A teenage boy has tragically died after his "abusive" mother continued to feed him takeaways while he lay dying in a hospital bed.
A review into the 13-year-old's death found the boy's mother had previously failed to provide a PE kit for him at school and tried to prevent the school from helping him exercise.
The Manchester teen, identified only as Child F1, asked his teachers not to tell his mum about the extra health and exercise classes he was taking at school.
At home, his mother would ply him with more than 2000 calories of food before lunch, often having two breakfasts, with the second a high-calorie takeaway.
The mother also missed appointments with healthcare officials leading to Child F1 suffering serious health issues.
At age 3, F1 weighed more than 30kg and was in the 99.6th BMI percentile, the top end of the range.
In 2015 Child F1 was hospitalised and nurses noticed his mother was aggressive with staff and emotionally abusive towards him.
During that hospital stay the child was found to have a dilated cardiomyopathy, a blood clot, and a history of morbid obesity.
When asked about her child's weight, she would describe him as "lazy doughnut".
Weeks later after being discharged F1 returned to hospital and was rushed to intensive care where his health "deteriorated significantly".
While in intensive care F1's mother would bring in takeaways and force-feed him.
Doctors wanted to carry out a heart transplant but couldn't due to F1's weight, lack of fitness and deteriorating condition.
He died in April that year.
The case review found: "Although all professionals in contact with Child F1 were aware of their morbid obesity, there was never a clear plan of action and neither an early help response nor an analysis of whether this was a safeguarding concern."
It also added that the school encouraged the mother to allow F1 to walk to school with their friends.
It said: "They mapped out a route to school so F1 could meet friends along the way and avoid reported bullying. Mother was unhappy with school's interference and undermined their approach by continuing to bring F1 to school by car."
A criminal investigation was started but no further action was taken, according to the report.