Should Wash. public schools send 'fat letters' to parents?

SEATTLE -- Across the country families and lawmakers are debating the risks and benefits of measuring children's Body Mass Index in a school setting and reporting the results to parents.

According to the U.S. Centers for Disease Control and Prevention, 17 percent of children and teens in the country are obese. The American Academy of Pediatrics released a report last week stating that measuring children's BMI in school and reporting their weight status to parents is a necessary step to fighting America's obesity epidemic.

Washington does not have a statewide policy or recommendation on measuring body composition in schools, but 21 other states do. In Massachusetts and Arkansas, a confidential letter referred to by many families as a "fat letter" is sent to parents of children with high BMIs recommending the family consult with its doctor.

In Arkansas, where schools have been required to perform BMI screenings since 2003, studies have found the percentage of parents who signed their children up for sports or exercise classes or improved their family's nutrition increased significantly in response to BMI reports.

But, not everyone has supported the practice. Legislators in Massachusetts and Arkansas have tried to ban public health departments from collecting height and weight data in public schools, though each attempt has failed.

Seattle Public Schools started an opt-in only program for measuring students BMI five years ago. It is one of five fitness assessments that students start in third grade and complete yearly on a voluntary basis. The information is collected for district surveillance and is reported to parents.

"We have a responsibility to educate our children about body composition, to help them create awareness for themselves," said Lori Dunn, physical education program manager at Seattle Public Schools. "We're not here to say, 'You have a fat child.' We're creating awareness for healthy standards."

Dunn said the district has established protocols to ensure health and fitness data is measured privately and kept confidential.

In the Puyallup School District, some teachers collect BMI information as a part of PE classes. The information is used to assess instruction across the district, but it can be made available to parents upon request.

"Some teachers use BMI to set up a baseline for students," the district's Director of Health and Fitness Rick Wells said. "Students can look at their progress over the semester."

Still, Wells said he would never send BMI scores to parents as a weight assessment.

"I teach kids on how to be fit and leave the medical analysis to the family doctor," Wells said. "A PE teacher is not an MD, and BMI is not a diagnostic tool."

Some parents agree, saying BMI should be measured at the doctor's office, not in school. Seattle mother Katie Karasinski said she would never want her daughter to step on a scale at school.

"Little girls grow up and are surrounded by media messages of what they should look like," Karasinski said. "I don't think they need one more place to be body shamed."

But, Dr. Mollie Grow, a pediatrician at Seattle Children's Hospital, said schools should provide parents with information on their child's weight status and the resources necessary to address weight problems.

"People are likely aware if their child is very, very overweight, but in that in-between zone parents are more likely to underestimate their child's BMI," Grow said. "And, the in-between zone is the best time to change that trajectory."

BMI screenings in school will help children who aren't regularly seen by a doctor, Grow said.

"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 checkup," she said. "Unfortunately, it's often the high-risk kids that miss appointments."

Grow said a student's BMI is related to their academic performance, so schools should be tracking it.

"Kids of higher BMIs tend to have more absenteeism and lower graduation rates," she said. "They also have higher rates of depression, anxiety and bullying."

The Washington Education Association and Seattle & King County Public Health both have staff members reviewing this practice and neither has determined a position on BMI measurements in schools at this time.

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