The mother of a 555-pound, 14-year-old boy in South Carolina was charged with neglect last week for allegedly failing to control her son's weight.
Before fleeing town with her son, Jerri Gray had been contacted by the local Department of Social Services previous times about her son's weight and was even issued a treatment plan to turn around Alexander Draper's morbid obesity, Gray's attorney Grant Varner told ABCnews.com.
But when Gray failed to bring Alexander in for some of his medical treatment appointments recommended by the department and he continued to gain weight, the state sent notice that Gray would lose custody of her only child.
"She panicked," Varner said. "She had no lawyer, she couldn't afford a lawyer and they took off. They had no destination really. They stopped in Baltimore to do laundry, which is where they were found."
Alexander has been placed in foster care and Gray of Travelers Rest, S.C., will appear in court to face two felony charges -- custodial interference, which carries a 5-year sentence, and child neglect, which carries a 10-year sentence.
"I have not heard a case involving parents charged in neglect with obesity," said Thomas L. Hafemeister, associate professor of law at the University of Virginia Law School in Charlottesville.
But Hafemeister said state interference with children for health care reasons has become an increasing problem in the past 20 years. Take, for example, the case of Daniel Hauser, whose Minnesota family initially refused chemotherapy treatments for his Hodgkin's lymphoma in May.
"Certainly, there are cases out there where parents are facing neglect and abuse charges for failing to provide needed medical care, in this case nutritional care," Hafemeister said. "But this is a very unusual case."
Jane Spinak, a professor at Columbia University Law School in New York, said that in many cases of medical neglect, public health officials are expected to offer help to a parent.
"I think the question is when is the outreach sufficient that a court could then say, 'Look, we're giving you all these opportunities to better care for your child?" Spinak said. "The state has to decide at what point is not accepting that voluntary assistance neglect."
Sometimes at issue, however, is whether child welfare officials can expect parents to show up to an appointment they reasonably cannot make.
Defining Neglect of an Obese Child
"The offers have to be realistic," Spinak said. "They have to be things that [a mother] and her child can actually take advantage of. If they want her to take him every day to something and she's working two jobs, that's not really realistic."
Only in the case of life-and-death situations do state officials normally intervene, family law experts say.
"If the child's life is at risk, the state can intervene: If it is a relatively non-life threatening situation, the state stays out," Hafemeister said. "With regard to obesity, in general, I don't think you're going to see a lot of interventions."
But in the case of a 550-pound teenager, pediatricians with an expertise in obesity say Alexander's health could be an issue of life or death. If not immediately, the extra weight may result in death 40 years down the road.
"At this weight, you can't sit in seats," said Dr. Keith Ayoob, director of the Nutrition Clinic and assistant professor of pediatrics at the Albert Einstein College of Medicine in New York City. "You're talking about three, 150-pound people, and then put a 100-pound, 10-year-old in their lap."
"He's at high risk," Ayoob said. "The point is to get this kid help. Otherwise, he's at a very high risk for an early death. He won't make it until 50."
Ayoob said a 14-year-old's skeleton may suffer significant damage under the extra 400 pounds. That pressure would likely lead to hip and knee problems. Being morbidly obese also puts children at high risk for hypertension, which puts the them risk for heart troubles. At that weight, Ayoob said, there is a high risk for Type 2 diabetes, which puts a person at risk for a slew of other health complications.
"With Type 2 diabetes, he is at risk for a heart attack, and he's at risk for kidney failure, and he's at risk for circulation problems meaning he may lose fingers and toes and sometimes limbs," said Dr. Reginald Washington of the American Academy of Pediatrics and the chief medical officer for the Rocky Mountain Hospital for Children in Denver.
Added to that laundry list are sleep apnea and a fatty liver, with risk of liver failure, Washington said.
But obesity, as much of a public health issue as it its, is not always a proven grim health sentence.
Obese Children Open Up Family and Health Questions
Dr. Marc Jacobson, of the American Academy of Pediatrics, Obesity Leadership Workgroup, said a sizable fraction of obese people don't have co-morbid health problems.
"He could have orthopedic complications like bowed legs," he said, "It's called Blount's disease, he could have metabolic complications ... breathing complications. But he could also conceivably not have any of those."
"Believe it or not, there are people who are quite overweight who don't have any medical complications, about 1 out of 3," he said. "But that data comes from adults."
But even if an obese child were lucky enough to not face any medical problems, those who treat childhood obesity say there are frequently co-morbid psychological problems or family dynamic issues.
"There's a chance that he has one of the genetic problems that can cause massive weight gain," Washington said. "When we see a child, especially at that age who is massively obese, we test him for that, but often they're negative. The [genetic] problems are very rare, but they're known.
"But you have to imagine that a 14-year-old probably doesn't have the resources to eat that much. Someone had to enable that to happen."
Ayoob, who treats morbidly obese patients on a regular basis, agreed. "If he's eating like a typical 14-year-old, he would lose weight," Ayoob said. "The heaviest patient I had was 675 pounds. That man was put in the hospital on 2,000-calories a day and he was losing six pounds a day at first."
Ayoob said the first question he often asks of his obese pediatric patients is, "Where is the food coming from," because there is often an enabler. Ayoob also insists on psychological treatment and family counseling.
"It has nutritional consequences but it's a mental health issue," Ayoob said. "I could put someone on all the right foods and nutrition but then you're just going to have a normal-weight person with an eating disorder. You work together with a counselor."
Gray's lawyer declined to give details about what kind of therapy Alexander and his mother were offered by the court. At the moment, he said, Gray cannot afford health insurance, but Alexander does have health care.
"She basically is on a very limited income and there were often appointments she could not make it to," said Varner, who mentioned a difficulty paying for gas money.
Varner said a local bond agency, Trotter Bail Bonds, volunteered to pay Gray's $50,000 bond.