Should schools be allowed to tell parents if their child’s (Body Mass Index) BMI is healthy or dangerous? Many schools are “measuring students at an annual weigh-in and sending reports home (which have been coined 'fat letters'), telling parents whether their child’s BMI is healthy or dangerous.” The schools goal is to reduce childhood obesity.
But there are many discrepancies regarding this concern, as parents and children are frustrated and offended. According to a report on the Good Morning America show, girls hate the reports; they feel that it makes them insecure about themselves; that it could cause bulimia; and parents are concerned about adolescence stage—how it could affect weight gain, and the stress that their children may encounter.
Yet, American Academic of Pediatrics indicates that "it’s the best way to measure if a child is healthy or unhealthy." Eating disorder experts “worry that this practice sends the wrong message to children, and can even trigger the onset of eating disorders and school bullying.”
Stephanie Reed: Do you believe sending annual weigh-in reports coined as “fat letters” home to parents telling them their child’s BMI is healthy or dangerous makes a difference in children’s diets?
Jennifer Lombardi: As a parent and the wife of a teacher, I understand that the intention in sending these letters is to educate or support families by making them aware of their child’s health and wellness. The challenge is that according to research in the past two years, these letters are often vague, do not help families understand what the BMI really means, nor do they give suggestions on next steps. If the intention is to provide support, then we need to do more than just send a confusing, incomplete letter.
SR: According to American Academic of Pediatrics, school’s BMI readings are “the best measurements they have to determine whether a child’s weight is healthy or unhealthy.” But many eating disorder professionals believe the reading will do more harm than good. As an eating disorder program director, what are your thoughts and/or experiences?
JL: At our treatment center, we never use the BMI – it was never intended to be an assessment tool, and it does not take into consideration bone structure, cultural differences or muscle mass. As a provider in this field for more than 10 years and someone who has done extensive prevention work in schools, I am well-aware of the challenges associated with finding a cost-effective way to measure a child’s wellness. But this is not the tool. In that sense, it is taking a shotgun approach to a complex problem.
SR: According to National Eating Disorder Association, 40 – 60% of elementary school girls (ages 6-12) are worried about their weight. How could this trigger eating disorders?
JL: Through research over the past decade, we know that people at risk for developing an eating disorder have certain temperaments and other biological factors. When they are exposed to and engage in dieting behaviors, these behaviors mean something different for them. This is similar to what we’ve known about individuals at risk for developing alcoholism – that lots of individuals can have a glass of wine, but for a subset of the population, that drink means something different to them. Living in a society that exposes children to negative beliefs about weight and appearance, and promotes dieting and obsessiveness around exercise, creates a toxic environment in which eating disorder behaviors can flourish.
SR: During adolescence, children’s bodies encounter many changes, puberty and hormonal changes. How does puberty hormonal changes contribute to obesity and/or BMI readings?
JL: Many families (and teenagers) are unaware of the natural changes that occur during puberty. For example, research has shown that the average girl will gain 38 pounds during puberty – and this is normal. At the same time, puberty and associated hormonal changes occur at different ages, so there is an understandable increase in appetite associated with this normal growth spurt. What’s interesting is that most schools take BMI readings in grades 5, 7 and 9 – right when girls and boys are going through puberty. So there can easily be a misinterpretation of this spike in weight as unhealthy, when in reality it is not.
SR: As an eating disorder professional, how would you deal with children who have a high BMI index, and whose parents have been notified by their school and/or physician regarding the issue?
JL: I would approach them the same way that I do any patient and family with weight concerns: first, educate them about what is normal in terms of weight, puberty and changes during adolescence. Second, I would take a thorough evaluation of what a typical week looks like in terms of family meals and activity. Finally, we would identify activities the family and child actually love. Goals would focus on increasing cooking together, family meals and engaging in a diverse array of activities most days of the week. And most importantly, drop the diet-based, good food/bad food talk, and if there is a scale in the home, throw it out.
SR: Many of us have seen children who were obese as a child, and slim as an adult. And, yes, weight should be a concern, as well as healthy eating habits. Can we really say that all obese children will be obese adults?
JL: I think if we believe that, then we are giving up on providing nurturing and effective guidance and support to future generations. The most important thing is to promote balance across the board, from food to exercise, from academics to down-time. The messages that should be promoted are that we need food for fuel and food for fun, and we need to engage in activities that we love. It may sound simple, but given our stressful and overly-scheduled lives, trying to incorporate these simple things is no small task. It’s important to support families and children without shaming them, and make goals simple and achievable in order to promote sustainable change.
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