S. explosion in obesity and related medical problems, and health officials have been urging people to cut back for years. Some officials have proposed an extra soda tax and many schools have stopped selling soda or artificial juices.

But advocates say those efforts are not enough, and on Wednesday a coalition of 100 organizations announced a new push. The effort includes the American Heart Association and the some city health departments who plan to prod companies to stop the sale of sugary drinks on their property or providing them at business meetings — as Boston's Carney Hospital did in April. There will also be new media campaigns, like one starting soon in Los Angeles that will ask "If you wouldn't eat 22 packs of sugar, why are you drinking it?'

The new CDC report may be ammunition. It found:

  • About half the population drinks a sugared beverage each day.
  • Males consume more than females, with teenage boys leading the pack. On average, males ages 12 through 19 drink the equivalent of nearly two cans of soda each day.
  • Poor people drink more than the more affluent. Low-income adults got about 9 percent of their daily calories from sugary beverages; for high-income adults it was just over 4 percent.
  • Blacks get more of their calories from sweetened beverages than other racial and ethnic groups.

The study is based on in-person interviews of more than 17,000 people in the years 2005 through 2008. They were asked to recount everything they ate and drank in the previous day. However, diet sodas, sweetened teas, flavored milks and 100 percent fruit juice did not count.

Healthy-eating recommendations call for people to limit sugary beverages to about 64 calories per day. That's a little less than half of a 12-ounce can of regular Coca-Cola, which is 140 calories.

In other terms: An average can of sugared soda or juice has 10 to 12 teaspoons of sugar.

There have been efforts to reduce children's access to sodas and sports drinks in schools, with beverage companies agreeing to remove full-calorie soft drinks. But the CDC study found more than half of the drinks are consumed at home. Less than 1 percent are bought at schools or day-care centers.

That's why some members of the coalition argue that parents shouldn't drink sweetened beverages, so they don't serve as a poor example at home. They hope drinking soda will become as unfashionable as smoking.

A spokesman for Carney Hospital — the 149-bed Boston facility that stopped allowing full-calorie soft drink sales — said the approach makes sense. When the policy was implemented in April, sales of beverages dropped, but have gone back up, as more people apparently are adjusting to water and other non-sweetened drinks.

The hospital's Dorchester neighborhood has high rates of diabetes and other weight-related illnesses, said spokesman Joe Burnieika. "We can't afford to feed people's bad habits if we can give them a healthy alternative," he said.

In a statement, the American Beverage Association on Wednesday suggested that the coalition's effort was misguided. Citing sales data and some other research, the industry group said sales of full-calorie soft drinks have been declining, which they credited to soda makers offering more no-calorie and low-calorie options and improved calorie labeling on the front.

These initiatives "will contribute far more to solving complex health issues like obesity than (the coalition's) sound bite solution that offers plenty of hype but no substance," the statement said.


If we don’t change, one out of every two adults in U.S. will be obese by 2030

If we don't change our eating, nutrition and exercise habits, we'll be facing a very grim scenario. Researchers predicted that one in every two adults in the U.S. will be obese by 2030, according research reviewed by Agence France Press. That's less than 20 years away.

On present trends, 50-51 percent of American men and 45-52 percent of American women will by 2030 have a body mass index (BMI) of 30 or more, adding as many as 65 million to the country's population of obese adults, says one of the papers. Twenty-four million of these 65 million will be older than 60.

Claire Wang of Columbia University in New York City and Klim McPherson of Oxford University in Britain extrapolated the numbers based on 2007-2008 data. About 32 percent of U.S. adults were obese then, and the trend hasn't decreased. They published their findings in the British medical journal The Lancet. The main Lancet website has other articles and videos about the global obesity pandemic. You can register and peruse the articles for free. The Wang-McPherson study in its entirety is fascinating and scary.


Study shows kids’ fast-food lunches accounted for half their daily calorie need

Researchers from UC San Diego surveyed 544 families that bought lunch at a fast-food restaurant inside a children's hospital, according to this post on They found that the kids derived 51 percent of their daily calorie needs from the lunch, more than 50 percent of their daily sodium, and that 35 percent of the lunch's calories came from fat.

"We found that families perceived fast-food restaurants as easy and cheap, and many were using fast food as a reward for their children," Kerri N. Boutelle, behavioral director of the Weight and Wellness Clinic at the University of California, San Diego and Rady Children's Hospital-San Diego, said in a university news release. "Considering the high prevalence of fast-food consumption by adults as well as kids, it's important to recognize the impact of fast food and its impact on the current obesity epidemic in the U.S."

Although several limitations exist with this study -- researchers don't know how much each person ate and it's not known how many times a week each family visits a fast-food restaurant (is it the occasional reward?) -- it does raise a question about exactly what Boutelle said: "...the impact of fast food and its impact on the current obesity epidemic in the U.S."

There are many, many reasons for the obesity epidemic, ranging from the effects of childhood trauma to the lack of healthy, low-calorie choices at fast-food and regular restaurants.

But it's clear that it's particularly important to look at this in terms of how children are eating, because their food choices and intake are guided and controlled by adults -- parents and other people who make decisions about the food available in neighborhood grocery stores, provided at school lunches, and, yes, on the menus at restaurants.

Which brings up McDonald's Happy Meals. San Francisco adopted an ordinance that goes into effect December 1 of this year that requires restaurants that offer a toy with a meal to adhere to these guidelines in which the meal is limited to:

  • 600 calories
  • 640 mg of sodium
  • 35% total calories from fat (not counting nuts, peanut butter, eggs or low-fat cheese)
  • 10% saturated fat
  • 0.5 grams trans fat

The meal also has to contain half a cup of fruit and three-quarters of a cup of vegetables, unless it's a breakfast Happy Meal.

In the San Diego study, only about half the families bought the Happy Meal because it had a toy. Buying a Happy Meal for a kid is mostly a matter of convenience -- a no- or low-choice package.

McDonald's recently announced changes to its Happy Meal:

New Happy Meal: McDonald’s will begin rolling out the new Happy Meal in September 2011, with the goal of having them available in all 14,000 restaurants during Q1 2012. The new Happy Meal will automatically include both produce (apple slices, a quarter cup or half serving) and a new smaller size French fries (1.1 ounces) along with the choice of a Hamburger, Cheeseburger or Chicken McNuggets, and choice of beverage, including new fat-free chocolate milk and 1% low fat white milk. For those customers who prefer a side choice of apples only, two bags of apple slices will be available, upon request.

It's still not enough to meet San Francisco's standards, which came after some careful consideration of the cost of obesity to its citizens (the first part of the ordinance goes into that in some detail, and is worth a read.)

Nutritionist Marion Nestle posted on her blog a column she wrote for the San Francisco Chronicle about McDonald's changes. She was answering these questions: Wouldn’t it be the best form of activism to encourage people to buy McDonald’s slightly-less-bad-for-you Happy Meals? If the new formulation flops, do you really think McDonald’s will take more baby steps in the same direction? Aren’t you letting perfect be the enemy of the good?

It's an interesting read. Here's a taste:

So let’s get back to the underlying question: Isn’t perfect the enemy of the good? Aren’t baby steps like these in the right direction and, therefore, deserving of support?

I don’t think so. McDonald’s proposed changes are a reason to ask a different question: Is a better-for-you Happy Meal a good choice? Wouldn’t your child be better off eating something healthy, not just slightly healthier?

Couldn’t McDonald’s, the largest fast-food maker in the world, come up with something genuinely healthy that also tastes good?


New approach to obesity counseling ditches emphasis on personal choice, willpower

Instead, a team at Rush University Medical Center in Chicago focuses on three behaviors that will help changes in the brain -- food reward, inhibitory control and time discounting. explained those behaviors this way:

Food reward refers to the pleasure or comfort a person receives from eating. Inhibitory control is resisting eating high-calorie foods in favor of low-calorie foods. Learning how to identify and manage stress will reduce the need for food reward and increase the ability to follow-through on going for the apple instead of the ice cream.

According to the post, "time discounting refers to choosing immediate pleasure from eating over the delayed health benefits of weight loss." Based on research that shows that people who have experienced child trauma use food, among other things, to comfort themselves when they become anxious, I'd add "immediate relief" to "immediate pleasure".

Researchers recommend removing high-fat foods from the environment, shopping for groceries with a list, practicing stress management, and avoiding restaurants and buffets. noted that one of the researchers, Brad Appelhans, a clinical psychologist and obesity researcher, said this:

Telling patients that their obesity is caused by unhealthy personal choices or lack of willpower can be stigmatizing and is unlikely to motivate them to lose weight.

The research is in the Journal of the American Dietetic Association. If you aren't a member, it'll cost you $31.50 to see the research. There's also a write-up by Rush University Medical Center; at this posting, the link's broken, but may be fixed by the time you check it.


It gets worse: being overweight, smoking, diabetes, high blood pressure….all this makes your brain shrink

Here's yet another reason to scratch, claw, push, pull your way onto a path into healthy living: researchers have found that the brains of people who smoke, who are overweight at mid-life or who have diabetes or high blood pressure actually shrink, says Rosie Mestel in the Los Angeles Times' BoosterShots blog in her review of another piece of research coming out of the world-famous Framingham Heart Study.

That's not a good thing.

Researchers followed 1,352 people, all of whom were children of the original group of people in Framingham, MA, who began the study in 1948. When this particular study began, these offspring, whose average age was 54, had their risk factors assessed. A few years later, between the ages 61 and 67, they all had MRI scans of their brains, and their cognitive function was tested.

Brain shrinkage was linked to all four risk factors, though the pattern differed in each case. People with high blood pressure, for example, developed “white matter hyperintensities,” -- basically places in the brain’s white matter where damage is occurring -- at a faster clip than others did. And those who had diabetes in midlife had more rapid shrinkage of the hippocampus, part of the brain that’s crucial for memory. If you smoked, the whole brain shrunk more than if you didn’t. Ditto for being overweight. And more.

The research was published in the journal Neurology.

The post is definitely worth checking out, as Mestel explains why these conditions affect the brain. She also includes a list of the amazing milestones that came out of the Framingham Heart Study. It began in the days when physicians were advertising cigarettes on TV. That's where the link between high cholesterol and heart disease came from. And who doesn't know their cholesterol score today? (And if you don't, you probably should.)

This brings up an interesting issue. In other posts on this site, it's been pointed out that many people who smoke, drink, overeat do it because it's a solution, not a problem. And not smoking, drinking, overeating, etc., causes more pain than continuing. But some people have made the turn, jumped to a different track, awakened to a different life, etc. So, isn't the big dilemma: How can you get to that turning point faster? And what support do you need to stay in a healthier life?

Does anyone want to share her/his story?


Depressed diabetics more likely to go blind

One of the consequences of the increase in obesity in this country is the startling increase in diabetes. A consequence of diabetes is blindness. In fact, the leading cause of blindness in adults in the U.S. is diabetic retinopathy, a disease that damages the eye’s retina. And patients with diabetes who are depressed have a higher risk of developing that disease, according to this Health Behavior News Service review of a five-year study.

Dr. Wayne Katon, one of the study's co-authors and director of health services and psychiatric epidemiology at the University of Washington Medical School in Seattle said:

“Our study controlled for obesity, smoking, sedentary lifestyle and HbA1c levels [test that measures blood sugar levels], and still found that depression was associated with an increased risk of retinopathy.”

“Our findings suggested that psychobiologic changes associated with depression such as increased cortisol levels and activity of blood-clotting factors may be linked to the development of retinopathy.”

The research was published in the journal General Hospital Psychiatry.


Good news: More than half of Alzheimer’s cases may be preventable

That's what Dr. Deborah Barnes, a mental health researcher at the San Francisco VA Medical Center and associate professor of psychiatry at the University of California, San Francisco., told the 2011 meeting of the Alzheimer's Association International Conference on Alzheimer's Disease in Paris, France. The meeting is being covered by

Analyzing data from studies around the world involving hundreds of thousands of participants, Barnes concluded that worldwide, the biggest modifiable risk factors for Alzheimer's disease are, in descending order of magnitude, low education, smoking, physical inactivity, depression, mid-life hypertension, diabetes and mid-life obesity.

In the United States, Barnes found that the biggest modifiable risk factors are physical inactivity, depression, smoking, mid-life hypertension, mid-life obesity, low education and diabetes.

These risk factors are associated with up to 51 percent of people who have Alzheimer's worldwide (17.2 million people out of 34 million) and up to 54 percent of people who have Alzheimer's in the United States (2.9 million people out of 5.4 million), according to Barnes. Unless significant changes occur, the number of people with Alzheimer's disease is expected to triple over the next 40 years. And, although this study is promising for prevention approaches, research must still be done that show if the risk factors are changed, then people will not get the disease.


Obesity hits more boomers than others in US

Lauran Neergaard/Associated Press Medical Writer

Baby boomers say their biggest health fear is cancer. Given their waistlines, heart disease and diabetes should be atop that list, too.

Boomers are more obese than other generations, a new poll finds, setting them up for unhealthy senior years.

And for all the talk of "60 is the new 50" and active aging, even those who aren't obese need to do more to stay fit, according to the Associated poll.

Most baby boomers say they get some aerobic exercise, the kind that revs up your heart rate, at least once a week. But most adults are supposed to get 2½ hours a week of moderate-intensity aerobic activity — things like a brisk walk, a dance class, pushing a lawn mower. Only about a quarter of boomers polled report working up a sweat four or five times a week, what the average person needs to reach that goal.

Worse, 37 percent never do any of the strength training so crucial to fighting the muscle loss that comes with aging.

Walking is their most frequent form of exercise. The good news: Walk enough and the benefits add up.

"I have more energy, and my knees don't hurt anymore," says Maggie Sanders, 61, of Abbeville, S.C. She has lost 15 pounds by walking four miles, three times a week, over the past few months, and eating better.

More boomers need to heed that feel-good benefit. Based on calculation of body mass index from self-reported height and weight, roughly a third of the baby boomers polled are obese, compared with about a quarter of both older and younger responders. Only half of the obese boomers say they are are regularly exercising.

An additional 36 percent of boomers are overweight, though not obese.

The nation has been bracing for a surge in Medicare costs as the 77 million baby boomers, the post-war generation born from 1946 to 1964, begin turning 65. Obesity — with its extra risk of heart disease, diabetes, high blood pressure and arthritis — will further fuel those bills.

"They're going to be expensive if they don't get their act together," says Jeff Levi of the nonprofit Trust for America's Health. He points to a study that found Medicare pays 34 percent more on an obese senior than one who's a healthy weight.

About 60 percent of boomers polled say they're dieting to lose weight, and slightly more are eating more fruits and vegetables or cutting cholesterol and salt.

But it takes physical activity, not just dieting, to shed pounds. That's especially important as people start to age and dieting alone could cost them precious muscle in addition to fat, says Jack Rejeski of Wake Forest University, a specialist in exercise and aging.

Whether you're overweight or just the right size, physical activity can help stave off the mobility problems that too often sneak up on the sedentary as they age. Muscles gradually become flabbier until people can find themselves on the verge of disability and loss of independence, like a canoe that floats peacefully until it gets too near a waterfall to pull back, Rejeski says.

He led a study that found a modest weight loss plus walking 2½ hours a week helped people 60 and older significantly improve their mobility. Even those who didn't walk that much got some benefit. Try walking 10 minutes at a time two or three times a day, he suggests, and don't wait to start.

"I don't think there's any question the earlier you get started, the better," says Rejeski, who at 63 has given up running in favor of walking, and gets in 30 miles a week. "If you allow your mobility to decline, you pay for it in terms of the quality of your own life."

When it comes to diseases, nearly half of boomers polled worry most about cancer. The second-leading killer, cancer does become more common with aging.

"It's the unknown nature, that it can come up without warning," says Harry Forsha, 64, of Clearwater, Fla., and Mill Spring, N.C.

Heart disease is the nation's No. 1 killer, but it's third in line on the boomers' worry list. Memory loss is a bigger concern.

"On a scale of one to 10, seven or eight," is how Barry Harding, 61, of Glen Burnie, Md., puts it. "It's more talked about now, Alzheimer's and dementia."

In fact, more than half of boomers polled say they regularly do mental exercises such as crossword puzzles.

After Harding retires, he plans to take classes to keep mentally active. For now, he's doing the physical exercise that's important for brain health, too. He also takes fish oil, a type of fatty acid that some studies suggest might help prevent mental decline.

Sanders, the South Carolina woman, says it was hard to make fitness a priority in her younger years.

"When you're younger, you just don't see how important it is," says Sanders, whose weight began creeping up when breast cancer in her 40s sapped her energy. Now, "I just know that my lifestyle had to change."

The poll was conducted from June 3-12 by Knowledge Networks of Menlo Park, Calif., and involved online interviews with 1,416 adults, including 1,078 baby boomers born between 1946 and 1964. The margin of sampling error for results from the full sample is plus or minus 4.4 percentage points; for the boomers, it is plus or minus 3.3 percentage points.

Knowledge Networks used traditional telephone and mail sampling methods to randomly recruit respondents. People selected who had no Internet access were given it free.


Should parents lose custody of their morbidly obese children?

By Lindsey Tanner

Associated Press Medical Writer

Should parents of extremely obese children lose custody for not controlling their kids' weight? A provocative commentary in one of the nation's most distinguished medical journals argues yes, and its authors are joining a quiet chorus of advocates who say the government should be allowed to intervene in extreme cases.

It has happened a few times in the U.S., and the opinion piece in Wednesday's Journal of the American Medical Association says putting children temporarily in foster care is in some cases more ethical than obesity surgery.

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 that for whatever reason their parents can't provide.

State intervention "ideally will support not just the child but the whole family, with the goal of reuniting child and family as soon as possible. That may require instruction on parenting," said Ludwig, who wrote the article with Lindsey Murtagh, a lawyer and a researcher at Harvard's School of Public Health.

"Despite the discomfort posed by state intervention, it may sometimes be necessary to protect a child," Murtagh said.

But University of Pennsylvania bioethicist Art Caplan said he worries that the debate risks putting too much blame on parents. Obese children are victims of advertising, marketing, peer pressure and bullying — things a parent can't control, he said.

"If you're going to change a child's weight, you're going to have to change all of them," Caplan said.

Roughly 2 million U.S. children are extremely obese. Most are not in imminent danger, Ludwig said. But some have obesity-related conditions such as Type 2 diabetes, breathing difficulties and liver problems that could kill them by age 30. It is these kids for whom state intervention, including education, parent training, and temporary protective custody in the most extreme cases, should be considered, Ludwig said.

While some doctors promote weight-loss surgery for severely obese teens, Ludwig said it hasn't been used for very long in adolescents and can have serious, sometimes life-threatening complications.

"We don't know the long-term safety and effectiveness of these procedures done at an early age," he said.

Ludwig said he starting thinking about the issue after a 90-pound 3-year-old girl came to his obesity clinic several years ago. Her parents had physical disabilities, little money and difficulty controlling her weight. Last year, at age 12, she weighed 400 pounds and had developed diabetes, cholesterol problems, high blood pressure and sleep apnea.

"Out of medical concern, the state placed this girl in foster care, where she simply received three balanced meals a day and a snack or two and moderate physical activity," he said. After a year, she lost 130 pounds. Though she is still obese, her diabetes and apnea disappeared; she remains in foster care, he said.

In a commentary in the medical journal BMJ last year, London pediatrician Dr. Russell Viner and colleagues said obesity was a factor in several child protection cases in Britain. They argued that child protection services should be considered if parents are neglectful or actively reject efforts to control an extremely obese child's weight.

A 2009 opinion article in Pediatrics made similar arguments. Its authors said temporary removal from the home would be warranted "when all reasonable alternative options have been exhausted."

That piece discussed a 440-pound 16-year-old girl who developed breathing problems from excess weight and nearly died at a University of Wisconsin hospital. Doctors discussed whether to report her family for neglect. But they didn't need to, because her medical crisis "was a wake-up call" for her family, and the girl ended up losing about 100 pounds, said co-author Dr. Norman Fost, a medical ethicist at the university's Madison campus.

State intervention in obesity "doesn't necessarily involve new legal requirements," Ludwig said. Health care providers are required to report children who are at immediate risk, and that can be for a variety of reasons, including neglect, abuse and what doctors call "failure to thrive." That's when children are severely underweight.

Jerri Gray, a Greenville, S.C., single mother who lost custody of her 555-pound 14-year-old son two years ago, said authorities don't understand the challenges families may face in trying to control their kids' weight.

"I was always working two jobs so we wouldn't end up living in ghettos," Gray said. She said she often didn't have time to cook, so she would buy her son fast food. She said she asked doctors for help for her son's big appetite but was accused of neglect.

Her sister has custody of the boy, now 16. The sister has the money to help him with a special diet and exercise, and the boy has lost more than 200 pounds, Gray said.

"Even though good has come out of this as far as him losing weight, he told me just last week, 'Mommy, I want to be back with you so bad.' They've done damage by pulling us apart," Gray said.

Stormy Bradley, an Atlanta mother whose overweight 14-year-old daughter is participating in a Georgia advocacy group's "Stop Childhood Obesity" campaign, said she sympathizes with families facing legal action because of their kids' weight.

Healthier food often costs more, and trying to monitor kids' weight can be difficult, especially when they reach their teens and shun parental control, Bradley said. But taking youngsters away from their parents "definitely seems too extreme," she said.

Dr. Lainie Ross, a medical ethicist at the University of Chicago, said: "There's a stigma with state intervention. We just have to do it with caution and humility and make sure we really can say that our interventions are going to do more good than harm."