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ADVANCE Perspective: Nurses

The Fat Letters

Published June 28, 2007 9:48 AM by Adrianne OBrien

 A few years ago, a school district in my neck of the woods, suburban Philadelphia, sent, as they came to be known, "the fat letters."

The confidential letters from the East Penn School District notified parents of their child's body mass index (BMI), explaining that BMI was a screening tool and encouraging parents to share the results with their child's pediatrician.

"Studies have shown that BMI in children and adolescents compares well to laboratory measurements of body fat," the letter stated, "and also correlates with known health risks associated with being overweight. These risk factors include abnormal lipid levels, high blood pressure and insulin resistance, a precursor to diabetes."

George Ziolkowski, PhD, the director of pupil personnel service with the East Penn district, said that it took the school's nurses a year "to convince me that we really had to start doing something about this."

The school's intentions were good.  The numbers of heavy kids, as we all know, are on the rise. Today's overweight children may be tomorrow's diabetics and heart disease patients, adding more to the rolls of an already-strained healthcare system.

But as a parent, how would you feel if you received one of these letters (parents of children whose BMI fell under the 5th percentile for age and gender also were notified)? Would you view it as a helpful tool, or an invasion of privacy or even an insult? 

To view the East Penn letter, which now allows parents to opt out of receiving information on their child's weight, click here.

--Adrianne O'Brien, editor, ADVANCE for Nurses


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Sabine Sabine, Modular office equipment - Modular office equipment, Modular office equipment August 14, 2009 8:57 AM
Timor CT

The negative comments about informing parents about their child's fitness level does not take into account that children born today are the first generation that will not outlive their parents.  Further it does not take into account the health of our country which despite fantastic medical resources is among the worst in the world.  Our school system makes sure that the BMI is only one measure sent home to every family.  The other information is about fitness testing.  Please don't think we embarass students when they are measured.  Each one is given privacy.  It would also surprise you how much they enjoy watching themselves grow.  I do the measuring - I know.

edwina zagami, , school nurse Phillips Middle July 16, 2007 9:14 AM
Chapel Hill NC

I remember when they lined us all up in 4th or 5th grade and weighed us all one at a time. How humiliating was that!!!!!!

No one thought anything of it at that time, though. They didn't spend so much time showing concern for our little "psyches".

Why not send a letter home to every parent, positive BMI or negative? Then the ones with the negative reports don't get singled out. If the others find out about it, it is the fault of the kid or the parents who shared the information with others.

But why is it the business of the school to stick their nose into the health issues of the kids? Offer a healthy breakfast and lunch, plenty of PE, less TV in the classroom, cut out the fast food and junk food inside the school building at any time.

Stick with education. If it takes a village to raise a child, it is not just the responsibility of the public schools to fix everything that is wrong with kids and families today. It is the effect of media, stores, churches, family members.......all together.

S K, MHMR - RN, Group Home July 15, 2007 3:25 PM
Georgetown TX

Absolutely it is a responsible move to send this info to parents.  Parents are irresponsible for sharing the information with the kids without explaining the more positive food choices that are necessary to correct high BMI issues.  However, sending out info on the child's BMI to parents opens up a world of responsibility - I've found that many parents believe they are feeding their children healthy meals, sometimes simply because the package says "fortified" or "fat free" and sometimes they believe it without really knowing why they feel it is healthy.   Additional information needs to come along with BMI information - things like what consitutues a healthy meal.  There would also need to be a serious campaign against packaged and processed food, which is generally what people are feeding themselves and their children today.  There needs to be mainstream information available to people which outlines what all the chemicals in our food are, why they are there, and what, OVER TIME, they do to our bodies.  BOTTOM LINE: yes, the BMI information is very necessary and to some parents, very helpful.  BUT, truly eating healthfully requires that people ignore what they see around them 24/7: packaged, processed, unhealthy and convenient food and make serious changes in what goes on their tables and in their mouths at mealtime- this seems to be too much to ask of a lot of families.

Barbara, Biology - Teacher, Community College July 12, 2007 11:29 AM
Chicago IL

The measurement of BMI is helpful in understanding how one falls on a chart to measure body fat ratio. It is not helpful in isolation. Information that would be most helpful is guidance in making better food choices. Educating parents on the importance of all food groups (including fats), and how each food group plays a pivocal role in maintaining  homeostatis. Connecting the relationship of homeostasis to daily body functions and responses. Supply information on reading food labels and comparing the varied nutritional facts. An isolated BMI  holds no value. Growth spurts and gene pool play a big role in its true value.  Tracking and general nutritional education would be more well received. Taylored GYM exercises that promote individual accomplishments will build self confidence and self esteem which in turn will create a positive willingness to stay on track with other life issues.

Crystal Williams, Health Information - RN, Matria July 12, 2007 9:16 AM
Harleysville PA

Hooray for the East Penn School District!  Hopefully this will be a wake up call for parents.  If something like this had been done in previous years (ie: when the parents were in school) the US obesity problem might not now be so bad. I like the fact that it is confidential and ALL children are tested, not just those who are deemed to be overweight visually.  I do have to agree with Abbey Scott on two points: 1) any notification in a report card is wrong, 2) the school should also focus on more physical education and more nutritious food.

Maryann Dario, RN July 11, 2007 4:09 PM

I personally think "fat letters" are a witch hunt. Do kids really need another reason to feel inferior to their peers? Although these letters are supposedly confidential, kids are crafty and can find some way to get the details.

An article in the Jan. 8, 2007 New York Times tackles this issue, citing one 6-year-old who got what I call a "fatty-gram" with her regular report card. She was in the 80th percentile for weight and her mother said since then she barely touches her dinner.

The article also raises the point of state-mandated report cards on children's weight, even as schools cut back on physical education and still serve junk food for breakfasts and lunches.

Abbey Scott, ADVANCE - Sr. Associate Editor June 29, 2007 9:00 AM

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