Fat letters from schools spur childhood obesity debate

Childhood obesityReceiving report cards from schools is a standard practice that helps parents stay informed about their child’s academic performance. But now, schools in some states have been going one step further and are also letting parents know how their child’s weight measures up.

A new report released this week in Pediatrics has spurred debate around this issue as it states that Body Mass Index (BMI) screenings in schools and subsequently informing parents about their child’s weight category is a necessary step in the fight against the childhood obesity epidemic.

Twenty one states, not currently including Washington, have enacted policies or made recommendations about collecting height and weight data and assessing body composition in schools. In some states, like Massachusetts and Arkansas, a confidential letter that has been dubbed a “fat letter” is mailed to parents whose child has a high BMI, informing them of their child’s weight status and advising them to talk with a doctor.

Childhood obesity: A significant health problem

According to the Centers for Disease Control and Prevention, about 17 percent, or 12.5 million, of children and teens in the U.S. ages 2 – 19 years are obese. Since 1980, obesity prevalence among children and teens has almost tripled.

“Childhood obesity is one of the most significant health problems affecting children and teens today and it can greatly impact a child’s quality of life and risk for developing chronic diseases later in life,” said   Mollie Grow, MD, MPH, a pediatrician at Seattle Children’s Hospital. “Addressing this issue is imperative and we need to provide parents with the information and resources to help them recognize if their child has an issue and address it.”

Knowledge is power

Grow believes that using schools to support parents with knowledge about their child’s health status and informing them about helpful resources is reasonable and important from a public health standpoint. Especially since she says that, as a pediatrician, it can be difficult to monitor a child’s health since children over age 5 only come for check-ups once a year, or sometimes even less.

“The goal is that every child is seen and screened by a health care provider at least once each year, but the reality is that not all kids come in for their yearly check-up,” said Grow. “Unfortunately, it’s often the high risk kids that miss appointments.”

Grow said that the information can be very helpful to raise parents’ awareness. Many studies have shown that parents are often not aware of their child’s BMI and they often don’t recognize or they underestimate their child’s weight status.

“This is information that parents otherwise wouldn’t have if they don’t recognize their child may be at an unhealthy weight, which we know happens, or if they haven’t been to their pediatrician, which we also know happens,” said Grow.

Therefore, she says that allowing schools to screen kids’ health status and then send letters home to parents can be very useful, but only if it’s done right.

“The more we can do to proactively address childhood obesity is critical, but it must be done in a way that is discrete, very respectful and supportive,” said Grow. “Ideally, the letters provide more comprehensive information to families beyond BMI and include information about their child’s fitness levels, as well as useful resources that can help parents address the issue.”

This process can prompt families to be aware of their child’s health status and give them the opportunity to be proactive about assessing the issue. Arkansas, which has the longest experience with providing children’s BMI information directly to families, has seen parents increase their child’s enrollment in sports and exercise classes, as well as make nutrition changes.

Grow also said that the health screening should be done in a private setting at school so kids don’t feel stigmatized when measured. The goal is to reduce the possibility of bullying and create a culture of respect at school. No schools should tolerate teasing or bullying because of a child’s weight. Families should also not engage in or tolerate teasing based on weight at home, which tends to only make people feel worse and not motivated.

What parents can do

If parents become aware or are concerned that their child may be at an unhealthy weight, it is important for them to visit their pediatrician. The doctor can then assess their child’s risk, putting it in the context of the child’s overall health and the family’s medical history. Grow cautions that BMI is far from perfect for diagnosis and so it is important to talk with a doctor to interpret what the level means for each person.

The family can then decide with their doctor how to best move forward toward a healthy lifestyle for their child so their weight status doesn’t become a problem.

Here are a few tips Grow recommends to parents to help children and teens lead healthy lives:

  • 7-5-2-1-0 for a healthy lifestyle – Parents should encourage kids to eat breakfast seven days a week, eat five servings of fruits and vegetable a day, keep screen time to two hours a day or less, be active for at least one or more hours a day and aim for no soda and other sugar-sweetened drinks.
  • More physical activity and fewer sugary drinks – Grow said that these two areas can really make a difference in improving a child’s health.
  • Make physical activity fun or part of a routine – Parents can look for physical activity resources through their local community centers and the YMCA. It is important that kids find an activity that they enjoy, like playing a sport, or that is part of their daily routine, like biking or walking to school, so they are more likely to keep up with it.
  • Support physical activity – Parents should be supportive of physical activity in terms of getting kids to activities, doing activities as a family and encouraging outdoor play, as well as providing verbal encouragement.

Obesity Program at Seattle Children’s

Seattle Children’s Obesity Program comprehensively addresses both obesity prevention and treatment through clinical care, advocacy and community programsresearch and education.

At Children’s specialty clinics, health care providers evaluate children and teens who have concerns about being overweight, are overweight or obese. The Child Wellness Clinic sees children ages 2 to 11 years and the Adolescent Wellness Clinic cares for youth ages 12 to 21 years.

Children’s is also actively engaged in community programs. In a partnership with the YMCA, Children’s offers the ACT! program (Actively Changing Together), a healthy lifestyle program available for overweight and obese youth, 8 to 14 years old, who have a BMI greater than the 85th percentile. The program teaches families ways to improve nutrition and increase physical activity to develop healthy lifestyles.

In addition, Fit 4 You is a program offered at Odessa Brown Children’s Clinic (OBCC) that promotes healthy lifestyles during well-child visits. Families can learn about healthy eating and attend nutrition and cooking classes among other activities.

The hospital also partners with the local Puget Consumers Co-op (PCC), which comes to the hospital quarterly and provides patient families with ingredients to make healthy recipes, like kaleidoscope salad, and raises money for both Fit4You and the ACT! program.


For more information about Seattle Children’s Obesity Program or to arrange an interview with Dr. Grow, please contact the public relations team at 206-987-4500 or [email protected].