Choking on the facts

‘When a three-year-old girl who weighs 40 kilograms dies of heart failure brought on by obesity, you know her parents are guilty of gross child abuse….’

That was one commentator’s verdict on the tragic death of a young Bengali girl in a London hospital, brought to Britain’s attention by the UK House of Commons Health Select Committee’s report on obesity, published on 27 May. The report flagged up – in paragraph two of 411 – the evidence of Dr Sheila McKenzie at the Royal London Hospital, who told the Committee that a three-year-old in her care had died of heart failure ‘where extreme obesity was a contributory factor’, and that four other kids are having non-invasive ventilatory assistance for sleep apnoea – ‘in other words, they are choking on their own fat’ (1).

If the Committee’s aim in upfronting this tragic death was to get its report on the front pages of the papers, it succeeded. ‘Three-year-old dies from obesity’ said the simplistic headlines. One report described the death as a ‘wake-up call’ for parents; others accused the three-year-old’s parents of ‘stuffing her to death’, as if this were some morbid modern-day version of a Grimm brothers’ fairytale. Anyone who dares venture into the depths of the Daily Mail’s online discussion board will discover that some people think the parents should be ‘charged with child neglect’, are ‘too thick’ to have kids, or maybe ‘hate’ their kids and ‘wish them dead’ (2).

Was this child really stuffed to death, overfed by uncaring parents until her heart packed in? Can we even say that she ‘died from obesity’, let alone that her death sounds the alarm for a coming obesity epidemic? There are experts on childhood obesity – including one who has some experience in dealing with this particular child’s case – who very much doubt it. They think that the way in which this tragic, rare, isolated incident was made public and then discussed by the media has been a disgrace.

‘I was horrified and quite upset at how this death was portrayed’, says Dr Sadaf Farooqi, a clinician scientist at Addenbrookes Hospital in Cambridge. ‘The suggestion is that the parents caused the child’s death by allowing the child to get so obese. No thought or consideration was given to the fact that for a child so young to become so obese, it’s highly likely that there is some medical cause, some genetic cause, to their obesity.’

Dr Julian Hamilton-Shield, a consultant senior lecturer in child health at Bristol University and recognised as an expert on childhood obesity, agrees that there must be more to this death than overeating. He points out that he has ‘no specific knowledge’ of the case – but ‘in our experience, it would be very hard to accept that the single, simple cause of death in a three-year-old could be obesity. I find it incongruous that obesity could have been the sole contributor to a death so young’.

Dr Sadaf Farooqi is in a good position to know that there was a medical condition behind the three-year-old’s extreme weight problem. ‘I know there was a genetic cause to the child’s obesity, because I identified it’, she tells me.

Farooqi works with Professor Stephen O’Rahilly at the University Department of Clinical Biochemistry at Addenbrookes in Cambridge. The team studies extremely overweight young children in order to locate potential gene defects that may have caused their obesity. Farooqi tells me the team has recently cared for a child who had errors in both copies of the gene that codes for the hormone leptin produced in fat cells, which resulted in the child’s body telling the brain that it was starving, no matter how much the kid had eaten. So the child ate continuously, anything he could get his hands on, and weighed 190lb at eight years of age, despite undergoing liposuction and surgery.

The doctors who cared for the three-year-old child featured in the Select Committee report sent information and blood samples to the Addenbrookes team so that they could check whether there was a genetic cause to the child’s obesity. Farooqi discovered that there was, but unfortunately the child died while her team was conducting its studies. Farooqi declines to tell me what the genetic defect was, ‘because it would probably identify the family and we don’t want to do that’. But it’s fair to say that, where this death was presented as an open-and-shut case of death by overeating where parental neglect was the main culprit, it was nothing of the sort? ‘Nothing of the sort’, says Farooqi. ‘That was shocking, the notion that this death shows what can happen to any three-year-old who eats too much. No, there was something different in this case, something medical, and that should have been taken into account.’

Whatever the three-year-old’s condition, childhood obesity experts agree on one thing – the death of a three-year-old where ‘extreme obesity was a contributory factor’ is extraordinarily rare. Indeed, most claim that they have never heard of such a case before. Dr Julian Hamilton-Shield testifies to the rarity of such deaths. He says that when he sees three-year-olds who are overweight he is not even particularly keen to suggest that they lose weight. ‘It is likely that obese three-year-olds will lose that weight as they grow up’, he says. ‘We concentrate on older obese children, seven and over, where there may be a need to reduce weight.’

Despite the fact that there likely was some complicated medical cause to the three-year-old child’s obesity, and that this disturbing case is virtually a one-off, which has shocked even those who care for obese seven, eight and nine-year-olds, the death has been transformed into a warning sign that all parents must heed.

The three-year-old’s death has featured in articles about children’s eating habits, growing waistlines and parental responsibility, as if death by heart failure could happen to any toddler who likes fizzy drinks and chocolate. ‘The death has become part of the discussion about what children eat’, says Farooqi, ‘when in fact it was the result of something else entirely. We are mixing up children’s weight issues with distinct medical problems’.

Farooqi pins much of the blame on the media’s sensationalist coverage. The papers have certainly had a field day focusing on the three-year-old’s death, alongside gratuitous photos of fat kids in ill-fitting jeans and t-shirts. But is the media alone at fault here? The three-year-old’s death was brought to our attention, sensationally, by the Health Select Committee. It is one of the first things you come across when you read the Committee’s report: paragraph one says, ‘With quite astonishing rapidity, an epidemic of obesity has swept over England….’; paragraph two tells of ‘….a child of three dying from heart failure where extreme obesity was a contributory factor’. There’s no context and no explanation for how this child got to be so large or what ultimately caused her death – just a suggested link between an alleged epidemic of obesity sweeping England and a fat toddler dropping dead from heart failure.

Farooqi says that one of the most distasteful phrases in the current debate about obesity is ‘children choking on their own fat’. ‘What a disgusting way to talk about a medical condition’, she says. ‘If someone has a tumour in their throat you wouldn’t say, I hope, that they were choking on their own dirt or something.’ Yet while the ‘choking on their fat’ phrase may have been reproduced in newspaper headlines across the UK (and, indeed, in other parts of the world), it was first used by Dr Shelia McKenzie of the Royal London Hospital, and first published in the Health Select Committee’s report.

‘I haven’t had a chance to speak to Dr McKenzie’, says Farooqi. ‘I imagine that she is also shocked by the media coverage.’ She may well be, though she is currently unavailable for comment. Neither McKenzie’s team at the Royal London Hospital nor the authors of the Health Select Committee report have come forward to correct the misconception – which they surely did much to create – that this three-year-old ‘died from obesity’ and that the same could happen to any other three-year-old.

It is the broader hysteria about childhood obesity that allowed this death to be discussed in such crude and cruel terms. The debate about children’s weight has itself become a sensationalist discussion, where we imagine that kids across the country are ballooning and that parents need help and guidance on all matters food-related, because, in the words of the Health Select Committee’s report, ‘many parents are no longer even able to identify whether their children are overweight or not’. In this kind of climate it is not surprising that an isolated death can be turned into a modern morality tale, and that even bereaved parents, about whom we know nothing, can be accused of effectively killing their child. Now that really is disgusting.

Read on:

Obesity and gross insults, by Jennie Bristow

spiked-issue: Obesity

(1) Dying for another snack, Miranda Devine, Sydney Morning Herald, 30 May 2004; House of Commons Health Committee: Obesity, 27 May 2004

(2) See Mail Online discussion board: Three-year-old killed by obesity, May/June 2004