One day last year, Selectman Tracy Watson received a school letter about her son Cameron. It wasn't about his grades or his behavior. It was to inform her and her husband that Cameron was classified as "obese."
"Honestly, I laughed," Watson said. The letter -- part of a state initiative to monitor children's Body Mass Index -- explained BMI standards and encouraged her and her husband to contact their pediatrician.
But the letters have many in town crying foul and have ignited a debate over the government's role in children's health.
Screening for Size
Body Mass Index is a number used to indicate body fat, and the number is determined by a child's weight and height.
Watson's laughter was from surprise. Cameron plays sports and participates in martial arts. He's a member of the North Andover Booster Club wrestling team and the Doughboy Wrestling Club, and he's also a football player. How could he be "obese," and why was his school sending a letter home saying he was?
A child's BMI is factored with a BMI-for-age chart established by the Centers for Disease Control, and a percentile (compared with age and gender) is determined for classification: underweight, healthy weight, overweight or obese. Those in the 95th percentile are classified as obese.
In 2009, the Massachusetts Department of Public Health adopted a "BMI initiative" requiring public schools to calculate the BMI of children and teens of certain ages and send the results to the children's parents along with instructions for parents on dealing with the child's weight issues.
Officials from the Massachusetts Department of Public Health have not yet responded to request for comment, but according to the Department of Public Health Web site:
"Overweight and obesity have become a serious health problem in Massachusetts. Almost one-third of school-aged children are either overweight or obese. Overweight and obese children are at risk for diabetes, heart disease, and other chronic conditions. Helping children maintain a healthy weight can prevent potential health problems and serious diseases."
On Beacon Hill
It turns out, many parents receive these letters.
Nicknamed the "fat letters," these notices are part of an effort of the Department of Public Health to battle childhood obesity. But they're not just to warn parents of overweight kids. Underweight kids get the letters as well.
And many parents have complained, saying the letters amount to government interference in parenting and invasion of privacy.
"I have come across many parents whose children are perfectly fit, healthy and active in sports, but muscular in build and are reporting that they've received letters stating their child is obese or at risk for obesity," Bridget Martin said. "Some of these children laughed at these letters stating that they are obese because they know it is ridiculous, while others become upset, depressed and ashamed, even though they are far from obese."
In January, State Rep. Jim Lyons filed legislation -- with a petition from Watson -- to stop the "fat letters." H2024 seeks to amend Section 1, Chapter 71 of the General Laws by inserting the following language:
"(h): No language in this section shall authorize the Department of Public Health to collect data on height, weight, or calculate a student’s Body Mass Index."
This is not the first time Lyons has taken on the state's Department of Public Health. When he addressed the North Andover Board of Selectmen last month, he called for taking money from the DPH to pay for targeted local aid. And last year, Lyons took issue with the controversy over whether or not schools should be allowed to sell cupcakes at events.
"It goes to a larger problem, the Department of Public Health is losing sight of what its focus is and expanding too many areas," Lyons said. "I dont think it [a child's BMI] is something that parents need to be told through a school department."
H2024 is currently referred to the Joint Committee on Public Health, of which Lyons is a member. Lyons said he expects it to be up for debate and a vote some time this spring.
"Just think about it in a broader sense, some of this regulation that the Department of Public Health is getting bogged down in, at the same time they're not inspecting our pharmaceuticals labs, we have a crime lab situation that's going to cost us tens of millions of dollars, and the Department of Public Health is concerning itself with whether or not local schools can sell cupcakes," Lyons said. "The focus ought to be to protect the safety of our citizens."
About the Children
But how might BMI monitoring and parental notifications impact the children themselves?
The Massachusetts Department of Public Health guideline for BMI screening (attached in full to this article) cautions:
"To avoid stigmatization of any student and protect the confidentiality of individual screening results, BMI screening results should be mailed or otherwise directly communicated to the parents and guardians, and not sent home with the student. When possible, for screening results that are significantly out of range or of particular concern, it may be appropriate for the school nurse to personalize the letter or place a phone call to the student’s parents or guardians."
But the notification would tend to be known to the child eventually, especially once there is follow-up discussion with a pediatrician.
"Overweight children know they are overweight," Watson said. "We spend so much time discussing 'bullying' that to a degree our younger children think almost everything is bullying. I have heard one than one child express feeling bullied by these letters."
State Sen. Kathleen O'Connor Ives agrees, which is why she signed on to Lyons' legislation.
"It's an example of an unfunded mandate that results in additional administrative cost, but I think also has the potential to do harm to a child's self-esteem," O'Connor Ives said. "I think that there are tools that schools can use independently to inform parents about that [childhood obesity] being a public health issue for children without targeting individual children and putting them into these categories, whether they are underweight or overweight."