Massachusetts Schools to Stop Sending 'Fat Letters'

Parents have said the letters promote bullying and poor self-esteem in children.

Obesity rates among low-income preschoolers declined by at least 1 percent in 19 states in recent years, according to the CDC.
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Massachusetts public schools will stop sending controversial "fat letters" home with information about students' weight, the state's Public Health Council voted on Wednesday.

Nearly a quarter of all states already collect and record information on students' height and weight, and nine states, including Massachusetts, send letters home if a student is classified as overweight or obese based on his or her body mass index (BMI) score. The council voted 10-1 to stop automatically sending the letters home, after parents expressed concern that the letters could promote bullying and perpetuate self-esteem issues.

Lynn Grefe, president and CEO of the National Eating Disorders Association, says sending BMI report cards home with students can make children more self conscious and potentially push them towards developing an eating disorder. 

[READ: Childhood Obesity Linked to a Mother's Weight Gain in Pregnancy, Study Finds]

"It doesn't necessarily lead them to healthier behaviors, but rather among some, it leads to unhealthy behaviors - laxative abuse, purging, excessive over-exercising, dieting - all things that are risky in developing eating disorders," Grefe told U.S. News. "If we would all focus on the word 'health,' rather than weight and size, we would see better outcomes."

Grefe says BMI screenings do not belong in school systems, and should instead be limited to the doctor's office, where the focus is primarily on a child's health, not his or her image. 

"Everybody talks about bullying, but one of the primary sources or causes of bullying is weight," Grefe says. "I think there's enough evidence to show the more you put emphasis onto a child's size and weight and basically ridicule them or make them feel self conscious, the more you're steering them in our direction. And we have enough eating disorders, we don't need more." 

Another big concern for parents and students is privacy. The state Department of Public Health is not able to monitor how the information is being delivered and ensure it is done confidentially, according to a report presented at the council's meeting.

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"There have been reports of incidence where student confidentiality concerning height and weight measurements was not appropriately safeguarded, leading to alarm, confusion or embarrassment," the report says.

The report supported making the change to stop sending letters, saying there is more evidence that shows giving parents that information does not have an effect on obesity during childhood.

But state public schools will continue to collect information from students in first, fourth, seventh and 10th grades, as a way to monitor progress towards reducing obesity among children, and parents will be able to receive results if they ask for them.

Massachusetts began the practice in 2009 as national attention surrounding the obesity epidemic gathered strength. According to the Centers for Disease Control and Prevention, approximately 17 percent of children between the ages of 2 and 19 are obese, and obesity among children has nearly tripled since the 1980s.

[MORE: 'Fat Letters' Are Necessary to Fight Childhood Obesity, Report Says]

And in Massachusetts, one-quarter of all adolescents were either overweight or obese, according to a 2012 state report from the CDC. The high percentage could be the result of a lack of physical activity and unhealthy dietary behaviors among children. Nearly a quarter of all children drank soda at least once a day during the week leading up to the survey, and 23 percent did not participate in at least an hour of physical activity on any day during the week before the survey. Additionally, 30 percent said they watched television for three or more hours each day.

Still, many parents and some professionals take issue with using a child's BMI score as a measure of being overweight or obese. Children with a higher muscle mass could be classified as such, despite the fact that they are metabolically healthy. But some physicians say the information should be seen as an early warning, rather than a judgment.


Corrected on : Updated 10/17/13: This article has been updated to reflect comments from the National Eating Disorders Association.