Do Fat Letters Fight Obesity? ?>
Be Well

Do Fat Letters Fight Obesity?

by Keng Lam, MD

For the past month or so, there has been a lot of very public controversy about letters sent to some Massachusetts public school parents about their children’s weight. Dubbed “fat letters,” the communications reported each child's Body-Mass Index (BMI), a formula based on height and weight.

They also noted which percentiles are considered to be within the healthy range, and encourage parents of those considered significantly underweight or overweight (below the 5th percentile and at the 85th percentile and above, respectively) to talk to a pediatrician.

The missives sprang from a 2009 Masachusetts initiative, which mandated that public schools collect this data on children, and inform parents by mail of the results. Some 21 other states have similar statutes or recommendations in place.

Some parents have been quite unhappy about receiving the letters—so unhappy that the state's Public Health Council voted 10-1 last month to stop having schools send the letters.

I can understand the parents' upset. After all, BMI is not a perfect measure of a healthy child, because muscle tissue weighs more than fat tissue, which the Massachusetts letters pointed out.

“Up to a third of kids with a BMI in the overweight category do not have increased body fat and wouldn't be expected to have a higher risk of diabetes or other weight-related conditions,” explains pediatrician Kristine Madsen, M.D., M.P.H,, assistant professor, Joint Medical Program and Public Health Nutrition at UC Berkeley. “Some people just come with more muscle than others.”

In addition, some parents say they are concerned that such letters might hurt youngsters' self-esteem, while eating disorders advocates say they may actually promote anorexia or bulimia.

I disagree with the Massachusetts decision, and for several reasons. Parents are not always the best judges of their own children's health status, and some may be in denial about their youngsters' weight. For example, a July 2012 Gallup poll found that according to their parents, nearly three-quarters of children are "about the right weight" and only one percent are thought of as "very overweight." National data show that one-third of children in the nation are overweight, and 17 percent of that number are obese.

Parents, for their parts, should be asking that public health departments and schools take additional action in the fight against obesity by offering more time for physical education and healthier choices for school lunches. And schools should go beyond simply providing a BMI number in their communications to parents. They should also offer useful tools that will help parents address the issue, from tips for grocery shopping to contacts for local registered dietitians.

Combating childhood obesity requires schools, government and families working together—and ignoring this problem won't make it go away.