Does Childhood Obesity Amount to Gross Negligence?

Written by Kalina Hagen

Introduction

In February of this year, Alun Titford, a Welsh removal man, was found guilty of manslaughter by gross negligence for the tragic death of his sixteen-year-old daughter, Kaylea, in October of 2020. Kaylea was born with hydrocephalus and spina bifida, and used a wheelchair to get around. She was described by her teachers as ‘fiercely independent’, and by her friends as vibrant and funny. She was so good at her favourite sport, basketball, that she had been scouted as a potential paralympian. When she died, it was in unimaginable squalor. Her body was covered in sores and was being eaten by maggots. Her toenails had not been cut for six months. She was bedridden, encrusted with faeces, lying in a dark room that had not been cleaned in months - emergency workers recount a sickening 'rotting' smell. During the COVID-19 lockdown, something had gone horribly wrong - Kaylea’s parents, upon whom her ability to leave her bed depended, seemed to have ignored their duty of care completely.

Gross Negligence and Obesity

Alun Titford was prosecuted for more than just neglecting to care for his disabled daughter. He was also prosecuted for allowing her to become morbidly obese. When she died, Kaylea weighed 146 kgs. At just 1.45 metres tall, that put her BMI in the third class of obesity. Her official cause of death was determined as “inflammation and infection in extensive areas of ulceration arising from obesity and its complications, and immobility in a girl with spina bifida and hydrocephalus.”

This case is, above all, an immeasurable tragedy. A child has been lost, and a family irreversibly changed. Amongst it all, they have had to deal with not only the death of a child, but two criminal prosecutions as well as extensive media coverage. The tragic nature of this case, however, does raise important questions about obesity and whether or not it constitutes neglect and essentially child abuse. Today, 10% of Reception-age children in the UK are classed as obese. The World Health Organisation, our Government and the NHS are becoming increasingly concerned at what is officially classified as a public health epidemic. Could parents of obese children now be prosecuted?

The Disease of Obesity

Obesity has long been a controversial word. Derived from the latin word ‘obesus’, meaning ‘having eaten until fat’, obese has been used to describe people living in bodies much larger than normal since about the late seventeenth century- the infamously corpulent Henry VIII springs to mind. In 1948, the World Health Organisation classified obesity as a disease, but it was not until 1997 that they declared obesity as a global epidemic. Rates of obesity have been steadily rising for decades now. Currently in the UK, 25% of adults are obese, as opposed to just 10% in 1975. Today, our understanding of obesity, both scientifically and culturally, is split along several lines. On one side are what some might term the ‘fatphobics’: people who believe that weight gain is almost always an individual’s own fault, resulting from pure laziness and gluttony. Another camp are the researchers and doctors who believe that body weight is almost entirely genetic, and that most obese people have very little or no control over how much fat they have on their bodies - according to one study from Harvard University, up to 70% of an individual’s weight is genetically controlled. Yet another camp of public health researchers, including the World Health Organisation, attribute the steady rise in obesity to increasingly sedentary lifestyles and consumption of processed foods. What these camps all have in common is that they believe that being obese is dangerous to a person’s health, and that obesity needs to be treated and, when it can be, prevented. They all maintain that science clearly tells us that obesity, whatever its causes, is dangerous, and comes with serious risks of other co-morbidities and even death.

Not everyone agrees with this, even within the medical field. Particularly within the fat liberationist movement - a social and political movement that seeks to end the stigma and discrimination that comes with being fat - many consider it an unhelpful, offensive descriptor that prevents fat people from accessing healthcare. There are even those who reject the term ‘obese’ altogether, and consider it a kind of slur.

Dr Asher Larmie

This cultural and scientific debate is important to consider when talking about Kaylea Titford. I was lucky enough to interview Dr Asher Larmie, an NHS GP who is known as '@thefatdoctor’ on Instagram and runs a consultation service for people who consider themselves victims of medical weight stigma. Dr Larmie describes themselves as a fat liberationist, and holds many views about obesity that are very controversial in the mainstream medical community. For example, they asserted in a tweet that ‘we have no idea why the incidence of cardiovascular disease is higher in fat people.’ Most doctors would say that being obese puts someone at risk for cardiovascular disease, as excess fat can lead to a buildup of fat in the arteries. Dr Larmie, however, told me that these studies are unconvincing and only point to correlation, rather than causation - ‘a crucial distinction.’ They told me that fat people tend to have more co-morbidities due to the fact that they are often the victims of medical stigma, and have a harder time accessing healthcare. Many of Dr Larmie’s own patients have been told to lose weight before they can access certain medical treatments, or had crucial symptoms of deadly diseases missed due to their weight.

The perspectives of people like Dr Larmie, who essentially reject the idea that obesity is a cause for concern, are in the minority - the vast majority of medical professionals, including every major health organisation, cites obesity as dangerous to an individual’s health. Personally, while I respect Dr Larmie’s medical education and recognise that medical fatphobia is a significant issue, I am still inclined to view obesity itself as a health issue. In the context of the Kaylea Titford case, however, it does seem odd to me that so much legal attention and media coverage was devoted to Kaylea’s weight, rather than the horrific conditions she was found in. Dr Larmie believes that this stems from deep-seated fatphobia present in the medical community. ‘Kaylea did not die of obesity - you cannot die from being too fat. She died from the absolutely horrific neglect that her parents subjected her to,’ they conveyed to me.

"Kaylea did not die of obesity- you cannot die from being too fat. She died from the absolutely horrific neglect that her parents subjected her to." - Dr Asher Larmie, GP, 2023.

Parental Duty of Care and Obesity

In some ways, Kaylea’s parents were responsible for her weight gain, and in some ways it did lead to her death. Due to her disability and age, Kaylea was dependent upon her parents for her meals - Alun himself admitted that he failed to provide her with ‘healthy’ food. He asserted that as she gained weight, moving her and using her wheelchair became impossible. In a context where her parents were responsible for feeding her and helping her move, they were found to be neglectful in this case. However, as Dr Larmie pointed out to me, they could have asked for help - while this undoubtedly would have been difficult due to the pandemic, had they alerted authorities or healthcare professionals that they were unable to care for their disabled daughter, rather than neglecting her, Kaylea’s life may have been saved. The neglect in this case did not come from the fact that Kaylea became obese - in Dr Larmie's opinion. Kaylea was sixteen, still undergoing puberty, during which fluctuations in weight are extremely common. Arguably, the neglect came from the fact that her parents, upon realising that she was too heavy for her wheelchair and that they were now unable to care for her, didn’t reach out for help. Instead, they left her in her bed, resulting in bedsores and infections. To Dr Larmie, and to me, it was striking how much of the media coverage surrounding this unspeakable tragedy focused on Kaylea’s weight, when the conditions she was found in were so incredibly disturbing.

Future Implications of Kaylea's Case

So will the parents of obese children now be liable for criminal neglect? It remains to be seen. The causes of obesity are complex, and not yet fully understood. Following Alun Titford’s guilty verdict, there have been calls for a new safeguarding framework regarding childhood obesity and neglect. What has been seen, however, is that in some contexts, our legal system does consider obesity as gross negligence. Never before in the UK has someone been convicted for letting a child become obese, and in many ways it sets a new and controversial precedent. For someone like Dr Larmie, this has wide and potentially concerning ramifications that set the fat liberation movement back decades. However, others who see childhood obesity as a genuine public health crisis might herald the arrival of parental accountability for their children’s health. More than anything, however, it must be remembered that at the core of this case was the immeasurably tragic, horrific, untimely death of a vibrant young woman, Kaylea Titford.

Thank you to Dr Asher Larmie for your time and collaboration.