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Fighting Student Obesity with ‘Fat Letters’

Controversy over so-called “fat letters” mailed from district offices to parents, informing them if they have an overweight, healthy weight or underweight child, is erupting across the nation.

Massachusetts parents have recently complained of privacy invasion after the state Department of Public Health passed in 2009 the Body Mass Index (BMI) Initiative, which requires district nurses to measure the body fat of students in grades 1,4, 7 and 10 through a weight and height ratio. Districts then mail parents a letter stating what the BMI means. The “fat letters” controversy led North Andover Selectman Tracy Watson and State Rep. Jim Lyons to file legislation to stop the BMI screenings, after Watson’s son, a student athlete in the North Andover Public Schools, was classified as “obese,” Watson says.

The district has been performing these screens since 2009 with no complaints until now, says superintendent Kevin Hutchinson. “It’s a piece of the puzzle that helps families be able to talk more with their own health care provider and make decisions based on that and other factors,” he adds. “BMI, as we say in our letter, doesn’t tell the entire story of a student’s weight.” Parents also have the option to waive the BMI screening by submitting a written request to the school nurse, he adds.

Childhood obesity rates nationwide more than doubled to 18 percent over the past three decades, and in Massachusetts, more than 30 percent of children are overweight or obese, which can lead to diabetes, heart disease and cancer. “BMI screenings are part of a multi-faceted approach to address the significant public health problem of obesity,” says Anne Roach, media relations manager of the Massachusetts health department. “Helping children maintain a healthy weight may prevent serious illness later in life.”

Massachusetts is not alone: Arkansas implemented a statewide BMI screening program in 2003. And in California, students participate in physical fitness testing that also assesses BMI. Though the BMI scale is a “fairly strong” measure of body fat, according to the federal Centers for Disease Control and Prevention, it does not differentiate fat from muscle, so athletes may be mistakenly marked as obese.

Still, the national Institute of Medicine (IOM), an independent nonprofit organization, recommends schools nationwide annually measure students’ BMI, since studies have found that many students do not see a private doctor regularly to check their health, says Christine Stencel, senior media relations officer.

To avoid stigmatizing students, the CDC report recommends that schools with BMI screening programs:

-introduce the program to school staff and community members, and obtain parental consent

-establish safeguards to protect student privacy (such as letters sent directly to parents, rather than through students)

-regularly evaluate the program and its intended outcomes and unintended consequences.

Hutchinson says administrators will reexamine how to make the message clear to parents. “We have an issue with child health in the U.S., and this is about how we can impact that.”