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'Fat Letters' and the Childhood Obesity Debate

Experts, parents split over schools' role in weight screening

WebMD News from HealthDay

By Alan Mozes

HealthDay Reporter

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: obesity.

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 care provider.

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 said.

Flaherty, a clinical associate at the Tufts University School of Medicine, outlines his thoughts in a "perspective" piece published online Aug. 19 in Pediatrics.

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.

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