By RACHEL GUERRA
Published: December 12, 2013

In an attempt to lower the high rate of childhood obesity, many schools around the nation are implementing programs that target at-risk children. In 20 states, students are required to take a Body Mass Index (BMI) test at school, which assigns each student a number based on his or her height and weight. This number corresponds with a range that is supposed to be representative of personal health. If a student is not in the “healthy” range, a letter is sent home to notify the child’s parents or guardians.

However, it appears that the consequences of these initiatives are at odds with the initial implementation goals. These risks include parental promotion of dieting, increased stigmatization of obesity, lowered self-esteem, increased body dissatisfaction, and disordered eating.¹ Children are calling the send-homes “fat letters” or “fat reports”², suggesting that they feel as though they are being graded on their weight.  Parents worry that these measures may only cause harm, specifically to their children’s self-esteem Childhood and adolescence are important years in the development of one’s body image, and these “fat letters” could lead to insecurity or bullying.

In the few studies that support this weight feedback system, the results do not appear to be truly representative. In one study, for instance, only 51% of the parents opted to receive weight feedback, and only these families were represented in the data.³ One has to wonder if the data would be significantly different had the other 49%, who were opposed to receiving weight feedback, had been included. Other studies extensively interview the parents, but seem to neglect the potential impact on the children themselves.

BMI is an imperfect measure of overall health and there is research to support this.  And while obesity can lead to health complications, these same health complications can also occur in people who are labeled “healthy” by the BMI index. Many people are considered overweight by the BMI index but are metabolically healthy, and the reverse also applies.⁴ BMI can be misleading because it does not take into account many crucial factors of human health, such as amount of abdominal fat, ethnicity, bone density, or muscularity.

Another problem with wide-scale, mandated BMI-testing is the fact that, as of yet, we do not have enough research to support it.⁵ Simply knowing that your child is overweight does not necessarily motivate or equip you to do something about it.  In many cases, parents are already aware that their child is overweight because of BMI-tracking done annually by their child’s pediatrician or simply by observation. Sending home letters does not remove barriers to a healthy lifestyle, such as the high cost of fruits and vegetables and unsafe neighborhoods. The potentially negative impact of BMI-testing may be unintentional, but it should not be seen as a necessary evil. A more solution-oriented strategy would be to inform all parents about ways in which they could promote a healthy lifestyle for their children. In addition, if schools want to be involved in students’ health, they should allow more time for active play and offer nutritious foods. It hardly seems appropriate or necessary to risk doing serious damage to a child’s self-image. As Zanthe Taylor put it: “The BMI of a pre-adolescent child measures a moment in time, while obsessive thinking and eating disorders can last a lifetime.”⁶ Is it really worth that risk?

^{1 http://her.oxfordjournals.org/content/21/6/761.full.pdf+html
2 http://www.wkrn.com/story/23325342/school-bmi-testing-for-students
3 http://pediatrics.aapublications.org/content/122/3/e682.full.pdf+html
4 http://articles.latimes.com/2013/aug/22/science/la-sci-obesity-predicting-health-20130822
5 http://www.eatingdisorderscoalition.org/documents/TalkingpointsBMI.pdf
6 http://www.psychologytoday.com/blog/million-meals/201301/the-perils-bmi-screening}