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Should schools send 'fat letters' home to parents?

May 23, 2013

    Hanna Jaquith, Daily Briefing

    In some school districts, being a chubby kid can merit a note home from school.

    The nation's schools are increasingly joining the fight against soaring obesity rates by flagging at-risk kids using a height-to-weight formula called the Body Mass Index (BMI). The measure of body fat is the primary tool used to classify kids as underweight, normal weight, overweight, or obese. The Institute of Medicine recommends school-based BMI screenings as part of an annual physical since many students do not have access to a primary care physician, according to the Chicago Tribune's Julie Deardorff.

    However, the screenings have touched a nerve with some BMI critics, who argue that the screening—which does not account for age, sex, and ethnicity—is inherently flawed. BMI also cannot distinguish between excess fat, muscle, or bone mass, which can generate misleading labels for athletes, muscular individuals, and some racial and ethnic minorities.

    About half of children whose BMI labels them as overweight are healthy and have no risk of diabetes or other conditions, says Kristine Madsen, an assistant professor at the University of California-Berkeley School of Public Health and University of California-San Francisco Department of Pediatrics.

    Currently, about 19 states require school-based BMI screenings, while nine recommend it alone or as part of a broader health-related fitness assessment, the Tribune notes. Schools use and share the information from those screenings in different ways. For example, some schools have proposed including it as part of a physical fitness grade, while others only report it to the state or provide only aggregated data. Some schools even send letters home to the parents of kids considered at-risk of obesity.

    Sharing BMI scores with parents is intended to help correct perceptions about their child's weight—one survey revealed that parents live in denial about their children's' weight problems. However, the largest study to date on the issue found no difference in obesity rates between kids whose parents received fat letters and those whose parents had not. The researchers found the letters mailed home were poorly designed, overly complex, and lacked context.

    Moreover, parents lack information on how to respond appropriately to BMI scores. Dianne Neumark-Sztainer, a professor at the University of Minnesota's School of Public Health, says, "We want to correct parents' perceptions, but what are parents going to do with that information? She adds, "My fear is that their intentions will be good may they may inadvertently do something that will be harmful."

    More broadly, some parents take issue with weight screenings in school. They say that such screenings can trigger bullying, eating disorders, and inappropriate dieting.

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