by Lauren Fiechtner, MD

Is it fair to fine parents if their child with obesity does not lose weight? Lawmakers in Puerto Rico have proposed a bill that would do just that. Under the proposed bill, teachers would identify children with obesity and refer them to a counselor who would develop a diet and exercise plan. If the child does not lose weight in 6 months, the families would be fined $500. If in a year success still eludes, then the fines could increase to $800.
Such a proposal is regressive and flawed for several reasons. First, measuring a child’s success by weight loss alone is not an appropriate metric. Children should continue to grow in height; maintenance of a child’s current weight can produce a significant decrease in body-mass index (BMI) and a return to normal weight. Punishing families who successfully make healthful changes and decrease a child’s BMI but not weight may have harmful effects on future healthful behavior change for that child.

Second, there are multiple causes of obesity, many of which are out of parents’ control. There is a genetic predisposition to obesity. Children are exposed to vending machines and unhealthful food at school. Food companies target children, marketing directly to them. And, processed and unhealthy foods have some addictive properties, which can make change in a child’s diet very difficult. 

Puerto Rico is a largely low-income island.  Median household income in 2012 was just  $19,518 (this median is below the US federal policy level, which was $23,050 for a family of 4 in 2012). We know that the prevalence of obesity among children is highest in poor and Hispanic families, and, not surprisingly, 30% of children in Puerto Rico are obese, much higher than rest of the overall U.S. rate of 17%.

Why are low-income and racial minority families more affected? Healthy food can be expensive and often requires time to prepare, a challenge for families without resources and busy lives. Disadvantaged neighborhoods also tend to have fewer supermarkets, fewer opportunities for physical activity and more fast-food restaurants. All of these factors, beyond the control of parents, make it all the more cruel to financially penalize them for their child not losing weight.

Finally, why does obesity achieve special status as a disease? We would not consider fining people for developing cardiovascular disease or cancer, diseases that are more prevalent in people with less healthful behaviors, such as sedentary behavior and poor nutrition. This would seem absurd because we know these diseases are caused by multiple factors. The case is the same for childhood obesity.

Instead of fining families and creating a more uphill battle for struggling families, policy makers should invest in creating healthier neighborhoods: with affordable access to healthy food and safe places to play for all children.



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