View Hertfordshire SCB Procedures Manual View Hertfordshire SCB Procedures Manual

8.4c Smoking and Obesity


This chapter was developed/entirely revised in September 2012 and should be read in full


  1. Smoking by Potential Adopters or Foster Carers
  2. Smoking Practice Note
  3. Policy
  4. Obesity Information Sheet

1. Smoking by Potential Adopters or Foster Carers

Hertfordshire’s policy takes account of the LAC (98) 20 para 38, which states that “agencies have to take a positive attitude to recruitments”. Also para 46 “agencies have a duty to satisfy themselves that adopters who are about to have a child placed with them have a reasonable expectation of continuing to enjoy good health”.

The circular states;

“Following reports in the early 1990’s from the Royal College of Physicians and the Chief Medical Officer’s Expert Group on Cot Deaths, there was sufficient evidence for the Department to be concerned about the effect of passive smoking where babies and very young children were being placed for adoption with families who smoke”.

2. Smoking Practice Note

This practice note updates other guidance and has been produced following consultation with the Adoption Panel Medical Advisor and the Adoption Panel Management Team.

This guidance is given in the light of changing information and understanding of effect of health on children subject to passive smoking. Priority has been given to promoting the health of children and their carers.

This is general guidance for the adoption agency and does not represent a blanket ban. The paramount issue is to engage carers in discussing the implications the BAAF guidance on smoking (Practice Note 51) offering support, information and advice in order to promote their own health and that one of the children placed with them. Within these general guidelines it is also acknowledged that it is important not to disrupt the stable placement that is otherwise meeting the needs of the child.

3. Policy

Hertfordshire County Council Adoption Agency recognises the risk to the health of placing children in smoking households. The risk is greatly increased for children under 5, children with a disability, or those already registered with established medical conditions, especially heart and respiratory disease or glue ear. While there is no blanket ban when considering applications from adoption the agency would not routinely assess and approve adopters who smoke for the under 5s.

It is recognised that there may be exceptional circumstances where a child is already placed with kinship carers and has established a close relationship where this policy needs to be balanced against the need of the child to remain in the placement. In these circumstances, prospective adopters will be strongly encouraged to cease smoking and the agency will offer support and advice to assist in this.

4. Obesity Information Sheet

Obesity is a health risk and raises the risk of illness from:

  • High blood pressure;
  • Type 2 diabetes;
  • Raised blood lipid (including cholesterol);
  • Coronary heart disease;
  • Stroke;
  • Arthritis;
  • Breathlessness and sleep apnoea;
  • Gall bladder disease;
  • Certain cancers (e.g. uterus, breast, prostate, colon).

Measuring obesity

The most practical method to assess obesity is by using the Body mass Index (BMI). This describes weight for height and is calculated by dividing weight in kilograms and height in metres squared. According to UK definitions:

  • BMI > 25 means overweight;
  • BMI > 30 means obese;
  • BMI > 40 means severely or “morbidly” obese.

Who is at risk of health complications?

A BMI greater than 30 is associated with increased risk of health problems. Additional factors can raise this risk significantly, particularly of cardiovascular disease (including angina and ‘heart attack’) and stroke. These include:

  • Smoking;
  • Waist measurement >100cm;
  • Existing high blood pressure;
  • High cholesterol/ other high lipid levels;
  • Alcohol intake above recommended limits;
  • Family history of cardiovascular disease;
  • Lack of exercise.

Unless the applicant is severely incapacitated by obesity or is considered at such high risk that chronic ill health and early mortality are extremely likely, obesity by itself should not be a major consideration in approval. It is a factor, which must be taken into account along with all the other considerations. Information about dietary habits, lifestyle and exercise should be sought by the social worker and the applicants need to be informed that their weight is an issue and that it would be an issue for the Panel to consider.

Issues to be considered during the approval process include:

  • Does the applicant have the physical capacity to meet the needs of a young child;
  • Is the applicant sufficiently motivated to lose weight and committed to a healthy diet and lifestyle;
  • Does the applicant have sufficient commitment to a healthy diet and promotion of physical activity and exercise for a child;
  • Is the degree of the applicant’s excess weight such that it might reduce his or her chances of remaining in good health until a child reaches independence.