Boston pediatrician David Ludwig, the center of a media firestorm this week, wants to set the record straight on his view that a state should intervene in the most extreme cases of child obesity.

Ludwig and co-author Lindsey Murtagh at the Harvard School of Public Health triggered a backlash with an opinion piece in a leading U.S. medical journal about what could be done about highly overweight youngsters.

They argued that when all other efforts failed, a state should consider putting high-risk obese kids in foster care, and said doing so may be the more ethical choice that could avert drastic measures like weight-loss surgery.

Ludwig, of Boston's Children's Hospital, has since responded to dozens of e-mails this week from angry and terrified parents. Other medical experts have questioned the rationale of removing a child from an otherwise functional and supportive family if they are obese.

In his first interview since the backlash began, Ludwig said the article was meant to promote a dialogue on childhood obesity, which has become a life-threatening problem for many youngsters.
"It's absolutely understandable that if someone with an obese child heard the government could swoop in and take that child away, (they would) be frightened and outraged," Ludwig told Reuters. "I want to emphasize that foster care should only be the last resort when all other options have failed."

In his replies to parents, Ludwig has provided copies of his opinion piece, published this week in the Journal of the American Medical Association, that says there is a role for the state when it comes to helping obese children, but removing them from a home is very rarely the solution.

"It's just been heartbreaking to see how the story has been wildly exaggerated by some of the media, causing a great deal of pain and suffering for people," Ludwig said.

With at least 20 million overweight and obese children in the United States and some 2 million of those kids at the very highest risk, childhood obesity may be the "most important threat that exists to this generation of children," he said.

But placing a youngster in foster care "should absolutely not be an option" for most of the highest risk cases.

And that is what Ludwig and Murtagh wrote in the piece, he said. To prove his point and calm the fury that has erupted, JAMA is making the full text of the piece available free to the public for a week at: http://jama.ama-assn.org/content/306/2/206.full

Ludwig explained that state intervention could include financial support to families, social services, access to safe recreation areas and even parenting courses to help manage a child's uncontrolled eating habits.

In 99 percent of the most serious cases, removing a child from a home is not an option. Ludwig said that in over 15 years of treating some 10,000 patients battling obesity he only knows of one case where the child was taken from parents.

"The ultimate answer to the obesity epidemic is not to blame parents, it's to create a more healthful and supportive society," Ludwig said.

"But until we get there, what do we do about that 14-year-old, 400-pound child who's not facing increased risk of illness 20 years from now, but who's facing life-threatening complications today?" he said.