Wednesday, August 27, 2014
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Should schools send home 'fat letters'?

In recent years, Pennsylvania along with other states began screening for a student's BMI and sending home the results to parents. It has come under criticism in some states. Is the practice shameful or helpful for parents?

Should schools send home 'fat letters'?

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Should schools send letters home to parents indicating their child’s Body Mass Index percentile and weight category? An opinion piece in Pediatrics released online earlier this week discusses how the BMI screening letters have come under harsh criticism in Massachusetts and are now being called “fat letters.”

Currently, 21 states have enacted policies or made recommendations regarding the collection of height and weight data or assessment of body composition in public schools. Pennsylvania began to phase in BMI screening for all students in the 2005–2006 school year. New Jersey does not have a state policy. However, its State Board of Education Administrative Code requires annual height and weight screenings for each student in kindergarten through grade 12.

“No parent would be proud to receive a letter stating their child is in the overweight or obese category, but the awareness and acknowledgment that he or she could have a weight problem begins the process of a multidisciplinary approach to change. It is time to put aside this pride for the future of our children’s health,” writes author Michael R. Flaherty, DO, a pediatric resident physician at Baystate Medical Center, Springfield, Mass., and clinical associate at Tufts University School of Medicine in Boston.

While many of us balk at the idea of getting a letter from the school telling us, as parents, that our child is overweight, we must first realize that schools have long been utilized as vehicles for public health assessment and intervention. Dating back over the last century, schools have weighed, measured height, screened hearing and vision and vaccinated children, and sent letters home when a problem has been uncovered.  So, in one sense, this type of screening and suggestions for intervention is nothing new.  

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The state that has implemented obesity screening most widely to date has been Arkansas. According to my colleague Wendy Ward, who is a pediatric psychologist and director of Wellness at Arkansas Children’s Hospital, “Arkansas was very careful in how they write the letters. There has been no local stir about “fat letters” here. They are informative, nonjudgmental, and resource-focused rather than labeling.”  

That may be the key here, not to label or to pass judgement, but instead to give parents positive suggestions for healthy lifestyles. Regardless of weight status, we would probably see more parents making sure that their children got an hour of active play each day, ate meals with their family with no electronics, and got to bed on time for a full night’s sleep if they knew it would help their children do better in school academically and have better behavior. And if kids got exercise, enough sleep and ate with their families, fewer of them would be overweight. We need to help families see all of the benefits of good healthy habits and not become hypnotized by childhood obesity.

At this time, there is no evidence that these letters cause any harm, nor is there any evidence that they do much good.  But if they could be used as a vehicle to support healthy habits it may be worth the effort.  So, perhaps after the kids are weighed and measured, all parents should get a letter encouraging good health habits, perhaps links to a good website, and be informed of the behavioral, academic, emotional and physical benefits of those health habits.


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W. Douglas Tynan, Ph.D. Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical Colg
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The Healthy Kids blog is your window into the latest news, research and advice around children's health. Learn more about our growing list of contributors here.

If you have questions about your child's health, ask them here.

Anna Nguyen Healthy Kids blog Editor
Stephen Aronoff, M.D., M.B.A. Temple University Hospital
Peter Bidey, D.O. Medical Director of Family Medicine at Philadelphia College of Osteopathic Medicine
Christopher C. Chang, M.D., Ph.D Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical Colg
Mario Cruz, M.D. St. Christopher’s Hospital for Children, Drexel University College of Medicine
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist - The Anxiety Behaviors Clinic, CHOP
Gary A. Emmett, M.D. Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Lauren Falini Bariatric exercise physiologist, Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Crozer-Keystone Health System
Jessica Kendorski, PhD, NCSP, BCBA-D Associate Professor in School Psychology/Applied Behavior Analysis at Philadelphia College of Osteopathic Medicine
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, R.D. Children's Hospital of Philadelphia
W. Douglas Tynan, Ph.D. Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical Colg
Flaura Koplin Winston, M.D., Ph.D Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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