© Plain Dealer fileEven though the state health department estimates more than 12 percent of third-graders statewide are severely obese -- that could mean 1,380 in Cuyahoga County alone -- this is the first time anyone in the county or the state can recall a child being taken from a parent for a strictly weight-related issue.

Cleveland, Ohio -- An 8-year-old Cleveland Heights boy was taken from his family and placed in foster care last month after county case workers said his mother wasn't doing enough to control his weight.

At more than 200 pounds, the third-grader is considered severely obese and at risk for developing such diseases as diabetes and hypertension.

But even though the state health department estimates more than 12 percent of third-graders statewide are severely obese -- that could mean 1,380 in Cuyahoga County alone -- this is the first time anyone in the county or the state can recall a child being taken from a parent for a strictly weight-related issue.

The case plays into an emerging national debate that has some urging social-service agencies to step in when parents have failed to address a weight problem.

Others suggest there's hypocrisy in a government that would advocate taking children away for being overweight while saying it's OK to advertise unhealthy food and put toys in fast-food kids' meals.

Cuyahoga County does not have a specific policy on dealing with obese children. It removed the boy because case workers considered this mother's inability to get her son's weight down a form of medical neglect, said Mary Louise Madigan, a spokeswoman for the Department of Children and Family Services.

They said that the child's weight gain was caused by his environment and that the mother wasn't following doctor's orders -- which she disputes.

"This child's problem was so severe that we had to take custody," Madigan said. The agency worked with the mother for more than a year before asking Juvenile Court for custody of the child, she said.

Lawyers for the mother, a substitute elementary school teacher who is also taking vocational school classes, think the county has overreached in this case by arguing that medical conditions the boy is at risk for -- but doesn't yet have -- pose an imminent danger to his health.

They question whether the emotional impact of being yanked from his family, school and friends was also considered.

"I think we would concede that some intervention is appropriate," Juvenile Public Defender Sam Amata said. "But what risk became imminent? When did it become an immediate problem?"

Children are ordinarily removed from their homes for physical abuse, neglect or undernourishment.

Amata said that in his decades as a public defender, he has seen children left in homes with parents who have severe drug problems or who have beaten their children, with the reasoning that there isn't an immediate danger to the child.

In this case, Amata said, other than having a weight problem, the boy was a normal elementary school student who was on the honor roll and participated in school activities.

Records show the child's only current medical problem, sleep apnea, is being treated and that he wears a machine nightly that helps and monitors his breathing.

"They are trying to make it seem like I am unfit, like I don't love my child," the boy's mother said.

"Of course I love him. Of course I want him to lose weight. It's a lifestyle change, and they are trying to make it seem like I am not embracing that. It is very hard, but I am trying."

The mother and the boy are not named in this story because The Plain Dealer does not generally identify those involved in abuse cases.

The mother said that social workers took her son from his school on Oct. 19 and told her she could see him only once a week for two hours. The boy is living in a foster home.

Next month, the two sides will debate the case in front of a Juvenile Court magistrate, who will decide what is in the boy's best interest. A trial is set on the child's 9th birthday.

Rainbow hospital program for kids, families

County workers were alerted to the child's weight in early 2010 after his mother took him to a hospital for breathing problems. He was diagnosed with sleep apnea, which can be weight-related, and was given the breathing machine. Social workers began to monitor him under what the county calls protective supervision.

Last year, the boy lost weight but in recent months began to gain it back rapidly. That's when the county moved to take the child, records show.

The mother said that when she found out that other kids and a sibling might be giving her son extra food, she tried to put a stop to it and explain to him that he could eat only certain foods.

She tried to follow the recommendations of the doctors, such as getting him a bike and encouraging him to get exercise.

The mother wonders what role genetics plays in the boy's condition -- both she and his father and some other family members are overweight, she said. However, she also has a 16-year-old son who is tall and thin.

The mother agreed to enroll the child in a special Rainbow Babies & Children's Hospital program called Healthy Kids, Healthy Weight.

That program has evaluated more than 900 overweight and obese children from the ages of 4 to 8 since 2005. A team of specialty doctors, nutritionists, psychologists and others treat the children and work to educate families about creating healthy eating habits.

Dr. Naveen Uli, a pediatric endocrinologist and co-director of the program, said he is seeing more children who are quickly developing diseases that in the past were seen only in adults, like Type 2 diabetes and hypertension. These can affect a person's health, life span and health care costs, he said.

But he said interventions need to be targeted, if possible, for the whole family.

Uli said many families in the program have found it difficult to relearn how to eat, to read and translate confusing food labels and to make the healthy choices. Not all families complete the intense 12-week program, or they are unwilling or unable to grasp the seriousness of the threat, he said.

There is no policy on whether to report obese children to the county if they do not complete the program, but doctors can call if they think the child is at risk.

Uli said most of the children don't require immediate medical intervention but instead need help to prevent them from getting diseases like diabetes.

Uli said that in most cases, he thinks that keeping the family unit intact is better. But if that doesn't work, other interventions have to be derived, he said.

Debate emerges nationally on best ways to intervene

That is precisely what is at the core of a debate that is emerging nationally in the discussions about childhood obesity.

Earlier this year, Dr. David Ludwig, Harvard University professor and pediatric obesity expert, urged children's services agencies to intervene in severe cases when parents have failed to address a weight problem that leads to imminent health risks.

Ludwig, the co-author of an article that appeared in the Journal of American Medical Association this summer, said other interventions should be tried first and that children should be removed only as a last resort.

The article cited the example of a 12-year-old patient of Ludwig's who weighed 400 pounds and had developed diabetes, cholesterol problems, high blood pressure and sleep apnea -- conditions that could kill her before the age of 30.

But others question whether a future risk is enough to separate a child from a family.

Arthur Caplan, a professor of bioethics and medical ethics at the University of Pennsylvania, said that before a trend of removing children takes hold, the broader public-policy issue needs to be explored.

"A 218-pound 8-year-old is a time bomb," Caplan acknowledged. "But the government cannot raise these children. A third of kids are fat. We aren't going to move them all to foster care. We can't afford it, and I'm not sure there are enough foster parents to do it. "

He said he is worried that the families with the fewest resources, which are often minorities, will end up being ones with their children removed.

Caplan said one could get ethical whiplash in a world where one arm of government is so concerned about a child's weight that it removes him from his home, while another branch of government argues that french fries and tomato paste on pizza should be counted as servings of vegetables.

"It's completely hypocritical, or to put it another way, a schizophrenic stance," he said.

"It's OK to threaten to take a kid away or charge someone more for insurance," he said. "But it's also OK to advertise unhealthy food and put toys in kids' meals."

In the Cleveland Heights case, county workers believed that disconnecting the boy from his family, at least temporarily, might help. And he has lost a few pounds in the last month.

But now lawyers for the mother say they've been told that the foster mother who has the child in a neighboring suburb is having trouble keeping up with all of his appointments.

There was even a discussion about getting the foster mother additional help or moving the child again, this time to a foster home with a personal trainer, Amata said.

"I wonder why they didn't offer the mother that kind of extra help," Amata said.