Life-Threatening Childhood Obesity and Legal Intervention

To the Editor: Ms Murtagh and Dr Ludwig suggested that removal from the home may be a more desirable intervention than bariatric surgery in children with life-threatening complications of obesity.¹ They argued that bariatric surgery can be irreversible and has inherent complications. The authors also suggested that weight loss surgery may be unethical without first considering foster care.

While Murtagh and Ludwig's proposal opens an important discussion, we believe the decisions of whether to pursue weight loss surgery and social service intervention are actually independent pathways. The authors suggested that clinicians should use the existing criteria for social intervention described by Varness et al.² These criteria include that a family has not made a good-faith effort and all options have been explored. In the best practice guidelines for weight loss surgery, Apovian et al³ recommended that a psychological evaluation be done prior to surgery to assess whether the child has the necessary family support for the procedure. Thus, any family that meets the Varness et al criteria² for social service referral would not meet the generally accepted criteria to be offered weight loss surgery.