The lock-up diet

As the authorities in Derbyshire, England, threaten to remove an obese nine-year-old from her parents, Paul Campos tells the chilling tale of how an overweight toddler was taken from her family in the USA.

Paul Campos

Topics Politics

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Derbyshire County Council in England has threatened to take into care a nine-year-old girl, Samantha Collier, who weighs more than 13 stone. Samantha’s parents claim that their daughter’s weight problem is due to steroids that she took to combat asthma – but that hasn’t stopped the local authorities from getting involved, after being alerted by a school nurse. Here Paul Campos, author of The Obesity Myth, describes what happened when obese toddler Anamarie Regino was removed from her family in Albuquerque, New Mexico.

Although obesity has not yet been criminalised in the USA, it is possible to have your three-year old child taken from you for the offence of ‘allowing’ her to become fat. That is the stark lesson of the Anamarie Regino saga, which continues to play out in Albuquerque, New Mexico. The story of what was done to a child and her parents by an assortment of doctors, social workers, and government bureaucrats is a chilling tale of what can happen when people of modest means and social status find themselves, through no fault of their own, facing the full brunt of the prejudice that fuels the war on fat.

Anamarie – who weighed six pounds, 13 ounces at birth – gained 32 pounds in her first eight months of life. Her mother, Adela Martinez-Regino, realised from the beginning that there was something different about her daughter. ‘She was drinking 10 and 12 bottles a day and still wanting more’, she says. So Martinez-Regino, a native New Mexican and a counter agent for Mesa Airlines, started taking her daughter to doctors, in what became an increasingly desperate attempt to determine why her daughter was so large. (Besides her weight, Anamarie soon grew to be nearly twice as tall as other children her age, and developed a full set of teeth by the time she was a year old.)

Over the next few months, a parade of paediatricians, endocrinologists, and specialists in rare childhood syndromes examined Anamarie. None of them was able to successfully diagnose her condition. By the time the girl was 16 months old, her mother had taken Anamarie to 57 doctors’ appointments, yet her condition remained as mysterious as ever. And still, Anamarie continued to grow at a remarkable rate: she weighed 67 pounds at 16 months, 97 pounds at 28 months, and 130 pounds by July of 2000, when she was little more than three years old.

The following month, after Anamarie’s parents hospitalised her for a third time in an Albuquerque hospital for yet more tests, her mother was taken aside by a group of doctors and social workers. In Martinez-Regino’s words, she was told ‘Ana’s in grave danger. We know it’s hard not to give in to everything she wants. We just think you can’t handle your daughter. And we don’t want her to die down the line’.

What Anamarie’s mother didn’t know was that the state’s Child, Youth and Families Department was already preparing an affidavit that would accuse her and her husband, Miguel Regino, of endangering their child’s life by making her fat. According to the social workers who filed this document, Anamarie would ‘surely die’ if she was not placed immediately on a rigid diet and exercise programme. This, the social workers said, was ‘something which the parents have not been willing or able to do’. The affidavit concluded with some devastating charges. New Mexico’s social service bureaucracy claimed that Anamarie’s ‘family does not fully understand the threat to their daughter’s safety and welfare due to language or cultural barriers’. Furthermore, the social workers said, Anamarie might be a victim of Munchausen’s syndrome by proxy – a psychological disorder that causes parents to harm their children in order to draw attention to themselves.

The next few days were a nightmare for Anamarie’s parents. They were told the hospital would call security if they tried to take their child home. Deeply confused and angered by the charges being made against them, they watched with a growing sense of helplessness as the state proceeded to take Anamarie from them.

Martinez-Regino’s description of the final scene would chill the blood of any parent. On the morning of 25 August, they were forced to explain to their three-year-old that ‘you will be going to stay with some different people now, but mommy and daddy will come to visit’. Her mother recalls that, as a nurse pushed the child away down the hospital hall in a stroller ‘she kept screaming that she wanted her daddy to push her. But we knew there were armed guards outside, so we couldn’t do anything. It was so difficult to sit there and do nothing because you could hear her scream all the way down the hall’.

It is difficult to describe the sheer irrationality of the decision process that led to this appalling abuse of state power. Here are just some of the aspects of this fiasco that illustrate the depths of the craziness to which the war on fat can drive public officials:

— At the time she was taken into state custody, there was no evidence that Anamarie’s health was in danger. Despite her extraordinary size, an almost endless battery of tests had concluded that she was not suffering from any detectable cardiovascular problem, or any other major difficulties. Despite this, the state social workers’ affidavit claimed Anamarie was in grave danger of suffering ‘fatal heart damage’ if she was not taken from her parents immediately.

— Although the justification for taking Anamarie from her parents was that she was in immediate medical danger, the state took her from the hospital into which her parents had admitted her three times in the previous few weeks, and moved her to a private foster home, where she remained for the next two-and-a-half months.

— The state’s affidavit charged Anamarie’s parents with being unable or unwilling to keep the child on an appropriate diet, when in fact they had, on the advice of a constantly shifting cast of healthcare experts, placed her on a series of diets, all of which they followed faithfully. These diets began at 1200 calories per day, then declined to 1000 calories, then 900, and finally 550. This final diet, which Anamarie was on at the time she was taken from her parents, consisted of two Kindercal drinks (two such drinks might make up perhaps a third of a normal three-year-old’s daily caloric intake). In other words, Anamarie’s parents were being told to starve their child – yet even after agreeing to do so they were accused of causing, or at least seriously exacerbating, her still-mysterious condition, by feeding her ‘too much.’

That there could even be a discussion about whether the state ought to take a child away from her parents under these circumstances indicates how severely the topic of fat distorts public debate in America today. It should be unnecessary to point out that the whole idea that parental dietary practices might play a significant role in producing a 130-pound three-year-old is absurd. Such a theory is every bit as bizarre as the idea that Anamarie’s parents were damaging her health by forcing her to become twice as tall as other children her age. Anyone who has ever parented small children knows how difficult it is to get them to eat something they would prefer not to eat.

As for ‘overfeeding’ a toddler, lax parental supervision of a toddler’s eating habits might result in a three-year-old weighing five or perhaps even 10 pounds more than she would otherwise weigh – but at the time of her third hospitalization Anamarie weighed 90 pounds more than the average three-year-old.

Anamarie’s mother is not an obesity expert, but she is perfectly capable of critiquing the bizarre idea that her daughter is three times heavier than a normal toddler because her parents have made her that way. ‘ If we are overfeeding her, then why is she so tall?’ Martinez-Regino asks. ‘Why did she have all her teeth by the time she was a year old? Why does she have thick hair, adult kind of hair? Can overfeeding do all that?’ Martinez- Regino is also well aware of the subtext of the state’s claim that Anamarie’s family ‘does not understand the threat to their daughter’s safety and welfare due to language and cultural barriers’. A working-class woman of Mexican heritage living in Albuquerque, married to a man who does not speak English well, doesn’t need a doctorate in sociology to understand the threat to her parental rights emanating from that sentence. When she read those words in the affidavit, Martinez-Regino says, ‘I knew they decided about us before they even spoke to us’.

Leslie Prichard, a paralegal and the wife of Anamarie’s parents’ lawyer, Troy Prichard (the Prichards took on the case for free) asks the obvious question: if her parents had been white, upper-class professionals, would they have been charged with child abuse simply because their daughter was unusually large? Troy Prichard has little doubt about what led the state to take such drastic action. ‘There were so many veiled comments which added up to: “You know those Mexican people, all they eat is fried junk, of course they’re slipping her food.” That’s what they wanted to see.’

Yet whatever part class and ethnic prejudice may have played in the decision to take Anamarie from her parents, it seems clear that another factor played an even bigger role. ‘Everybody we were dealing with was skinny. There were no overweight doctors’, said Martinez-Regino. ‘People sometimes look at her and think she sits in front of the TV and eats and eats. But ever since she was a baby she’s been moving around…. It comes down to people are fat because they have a condition. But the public, they don’t look at it as a medical problem. They look at it as a mental problem. Her weight will go up and down. She will never be a Barbie.’

Anamarie’s story has a happy ending, at least to this point. Largely through the heroic efforts of many size acceptance advocates, most notably lawyer Sondra Solovay, and author and activist Marilyn Wann, a fierce legal and political battle was fought to return Anamarie to her family. These and other advocates volunteered countless hours of time – as well as their professional expertise and a good deal of money – in order to bring Anamarie back home. They played the most crucial role in an ultimately successful battle: a role that was almost completely ignored in media accounts of the conflict.

So it was that, two-and-a-half months after she was taken from her parents, Troy Prichard negotiated an agreement whereby the state retained legal custody of Anamarie pending a hearing. In exchange, her parents regained physical custody of their child. For the next two months Anamarie lived at her parents’ modest cinderblock house again, while a cadre of social workers made regular visits, during which they sat on the family’s living room couch and observed her interactions with her parents. As part of the agreement Martinez-Regino agreed to be evaluated by a psychiatrist, who found no evidence of Munchausen’s syndrome by proxy or any related psychological problems. In January 2001, a New Mexico state judge dismissed the charges of child abuse the state had filed against her parents, and returned legal custody of Anamarie to them.

Since then Anamarie has become something of a celebrity in the battle against fat prejudice. In a particularly galling irony, her parents have been accused of exploiting her situation to gain media attention. Such charges ignore the fact that Adela Martinez-Regino and Miguel Regino never sought to be accused of child abuse by the state of New Mexico, and that, given the underlying cultural politics of their situation, fighting the battle to win back their child through the media was one of their few realistic options.

To this day, Anamarie’s parents realise they are under more or less constant surveillance whenever they take their daughter outside their home. Recently a state social worker called them to let them know the department had received a report that Anamarie had been seen eating ice cream. Her mother was forced to explain to the authorities that her child had been eating frozen yoghurt – an approved treat within the strict confines of Anamarie’s latest diet, which forbids all candy, cake, ice cream, juice, fried food, or fast food.

As of this writing, Anamarie weighs 105 pounds – approximately 25 pounds less than she did at her heaviest. In addition to her strictly monitored diet, she spends three days per week at a local gym for children, called Kid Power. Here she swims, jumps, and exercises muscles that have to be much stronger than an average child’s to simply allow her to walk.

Troy and Leslie Prichard are preparing a civil suit against many of the doctors and social workers involved in the decision to take Anamarie from her parents. Ironically, her parents plan to use any proceeds from this suit to take their child to ‘the best doctors in America’, who they believe will be able to determine why their daughter is the way she is, and to give her condition a name. For Anamarie’s family, this last desire is not a minor point. Her godmother, says Martinez-Regino, is planning to have cards printed for the benefit of inquiring strangers, who still insist on asking questions about ‘what is wrong’ with their daughter, and of course, about what her parents feed her. ‘The cards’, says Anamarie’s mother, ‘will give the name of the condition and explain what it is. Then they’ll say, “Now mind your own business!”’.

The story of Anamarie Regino tells us a great deal about the meaning of fat in America today. It tells us that, for all its pretensions to knowledge, the medical profession still understands very little about the causes and consequences of much of what is labelled ‘obesity’. Nobody has been able to determine why Anamarie’s body is the way it is. Furthermore, nobody knows if her size endangers her health (how could anyone know this, given the complete failure to diagnose the nature of the underlying condition?). It follows that nobody knows whether it is in Anamarie’s best interests to severely limit her diet.

That a barely three-year-old child was put on a starvation diet of 500 calories per day says nothing about the potential efficacy of such a radical treatment (again, as is so often the case with weight issues and medicine, the Hippocratic injunction to ‘first do no harm’ was ignored in Anamarie’s case), but it does say a great deal about the hysteria that fat elicits among so many doctors, social workers, and other members of helping professions.

Anamarie’s story also illustrates the strength of the American belief that a person’s weight is something that is fundamentally under his or her control, or, in the case of small children, under the control of their parents. This belief is so deeply entrenched that it manifests itself in situations in which it can only be described as profoundly irrational. Perhaps the only thing that frightens Americans more than getting fat is the thought that there is often, practically speaking, little or nothing people can do about getting fat. One explanation for the absurdity of the state’s response to Anamarie’s situation is that her skyrocketing weight became a kind of metaphor for the anxiety so many Americans feel about their (or their spouse’s, or children’s, or fellow citizens’) expanding waistlines.

Most alarmingly, Anamarie’s saga helps reveal the lengths to which state power can be deployed in America today in the prosecution of the war on fat. Adela Martinez-Regino and Miguel Regino cannot allow their child to eat a spoonful of ice cream, or a piece of candy, or to drink a glass of fruit juice, without running a very real risk of having their child taken away from them once again. They and Ana live under this remarkably repressive regimen not because there is any medical evidence that it will protect their daughter’s health, but simply because it gives the authorities a false but comforting sense that they are ‘doing something’ about what is, for them, a profoundly disturbing sight – the sight of an unusually large child.

Anamarie’s story illustrates the intimate relationship between, on the one hand, slenderness and power, privilege, and money, and on the other, fat and powerlessness, lack of social status, and relative poverty. In both instances, these dichotomies manifested themselves along ethnic lines as well. (The Hispanic social worker who interviewed Martinez-Regino when the state began the process of taking her child from her insisted on doing so in Spanish, despite the fact that English is Martinez-Regino’s first language. According to Martinez-Regino, the social worker kept demanding the telephone numbers of her family in Mexico, even though Martinez-Regino was born in the USA and has spent her entire life here.)

Perhaps the most striking irony of Anamarie’s story is the faith her family maintains in doctors and medicine. Despite being accused by doctors, on the basis of no evidence whatsoever, of abusing their child, Anamarie’s parents cling to the belief that doctors can be trusted to explain the meaning of what has happened to their daughter. Ultimately, it is this faith – a very American faith in the ability of science and technology to answer what are, in the most fundamental sense, political and cultural, rather than scientific, questions – that plays perhaps the most crucial role in supporting the war on fat.

What remains difficult to see, even for those who have paid the heaviest price in that war, is that it isn’t people like Anamarie who have a weight problem. We live in a nation in which those in authority can look at a three-year-old girl with the ‘wrong’ sort of body and decide, on the basis of nothing more than irrational beliefs born of their own fear and loathing of fat, that her family must be torn apart. Now that is a weight problem.

Paul Campos is professor of law at the University of Colorado. This article is an edited extract from The Obesity Myth: Why America’s obsession with weight is hazardous to your health (buy this book from Amazon UK or Amazon USA).

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