1. Parenting
Katherine Lee

Should Schools Send Out BMI Letters?

By July 19, 2010

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An increasing number of parents are fuming over the so-called "fat letter" that they've received from their child's school.

In the past several years, a number of states have begun requiring schools to screen kids for obesity and send home body mass index (BMI) reports and letters to parents. States including Arkansas, California, Delaware, Florida, Illinois, Louisiana, New York, Pennsylvania, South Carolina, Tennessee, Texas, Vermont, West Virginia, and Massachusetts have passed legislation requiring schools to set up BMI measurement programs.

The problem: Many parents whose children are perfectly fit, healthy, and/or active in sports but muscular in build are reporting that they've received letters flagging their child as obese or at risk for obesity. What irks critics of these school-based BMI reports is that the reports are being issued with little or no guidance to help parents understand that BMI evaluations, especially for children, may not in fact be indicative of a weight problem. Others are questioning whether schools should be sending out these reports in the first place.

I think that while the laws are well-intentioned, there are better ways schools can spend money and energy to combat child obesity. For instance, they can ensure that school lunches are nutritious and full of healthy and delicious options. They can also work to make sure that kids have enough breaks for exercise and lessons about healthy eating and fitness in their school day.

Have you ever received an obesity report from your child's school? What do you think about schools issuing BMI reports?

Comments
July 19, 2010 at 3:51 pm
(1) Catherine says:

I agree that improving the overall health and fitness quality of life at schools (enough recess time, nutritious choices for breakfast and lunch). I think that many parents who receive the BMI letter might jump to defensive mode and not really hear the message; and as you note, BMI isn’t a particularly great measure anyway. Those who know their kids are overweight may already be trying to help them. Those who don’t realize that their kids are in jeopardy probably need more assistance (and confrontation?) than such a letter provides.

July 19, 2010 at 6:18 pm
(2) Bonnie says:

My daughter’s BMI was listed on her Presidential Fitness report (not a separate letter from the school). I think this was completely appropriate ~ and her BMI was in accordance with her performance on the test.

July 20, 2010 at 10:56 am
(3) Zakadabug says:

I do not agree with it at all. My daughter is exceptionally tall for her age…54in at age 7.5. She weighs 82lbs and since they are calculating this based on age she is considered overweight. However, when you look at the measurements for an 11 year old she has the height and weight right in the middle. Why should my child be marked for being tall for her age? She eats healthy, gets regular exercise, and is all around a wonderful child. I do not want her getting an eating disorder or self esteem issue because America is so stuck on skinny.

July 20, 2010 at 11:46 am
(4) mrsjay says:

I have an 8 year old son who is also 54 inches tall and weighs 64 lbs and is one of the largest boys in his grade. I’m sorry, but if your daughter weighs 20 more lbs than that, she IS overweight. I took my son to Dairy Queen yesterday to get a small plain cone and there was an obese child in line in front of us whose mother ordered for him a super sized adult meal! Large regular coke, large fries, large burger and large ice cream sundae. The boy looked and acted about 3 or 4 yrs old but probably weighed close to what I weigh(110 lbs). Parents do not want to see their kids for what they are – fat – and do not want to take responsibility for allowing their kids to eat so much. My mouth was hanging open in shock as I watched that preschooler devour a meal meant for an adult male.

July 20, 2010 at 1:56 pm
(5) Zakadabug says:

NO MY CHILD IS NOT OVERWEIGHT! Her educated pediatrician has stated such. He state that people need to focus on height in accordance with weight. She already has hips, breast, and I have been told is starting puberty early. She is tall and thin and has a very defined figure for her age. She also does not partake in overeating or supersizing. We eat well balanced meals and she would rather partake of a salad then candy any day. I can agree that some parents don’t take their child’s weight seriously but it’s comments like your’s about kids being fat is why we have an epidemic of teen and tween anorexia in this country.

July 21, 2010 at 12:40 am
(6) Duhon says:

@Zakadabug–

It sounds like you are doing everything right and most important are working with a pediatrician to make sure your daughter is right where she needs to be. But, I think you are in a minority.

Many parents simply do not realize the health danger their child might be moving toward. I do think that sending home some sort of letter for many parents is exactly what they need to encourage them to seek a pediatrician’s advice or to make healthy changes in the family for their child.

For several years, I have assisted our school nurses in doing health screening where overweight child after overweight child is flagged as a diabetes risk, many with diabetic symptoms already present.

Our school is a Title 1 school, meaning that–at least where we live–often there are special needs present in the home (low-income, low levels of parent education, non-English speaking, etc.). In many cases, the school nurse is the first or *only* heath provider these children will see.

Rather than pretend that nothing is wrong with the child’s health, the families need extra information and an offer of assistance. If (and this is a big IF) a BMI letter or something like it, are handled confidentially and include specific information on what the parent should do, such as seeking a pediatric exam, I think it can be a good thing.

I would rather be on the side of extra caution, and send out letters to parents that are already doing everything right, than to have children who need help slip through the cracks.

July 21, 2010 at 5:50 pm
(7) mrsjay says:

I think the upset response to my initial comment does prove that BMI letters won’t work because parents do not want to see what is happening. Here is an article about the link between early puberty and being overweight.
My son is the same height as your daughter and normal sized at 64lbs. I’m not sure how your daughter can look “thin” when she is the same height and 20 lbs more. I’m not advocating anorexia and it is rude to suggest I am. I am merely pointing out that what you perceive is normal and the actual numbers don’t match up.I do think parents should accept the facts of the numbers. The scale and measuring tape don’t lie. It is what it is. People have a tendency to normalize what is around them. If more and more people get obese than merely overweight begins to look normal.

http://www.medscape.com/viewarticle/411343

July 21, 2010 at 6:58 pm
(8) Christy says:

@mrsjay – If you look up BMI calculations for kids, you can see that @Zakadabug’s daughter is not considered overweight for her height/weight/age. I don’t think it’s up to us to tell people when their child is/or is not healthy. Hopefully all of our children see a pediatrician who is trained to make that judgement.

As for schools sending home BMI reports, I don’t think it’s helpful. I’d rather see some classes in healthy nutrition and cooking for kids and parents, as well as encouragement to engage in active play outside of school.

July 21, 2010 at 8:02 pm
(9) Stacie says:

This is a lengthy answer, so I apologize in advance. With the school budget crisis being what it is, money should be spent on implementing intramural programs, 5-2-1-0 programs and healthy lunch programs which include salad bars and vegetarian options, not on weighing children and sending letters home to parents.

Also, BMI charts for children are rubbish because they factor in age. Children do not all grow at the same rate, as is evidenced below.

@Zakadabug

My daughter is in a similar situation (albeit a bit older). At 11 years old she is 5′ 5″ tall and weighs 124 lbs. She swims competitively for USA swim and spends 14 hours per week in the pool working out. She has breasts, hips and has already started menstruating.

According to the charts for children her age, her BMI makes her at risk for being overweight (83rd percentile). Yet, plug in her same numbers on a BMI chart for an adult woman (which does not factor in age) the same size (that would be me) and she’s nowhere near being at risk (her BMI becomes just over 21% (which is smack in the middle of normal).

She has met with a nutritionist who has reviewed her food intake as well as her activity level (she also plays sports at school) and we were told that not only is she not at risk for obesity, she is far healthier than many girls her age that weigh what would be considered “normal.”

@mrsjay
Unfortunately, I was unable to view the article you linked to, but I would like to offer up another article from the University of Michigan which cites that obesity is a possible factor in early puberty, along with environmental contamination (hormones in dairy, pollution, etc) as well as social factors and a host of underlying diseases.

In addition, this article cites that puberty can happen for girls at any time between the ages of 9 and 16 (my daughter began developing breasts at around 8) and that race also plays a part in the onset of puberty. It’s scientific fact that boys develop later and are therefore far smaller than their female peers for quite some time during childhood; boys typically do not reach puberty until between the ages of 13 and 15 and this is when they gain muscle mass.

http://www.med.umich.edu/yourchild/topics/puberty.htm

I think telling Zakadabug that her daughter is overweight simply based on numbers is slightly ignorant on your part. Not only are you jumping to this conclusion simply based on your own son’s measurements, you are passing judgement on Zakadabug as a parent and suggesting (based on your Dairy Queen story) that s/he is not being honest about what is really going on with the child’s diet.

Health is about more than a number on the scale. It’s about endurance, body image, mental state and a host of other things. I can say that I was “stuck on skinny” for a long time and felt rundown, depressed and irritable. Our family adopted a clean eating lifestyle several years ago, eliminating processed foods, refined sugars, etc and I stopped counting calories. Guess what? The number on my scale went up, but I’ve never felt better in 33 years.

July 21, 2010 at 11:53 pm
(10) JnSAlger says:

@mrsjay What you state is very single minded on your part. Just because you child is a ‘normal’ doesn’t mean everyone bigger than him isn’t. For all we know he can be small boned and sits on his butt playing video games all day. My 8 year old plays competitive soccer and basketball. She is somewhere between 4’10” and 5′ and weighs 90 lbs. Based on an AVERAGE 8 year old she is overweight. The child has very little fat on her. She is a solid mass of muscle. She always has been. I’m 6’1” and her father is 6’5”. There is no way her height and weight are going to fit in the confines of a NORMAL 8 year old.

In the same breath, my extremely small boned and nearly no muscled 7 year old is 54 inches and 58 lbs. There is nothing to her. She is skin and bone and bruises easily. However, she too is very active.

As to our eating habits, we eat organic fruits and vegetables regularly and rarely every have any type of junk in the house. If we do it is organic frozen yogurt or coconut milk ice cream. We grow the vast majority of our vegetables ourself so we know what is in them. And most of this lifestyle started because I was the fat athletic kid. My mother didn’t care. However, as fat as I was puberty didn’t start until I was 13. I was the LAST in my class and I was THE fat kid. Just because YOU are 110 lbs doesn’t make you healthy. It just makes you easy to toss.

July 23, 2010 at 12:59 pm
(11) Chas says:

I don’t think you can say “too fat” or “too thin” in kids (under 15 or so) unless the height/weight ratio is way outside the norms. I looked up 54 inches for a female and one scale says 70 lbs is ideal while another says 83. Still, MrsJay has a point that parents are not always good judges because they see their kids through a filter (either extra judgmental or extra lenient).

It riles me when people when people are obviously fat, but say it’s beautiful or I’m big-boned or some other BS. It takes calories to maintain a lot of weight. I remember years ago Oprah had a really fat woman on her show (I can’t find the episode) talking about how she was happy with herself and it was OK to be heavy. She died the next month.

November 16, 2010 at 8:38 pm
(12) Wraxtiorre says:

So, at what point do we admit that the effects of such a program amount to persecution? Would it be appropriate to send Ancestry letters home with children? You have to ask yourself, why is it okay to send a fat kid home with a letter that says, “Your child is obese,” when it is not okay to send a Chinese kid home with a letter saying that “You child is Asian.”? How do you think the schools will react when they start getting responses that contain nothing more than a three-letter answer? “Duh!”

I’ll take the opposite side of the argument, from where I stand. When I was a kid, they didn’t notify my parents that I was in danger of suffering from malnutrition, they just called me “Beanpole!” Now, you have to ask yourself, would a malnutrition warning have been more appropriate? Officially sanctioned medical insurance-raising warnings that have nothing to do with my parent’s responsibility but rather just a factor of my metabolism?

November 24, 2010 at 7:12 pm
(13) Michelle says:

I received one of these letters, not in an envelope. My daughter, 9 in 5 days and reads at a 9th grade level, read the letter first. This letter was part of a “FitnessGram”. She didn’t 100% understand what was meant by “child at risk, needs improvement and info about her being at risk for health problems.” She did get the idea that she had failed at something. She ripped up the letter. I was concerned about her health suddenly! I went on websites, one of which was the CDC website. Her BMI is HEALTHY. I do not know what calculater this “FitnessGram” uses, but it on not accurate! Her BMI on the letter said 18.5-at risk. Her BMI on the CDC website and others is 18.5–HEALTHY. My child is not stick thin, she is short like me and strong! Her weight is in her butt and thighs…like me! I am not overweight, I just did my BMI. Her dad’s weight comes in overweight and he is not. If he weighed what the BMI say he should, he would look like he was out of a concentration camp! My GOSH, what are we doing to our beautiful daughters? Sending these prepubescent girls home with “letters” telling them they are overweight?! As a mother of three girls, I am ALARMED!! We live in a society in which thiness is more important than health, models are starving and photo edited. Schools should spend time working on reading and math. Leave the BMI calculations to the doctors. I do have to say I am a supporter of GYM class, I think it is very good to get the kids moving everyday or as often as possible. My daughter is 3’11 and weighs 58 pounds, wears a size eight, most of which are too loose on her! She would never even fit into a plus size eight. She weighed 50 pounds FOREVER, close to a year, the eight pounds is a growth spurt as she is finally getting taller! We eat healthy, I won’t let her eat the school lunch more than twice a week because it is NOT healthy. If I was worried about her BMI, I would bring her to her family doctor.

November 29, 2010 at 9:20 am
(14) Alan says:

i think during teenage years its hard to tell if a child is over weight or not. I was overweight since i was 11, put it on not going to school for a year and it stayed throughout my school years. my sister was quite chubby however she is 15 now and as she grows is slimming down. I have lost all my weight so im very happy. still wanting to slim down more cause im self obsessed. im 20 years old now and it feels great to be being told i need to gain weight rarther than loose lol. my bmi is 21.3 but i do have lots of stomach muscles from situps.

I think all parents and schools can do for kids is push them towards healthy eating and excercise. provide healthy meals. and everything should turn out great. saying there overweight, at risk of obeseity over afew extra lbs is silly, remember teenagers r growing and constantly changing.

and michel;l;e wen it says 18.5 at risk it means at risk of becomming underweight i think, but really? if shes eating 3 good meals a day then shes fine, the stupid world is going obsessed with it. just lyk i am with my weight lol. im aiming for a bmi in the 20′s and im being told im to skinny but as long as im happy thats all that matters right? same with u and ur daughter, good luck to her with what the teenage years may bring

April 6, 2011 at 8:53 am
(15) sirraya says:

my son is 7 and now he refuses to et because the school nurse sent home a bmi letter indicating that he is obese. i dealt with the same problem that lower my self esteem and know i believe my son is going thru the same thing in school. when does it STOP!!!!!!

February 28, 2013 at 8:34 am
(16) Jessica Groves says:

I would just like to say a little something about ‘school lunches’ Since they are apt to judge our children maybe they should take a second to look into what they are feeding our kids. I used to have my kids get hot lunch from the cafetieria until i found out what they were eating. Nacho cheese, chips, and some sort of gross processed meat. They eat this at least once a week. They can have chocolate milk every day eventhough it is loaded with sugar. They don’t even offer water as an option. Everything they eat is processed, full of sugar, and most likely GMO. It’s no wonder we are here with weight and health problems. Like they say you are what you eat. You can be the most active person out there and still be chubby because of what you eat. Maybe instead of wasting time and recorces on these tests to see how fat kids are they can look into finding healthier options for the cafeterias!!!

October 8, 2013 at 7:39 pm
(17) Paula Taylor says:

Tell the schools to BUTT OUT. These ridiculous letters will do nothing more than make the kids more paranoid about their weight. If they want to do something about it, then the schools shouldn’t serve fried foods, push high sugar energy drinks on the kids in sports as a way to “replenish”, stop selling energy drinks, soda, etc. to the kids as a way to supplement school budgets.

A child’s physician is in the best position to spot concerns relating to weight issues.

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