'Fat Letters' Take the Stage in Childhood Obesity Debate 08/21/13
WEDNESDAY, Aug. 21 (HealthDay News) -- If their kids are
frequently tardy, truant or failing to turn in homework, parents of
U.S. schoolchildren expect to be notified. And in some districts,
they might be contacted about yet another chronic problem:
The "fat letter" is the latest weapon in the war on childhood
obesity, and it is raising hackles in some regions, and winning
followers in others.
"Obesity is an epidemic in our country, and one that is compromising the health and life expectancy of our children. We must embrace any way possible to raise awareness of these concerns and to bring down the stigmas associated with obesity so that our children may grow to lead healthy adult lives," said Michael Flaherty, a pediatric resident physician in the department of pediatrics at Baystate Medical Center in Springfield, Mass.
About 17 percent of U.S. teens and children are obese -- three
times the number in 1980, according to the federal Centers for
Disease Control and Prevention. And one in three is considered
overweight or obese. Being overweight or obese puts kids at risk of
developing serious health problems, such as heart disease. Too much
weight can also affect joints, breathing, sleep, mood and energy
levels, doctors say.
Massachusetts -- which has had a weight screening program since
2009 -- is one of 21 states that have implemented statutes or
advisories mandating that public schools collect height, weight,
and/or BMI (body mass index) information. Some states further
require that parents receive confidential letters informing them of
the results, advising that they discuss the findings with a health
But some parents in the Bay State and elsewhere consider such
policies an unwelcome intrusion into private family matters. Other
objectors say "fat letters," as they are sometimes called, have the
potential to trigger bullying or eating disorders among the very
children they're trying to help.
In Massachusetts, where parents are letter-informed of BMI
results for students in grades 1, 4, 7 and 10, the state department
of public health is currently debating a possible repeal of the
letter portion of its screening protocol.
This would be a grave mistake, Flaherty believes. "The growing
number of children and adolescents seen day in and day out in our
clinics with hypertension, high cholesterol, diabetes, and
musculoskeletal issues secondary to weight do not lie," he
Flaherty, a clinical associate at the Tufts University School of
Medicine, outlines his thoughts in a "perspective" piece published
online Aug. 19 in
While acknowledging that the effectiveness of such programs
remains to be determined, Flaherty notes that school screenings are
nothing new, with many states having done so for many years. And in
2005, the U.S. Preventive Services Task Force determined that
calculating a child's BMI -- a calculation of body fat based on
height and weight -- should be considered the "preferred measure"
for tracking weight issues.
What's more, he suggests that parental fears that BMI
assessments may accidently identify healthy muscular children as
overweight is a misplaced concern over a relatively rare
"Additionally, no studies have shown any increased risk in bullying, eating disorders or unhealthy dieting patterns," Flaherty noted. "While these risks exist, they have not been proven in states where these programs have existed for several years."
The very point is to have a "confidential way of mailing letters
directly home to parents where these issues can be addressed in the
privacy of the home without any other students being aware of other
children's BMI," he said.
Other specialists are less enthusiastic about school BMI
Dr. David Dunkin, an assistant professor of pediatric
gastroenterology at the Icahn School of Medicine at Mount Sinai in
New York City, cautions that simply legislating parental
notification of school screening results will not help curb the
obesity crisis without comprehensive and well-designed
"While I feel that the intention is good [to] raise awareness among parents about their children being obese, and thus instilling motivation for behavioral changes or lifestyle modifications, this is unlikely to have effects in and of itself," Dunkin said.
To bring about change, notifications should include referrals to
programs that could help parents make lifestyle modifications for
their children, he added.
But Dunkin would prefer to see weight issues addressed by a
"I think it is the primary responsibility of the pediatrician to discuss obesity on a case-by-case basis with the child and the family, and try to help them with life changes," he said. "As a pediatrician I often speak to the family about this, and can assist them with advice on what to do to improve their child's health."
While Flaherty agrees that pediatricians should measure a
child's BMI at every child's well-care visit, he said these
check-ups are only performed annually.
"Pediatricians have 15 to 20 minutes per year to deal not only with BMI, but a variety of other preventive health issues," Flaherty said. "The public school system is a universal organization that has been used as a forum to reach children and parents for a variety of other issues: vaccinations, dental exams, and hearing and vision screening."
For more on childhood obesity, visit the
U.S. National Library of Medicine.
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