New Research Questions the Effectiveness of Foster Care in Reducing Obesity

Controversy over the legitimacy of removing children from their home because of excessive weight has ensued since the Cuyahoga County Department of Family Services removed an 8-year-old, 200-lb. Ohio boy from his mother’s care in 2011, citing medical neglect as the cause. Case workers noted that the mother failed to control the third-grader’s health, putting him at high risk for severe medical conditions in the future, according to a Time magazine article. However, a recent study investigating the impact of foster care placement on obesity revealed insignificant changes in weight for a population of children aged 0-19 years.

Janet Schneiderman, a research associate professor in the USC School of Social Work, examined the medical records of 360 children, predominantly Hispanic, who received care at the Community-Based Assessment and Treatment Center, a pediatric clinic in Los Angeles County linked to the county’s Department of Children and Family Services. She was interested in exploring the possible relationship between weight and out-of-home placement.

“There have been suggestions in the medical literature that morbid obesity in children, coupled with health consequences, could be a reason for placing children in foster care,” said Schneiderman. “I think it is important to see whether placing a child in foster care actually leads to a healthier weight for the child.”

In a 2011 commentary published in the Journal of the American Medical Association by David Ludwig and Lindsey Murtagh, both Harvard University faculty members, Ludwig was quoted as suggesting that actions taken by the state to intervene may be the only realistic approach to inducing successful behavioral changes in obese children.

However, Schneiderman’s study, which was published in the March 2013 issue of Child Abuse & Neglect, contradicted this assumption. She compared medical records from the initial health exam after placement in out-of-home care and 10 to 14 months after the initial exam to determine the prevalence of obesity at each time point.

Schneiderman discovered that no major differences were found between the prevalence of obesity at the first examination and the second. Of all the children studied, 12 percent reduced weight, 15.5 percent remained obese, and 7.7 percent increased their weight during the year of foster care. In addition, the results suggested the child’s age, rather than foster placement, was more of a deciding factor for weight losses and gains. What caught the attention of Schneiderman and her fellow researchers was that children between the ages of 2 and 5 experienced a remarkable decrease in weight after the year in foster care.

These changes are likely influenced by the nature of care provided to these children compared with older children. Because this age group is less responsible for their own eating and exercise habits, any change in home environment could create fluctuations in diet and exercise patterns. In addition, as children in this age group continue to develop their motor skills, their activity levels increase. However, children older than six, particularly adolescents, may have more independence in obtaining their own food and are more able to resist lifestyle changes.

“More research is needed to understand the pathways and characteristics of children and caregivers that encourage a healthier lifestyle for the child, whether in foster care or at home,” Schneiderman said.

Other factors may also play a role in obesity patterns and development for children, according to the study. Higher rates of out-of-home placement have been seen among children from low-income, ethnically diverse communities, which correlate with higher incidences of obesity in children from these communities.

This trend of weight gain in communities of lower sociodemographic status may be related to limited access to healthy foods, medical resources and environmental resources. Furthermore, many older children in foster care are dealing with psychological issues and are often prescribed psychotropic medication, which puts them at a greater risk of weight gain.

“This study illustrates that foster care is not likely to change a child's overweight or obesity status,” said Schneiderman, who noted at the end of the study that placement in foster care does not erase negative experiences such as abuse or neglect, nor does it reduce the anxiety and depression that can accompany out-of-home placement.

She further stated that interventions that help caregivers change their home environment to provide more nutritious food, promote physical activity and limit sedentary activities, as well as efforts by caseworkers to enroll children in extracurricular activities, could be more successful in promoting a healthier lifestyle for children.