UPDATE: The headline on this article originally stated "Obese children face CYF custody/referral". This was incorrect - in that talks have only just started - and CYF has issued the following statement:
"Responding to childhood obesity is an emerging area and agencies are talking about what the best approach is to ensure obese children and young people get the best outcomes."
The statement says CYF does not currently make statutory interventions "solely because of obesity or anorexia".
"It's still very early days but CYF has had initial talks with health agencies and health specialists around managing concerns relating to medical neglect.
"Child obesity and anorexia are in themselves a health issue.
"If Child Youth and Family believed that a child or young person was at significant risk of harm due to the way their parents were responding to their health issues, they would work closely with the child or young person, their family/whanau and other agencies - particularly health professionals - to address the issue."
A proposal to refer obese children to child protection services has been slammed by a child health expert.
Professor Wayne Cutfield, director of the Liggins Institute at Auckland University, told Newstalk ZB it was "incredibly disappointing that the way we manage child obesity could end up being children being removed from their families."
The NZ Herald revealed today that a "traffic light" system was being proposed for referring children to Child Youth and Family for "medical neglect".
Doctors are developing protocols to refer obese children to child protection services if their parents ignore medical advice to help their children lose weight.
Starship Hospital paediatrician Dr Patrick Kelly said the system was not specific to obesity but could include obesity cases.
Dr Cutfield told Newstalk that while there was no doubt obesity was a huge problem in New Zealand, "simply blaming and shaming and then potentially removing or incarcerating children is the wrong approach".
He said some families did not recognise their children were obese, particularly with young children.
When children are placed in hospital in order to lose weight, they regain the weight very quickly unless changes are also made within their family.
"I think we need to make more effort to work with not just their families but the community their families belong to," Dr Cutfield said.
A paediatrician from Perth's Princess Margaret Children's Hospital told a child abuse conference in Auckland that children and teens had been referred to child protection services when parents had failed to address children's obesity.
Australian paediatrician Dr Alice Johnson told a child abuse conference in Auckland yesterday that her unit at Perth's Princess Margaret Children's Hospital had referred 13 children and teenagers to child protection services since 2008 after parents failed to address children's obesity or when there were other child protection issues such as drugs or domestic violence.
In four cases the child protection agency removed children from their parents to ensure that they kept appointments with dietitians and tried to lose weight.
In New Zealand, Starship hospital paediatrician Dr Patrick Kelly said he was working with police and Child, Youth and Family (CYF) to develop a "traffic light" system to guide referrals to CYF for "medical neglect".
"Green means we are working with the family to make sure they have all the cultural support they need and all the access issues in place, such as transport," he said. "Orange is where you are starting to think we are still not making progress and this is putting a child at risk. Red is where you are starting to involve the statutory authorities. It's not specific to obesity, but I can imagine there might be some obesity cases."
Dr Johnson, who sees children referred to her Perth clinic from all over Western Australia, said some parents failed to make sure their children took medication for other conditions such as diabetes and cystic fibrosis. But the obesity cases had increased over the past five years.
"With the vast majority of children with obesity there are no child protection concerns," she said. "It's a very tiny minority of children with severe obesity who have medical complications or comorbidities and whose parents are not addressing their needs."
Many of the children have obstructive sleep apnoea, high blood pressure, insulin resistance and diabetes, fatty liver disease or mental health issues such as poor self-esteem or depression.
Dr Johnson said her hospital had developed a suite of interventions to help the families, including hospital treatment, intensive in-home support from social services, parenting programmes, financial support and "as a last resort" removing children from their parents.
Interventions had been put in place for 15 children so far. In two cases the parents responded as soon as they realised the serious risk to their children, but the other 13 were referred to the state's child protection service. Nine were left at home and four were moved to other carers.
Dr Johnson said all the children lost weight in an initial three- or four-week stay in hospital simply by eating a normal hospital diet and getting some exercise and physiotherapy. One 11-year-old boy who weighed 155kg lost 9kg in three weeks. "He loved doing the exercises and was feeling really good about himself."
However, the results after they left hospital were disappointing. Only one of the nine children who stayed at home lost significant weight. The four who were moved to other carers all lost weight initially, but three of them put it on again when they moved to other carers or back home.
A third to half of the children were Aboriginal, often in remote areas. Many had other issues in their families such as parental drug use, violence and mental health issues.
Otago University paediatrician Professor Dawn Elder said children's eating might be influenced by the stress of those other issues.
But Dr Johnson found no answers when she asked other experts at the conference if anyone had found a way to overcome the problem.
"There has been improved attendance at appointments, but no change in weight for the vast majority," she said. "The outcome is it doesn't seem to make a difference. What do we do?"
Medical Association chairman Dr Mark Peterson said later that New Zealand doctors would always try to help a family to change their diet and exercise more rather than reporting them to CYF. "I'm not saying there would never be a case for it, but it would be very rare," he said.
Otahuhu Recreation and Youth Centre nutritionist David Hill said most parents tried to help their teenage children to lose weight, but that the teens often resisted the pressure.
Q&A: Obesity protocols
Why are doctors considering referring obese children to CYF?
Some are at risk of serious illness or death from related conditions.
What might be the criteria for referral?
In Perth children are referred only if they are at medical risk and the parents are either not following medical advice or have other child protection risks.
What could CYF do about it?
In Perth the child protection agency gave home support for nine children but moved four to other carers.
Daughters follow mum's good example
Otahuhu mother Davina Collins was so keen to help her daughters lose weight that she joined a gym herself to set a good example.
Ms Collins, 39, was spurred into action after her mother died of lung cancer. She got a "green prescription" from her doctor, gave up smoking and joined the Otahuhu Recreation and Youth Centre all at once two years ago.
"I wanted to motivate my daughters and to motivate them I had to do it, so we did it together," she said.
Her younger daughter Joderci, now 19, found out soon after she joined the gym that she was pregnant, had medical complications and had to drop out.
But her other daughter Shontelle, now 20, lost about 16kg, and Ms Collins herself, who started at 127.5kg, has lost 23kg and is well on the way to her target weight of 80-85kg.
"I put myself on eight-week challenges," she said. "From next week I'll be going at 6.30am five mornings a week. My trainer has given me a workout programme so I follow that three times a week for an hour. The other two times I'm in training with him one on one."
Ms Collins, who is now training to be a nurse, also saw the centre's nutritionist David Hill and has changed her family's diet "heaps".
"Everything is light now, small portions, not big portions," she said. "Our bread has gone from white to multigrain, and just going to a non-stick frying pan so you don't need oil."
Her three younger children aged 15, 11 and 7 all "know what's healthy" and what's "a treat". "They know that they get a treat once a week.
Family First NZ said it supported intervention where obesity was an urgent issue, but that CYF involvement and removal of children from families would only exacerbate the problem.
National director Bob McCoskrie said intervention should only be a last resort where obesity is part of a package of neglect and abuse.
"The best solution is for non-governmental organisations to be resourced and equipped to work with the family in the home and the community, and to only use statutory intervention where there is persistent non-compliance and obvious dysfunction with the parents," Mr McCoskrie said.
"We should also be asking some of the harder questions around reasons for increasing obesity rates in New Zealand. These include issues such as reduced physical activity and increased screentime, sleep patterns, food quality especially in cheaper foods, busy parents, and 'obesogenic environments' - 'fat cities' with few parks and recreational facilities."
Mr McCoskrie said CYF workers had unmanageable caseloads and a lack of accountability of their procedures.
"We need CYF to get it right, and we need to know that they're getting it right. That evidence is not there."