Source: Murtagh L, Ludwig D. State intervention in life-threatening childhood obesity. JAMA. 2011; 306(2): 206– 207; doi: 10.1001/jama.2011.903The use of protective custody even as a last resort raises several concerns. First, if protective custody is to become a mechanism for treating a child’s obesity, even as a last resort, pediatricians should require some evidence of effectiveness. There is no evidence of the short- or long-term safety and effectiveness of protective custody as an alternative strategy. In the absence of some reasonable evidence suggesting that such a strategy benefits a severely obese child, it seems extraordinary to remove a child from a home. Interestingly, Murtagh and Ludwig suggest that protective custody of the severely obese child warrants discussion as an alternative therapeutic approach to bariatric surgery, in part because “the long-term safety and effectiveness of this invasive procedure in adolescents remains unknown.” While the protective custody might not be invasive in the same way bariatric surgery is, it certainly has the potential to do harm by disrupting the bonds that exist between a child and his family.Second, the use of any coercive strategy with the potential to disrupt family relationships cannot be justified unless the potential benefit to the child will more than offset the harm done by the intervention. The psychological harm that can be done to a child by removing him from his family and home must be factored into any decision about protective custody. The fact that the child may come to some harm by remaining with his family is not sufficient justification. That harm has to be so grave and so likely to be avoided by removal from the home that it would more than offset the harm done to the child and family.Third, a strategy of protective custody in the treatment of severe obesity may reflect the unreasonable expectation that parents of obese children can completely control their children’s eating behavior. Parents have little control over what their children might eat at school, at a friend’s house, or at night after everyone has gone to bed. Parents do have responsibility for their children, but their control over their children’s behavior is not limitless.Finally, the parents’ social context can make it very difficult for them to provide optimal oversight and healthy food. Children are bombarded by advertising about unhealthy foods; parents working a low-wage job may need to work 80 hours a week to provide basic food and housing, leaving little time for supervision, and may not be able to afford healthy foods. It seems ironic that a society that refuses to control advertising, offers a minimum wage on which a small family cannot survive without both parents working long hours, and where healthy foods are expensive would identify the solution to severe obesity as removal of a child from the home.