Do ‘fat letters’ really work?

Published on October 28, 2013
Amanda Burton

Recently, schools in our country and our neighbouring U.S. have been the focus for “fat letters” that have been sent home with children for their parents.

The letters have one of two purposes: a) part of a program to focus on collecting BMI, or body mass index (a measurement of weight over height indicating one’s weight status) solely for research purposes, or b) part of a larger plan to actually send a confidential letter to parents indicating that their child is obese.

BMI monitoring is being done in Toronto and St. Stephen, N.B., and fat letters are being sent home in 21 states across the U.S.

The state of Arkansas, which recent reports indicate is the only U.S. state where obesity still is continuing on an incline, now has a law requiring BMI measurements in its public school system.

Schools and health authorities using the measurements argue that weighing and measuring the height of schoolchildren, with letters sent home with overweight and obese kids, is an important tool for combating the obesity epidemic. They also note that this kind of screening has been going on in parts of the States for more than a decade.

Despite objections, it’s noted that it has led to positive lifestyle changes for many of the children identified as obese.

But let’s not forget that obesity is a multifaceted problem. There is not one root cause.

Sure, eating and exercise habits play a large role, but also lack of sleep, changes in hormones such as menstruation, genetics or medications also have the potential to create some gain weight.

Sometimes what may seem like a weight issue may not be.

It’s well known that BMI when used alone, is not best indicator of weight status.

It’s not the best indicator as it doesn’t take into account different body frame sizes, or muscle mass, and in addition different BMIs may be appropriate for different ethnicities.

To illustrate the problem with using BMI, take into account the highly publicized story of an

11-year-old volleyball player in Florida who came home with a letter saying she was at risk of being overweight. Her height is five-foot-three, weight 124 pounds, which gave her a BMI of 22.

Perhaps we should be commending kids for being active and making good dietary choices, while promoting health at different sizes.

One has to wonder, with these sorts of measures and letters, what are the effects on kids?

Sure, a letter may help a parent or family to take action on their lifestyle habits, but what about the effects on kids of walking down the hall and back to class with letter in hand?

Bullying is already a major problem in schools.

The Canadian Institutes of Health Research notes that 47 per cent of Canadian parents report having a child that has been a victim of bullying.

On the other side, obesity is also a major problem for many of our kids, too. Thirty per cent of Canadian children are overweight or obese.

Fat shaming — for anyone, kids or adults — is harmful and unproductive. These measurements and letters certainly are not without their controversy.

Schools can play a role in promoting good health. However, when parents get a fat letter, then what?

There may be one set of parents where receiving such a letter could be a wake-up call, and a chance to change the family’s lifestyle habits together.

For other families, it might seem more like a “blame game,” as they already know their child has a weight issue.

Aside from individual reactions, for a program like this to really make a difference, it would need to provide people with the resources to be able to make change.

Access to a dietitian for education on healthy eating advice for families, a fitness professional for advice on activity and programs to engage kids and family in fun activity, only healthy choices in schools, regular gym and nutrition classes in schools that are not optional but mandatory — these are some ideas, but really just a start.

As important as school is for learning, parents also need to be at the front lines for this type of education on lifestyle, and act as role models for healthy habits for their kids.

There certainly have been mixed reactions by students and parents with to these initiatives.

What are your thoughts on BMI measuring, or letters for parents of school-aged kids?


Amanda Burton is a registered dietitian in St. John’s. Contact her through the