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Fighting the 'Fat Letters'

After public backlash over BMI notifications, two North Andover lawmakers are joining the fight.

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."

Terence Michael Pinkston MSN, RN February 28, 2013 at 01:02 AM
Jim Lyons, are you aware that approximately 300,000 deaths a year in the United States are attributed to obesity and furthermore, approximately 55% of the U.S. population is overweight, and almost one in five is obese (Centers for Disease Control and Prevention, National Center for Health Statistics 2010). Or according to the World Health Organization (WHO) the United States spent 148 billion dollars last year treating obesity related medical conditions? Not to mention, the United States only spent 91 billion treating smoking related medical conditions the same year? Do the math and tell me this isn’t a problem. So let me ask you this simple question, if I let my child of 8 years old smoke cigarettes would I be charged with a crime such as child neglect? Also, if a parent enable a child by being in control with the child eats and the child is extremely overweight and as a result comes down with type 2 diabetes. Would I also be charged with child neglect in this issue? I control what I buy for the child to eat? As a result of my actions the child came down with a medical condition which in some cases could be for life due to my actions. I would really like to hear your feedback on this issue especially with the analogy I just gave you?
Terence Michael Pinkston MSN, RN February 28, 2013 at 01:06 AM
Not to mention that Jim Lyons by looking at his photos has some overweight issues as well. Nice triple chins you have there your honorable State Representative Jim Lyons.
Michael Quinlan February 28, 2013 at 01:53 PM
Clever method of encouraging a state representative to take you seriously.
Michael Quinlan February 28, 2013 at 01:56 PM
How make Democrats has Tracy voted for over the years? As the saying goes 'If you lie down with dogs, you will get up with fleas'.
Tracy Watson February 28, 2013 at 02:07 PM
While your orignal comment was something to discuss....your second comment now erases the validity of your first. Really too bad that you would jump to making fun of how someone looks.....when you do that you stop the conversaton and the possibility of enlightening others.
Tracy Watson February 28, 2013 at 02:08 PM
I voted for a good number of them MIke...all good folks in my opinion...I've also voted for a good number of republicans.....do I get fleas from them too? Silly thing to say....
MikeA February 28, 2013 at 02:38 PM
I propose the Affordable Nutritious Food Act. All the states will operate cafeterias where all citizens (the dream food act to follow later) are given three nutritious meals a day (two on weekends and holidays) free of charge. This program won't be much different from the meal provided over the summer on the Lawrence schools. The program will be funded by the savings resulting from removing the inefficiency of our current food distribution systems and having food preparation areas in every home.. Expert chefs and state of the art cafeteria kitchens will replace the need for kitchens in homes and restaurants. And we will no longer need convenience stores on every block and redundant supermarkets. And the many amateur cooks - in addition to the time savings - will no longer have to eat their own cooking or rely on canned items, junk food, or expensive restaurant meals. Those who work at full time jobs will get meals paid by their employers are company operated cafeterias. More to follow ...
Michael Quinlan February 28, 2013 at 09:36 PM
Desc BMI on NAPS website: http://www.northandoverpublicschools.com/cms_files/resources/Body%20Mass%20Index%20screening%20program.docx. Note there is no mention how to 'opt out'. "Body Mass Index screening program In accordance with the Mass Dept of Public Health (MDPH), schools are required to perform height, weight and body mass index (BMI) screenings for students in grade 1,4,7 & 10 and send home the results to parents and guardians. The purpose of the screening program is to give parents additional information about their child’s weight status and ideas for living a healthy life. BMI is a measurement that is used to show a person’s “weight for height for age.” It is calculated using a formula that includes an individual’s height and weight. Just like a blood pressure reading or an eye screening test, a BMI can be a useful tool in identifying possible health risks. BMI does not tell the whole story about a child’s health status. BMI does not distinguish between fat and muscle. For example, if a child is very athletic and has a lot of muscle, his or her BMI may be high even though he or she is not overweight. That is why parents are encouraged to share the results with their child’s health care provider and have them explain the results of their child’s BMI screening. They are in the best position to evaluate a child’s overall health. Please visit the MDPH website at www.mass.gov for Frequently Asked Questions about BMI and Mass in Motion. "
Michael Quinlan February 28, 2013 at 09:37 PM
All good folks who voted to expand government at every opportunity and impose this BMI circus.
Terence Michael Pinkston MSN, RN February 28, 2013 at 09:55 PM
Really Tracy? Last time I check first impression meant everything in our society? The comment wasn’t actually directed to him, but to show what other people feels in this issue and how others perceives others and you just reply to it. Now you know what overweight & obese people feels & what your state health department is trying to prevent. Look at the magazines, TV commercials, even your local fast food commercials. You don’t see overweight or obese people in them. Overweight people are discriminated all the time in this world. Employers are more likely not to hire them because they may think they are lazy and not productive and in the healthcare field they are often given the stigma that if they don’t bother to take care better self of themselves then why should we encourage the additional teaching to help them which is wrong but it does happen. All your state is trying to do is break this chain of events from happening and all you want to do is stop it. You can stop the letters maybe but you can’t stop the general public and their views on the issues. What you should be doing with Mr. Lyons is enforcing better parenting skills for those kids parents who are overweight because in my opinion if your child is overweight or obese & you control what the child eats than that is child abuse & neglect and if you’re not being a responsible adult to feed your children the right foods verse junk food than perhaps your child should be raised by someone else who can do this.
Terence Michael Pinkston MSN, RN February 28, 2013 at 10:20 PM
I agree with Michael on the BMI as I am 6'3 224 pounds with 10.5% bodyfat and the BMI has me almost in the obese section... However, insurances dont care all they care is what the BMI numbers are and for some reason people are just not to bright to use a simple plastic tool called a fat cailper these days...
Fritz February 28, 2013 at 10:28 PM
Another case of Teaparty politics... You'll get nowhere with Chainsmoking Tracey Watson... But thanks Terence for enlightening others. Any efforts to stop the cycle of obesity AND Parents SMOKING WITH CHILDREN IN THEIR CAR is money well spent!
Fritz February 28, 2013 at 11:32 PM
We all remember Tracy in Richard Tsei's ad claiming to be an average voter who always voted for Tierney... That precancerous voice reminded me of Marge Simpson's sisters. Find it hard to believe a Teaparty stalwart like Watson ever voted for a dem. Just glad there's a Gordon back in NA politics to keep these crazies in check!
Fritz March 01, 2013 at 01:27 AM
Sorry, I just find it funny that a tobacco user would have any valid criticism of public heath policies... Only on Faux! :-) For the majority of children, BMI is actually a cheap and effective way to identify obesity.
Carl Reppucci March 01, 2013 at 02:30 AM
Where is the data for the meals tax - does the town have this? Why do they allow junk food at the sporting events? The town meals tax is a joke and anyone who supports overrides should really consider how wasteful town, state and fed government is. Imagine the trickery to allow the meals tax. Quietly, and without much information was voted in. An under ride to remove the $1.7 million voted for should be out, meals tax when it gets a chance should be voted out. And someone should file a lawsuit against the school department for selling junk at all sporting events. Parents should boycott all fund raisers at local restaurants and have fund raisers at their homes, with home cooked meals.
Robert March 01, 2013 at 03:23 AM
Carl - did you ever try looking at the town's website? Or maybe pick up the phone and speak to the Town Manager? He is a very nice and knowledgeable man. Here is a link to current Budget Status report : http://www.townofnorthandover.com/Pages/NAndoverMA_Accounting/FY13%20Financials/jan13fr.pdf
Terence Michael Pinkston MSN, RN March 01, 2013 at 03:34 AM
Who is the smoker complaining about public health policies?
Fritz March 02, 2013 at 01:54 AM
Anyone run the bmi for a ten year old, 93lbs, 58 inches tall? Comes up with bmi of 19, which is healthy.... hmmmm. What am I missing??
Carl Reppucci March 02, 2013 at 03:23 AM
Robert, Thank you. I have contacted the town manager by email and nothing, selectman nothing, school department nothing. I have questioned the school budget of what I see as $100K for telephones - seems high. And, the question was here let the selectman respond and make it more public. Revenue from meals tax according to the finance page you sent has the town at $230K in 6 months. And note it has it as revenue, like any revenue, yet they seem to have spent it before they got it, $150K to plan, $100 K for school department lease etc. We didn't need the meals tax, we don't need to keep funding Stevens Estate - remember new growth is more money. CPA should be cut completely or at least in half, - anything historical allowed to be torn down and new rebuilt as new growth generates more money. Budgets may be on track but they constantly want more, and the town just like anyone needs to be careful with every penny they collect. Not just ask for more and have programs like the people here are complaining about run at any cost without accountability.
Terence Michael Pinkston MSN, RN March 02, 2013 at 03:50 AM
@Fritz, because you didn't calculate it right..You have percentage range in Peds and have to calculate the predictability of puberty and growth spurts which is not required in adults. I did the math and not knowing his parents height so I made him 6 feet tall and at current course of action at the age and current weight would weigh 263.35 pounds at the age of 18.
Terence Michael Pinkston MSN, RN March 02, 2013 at 04:47 AM
But the health dept should make their own employees walk the walk if they are going to talk the talk...For example, almost fifty-four percent of healthcare providers are overweight or obese. According to Brown, I., & Thompson J., (2011) fifty-three percent of nurses are overweight but lack the motivation to make lifestyle changes. Although ninety-three percent of nurses acknowledge that overweight and obesity are diagnoses requiring intervention, seventy-six percent do not pursue the topic with overweight and obese patients(Sally, K., & Patricia, T., 2010). So this is the fact what happens. You get a fat letter, go see your doc, all he will say is eat more greens and exercise more..Really that's all you will get..You only have a 24% chance of actually finding someone who care to take the time to help. As this is America and its all about how many patients you can see in a day and how much you can make in a day... Last time you go see your PCP just watch its blah blah blah and out the door... So if you get a fat letter, don't waste your money going to see your doc because you won't find help there either bc he is either fat himself or doesn't know what to tell you anyways...
Fritz March 02, 2013 at 04:58 PM
Terence-. Thank you. My calc was not factoring parents measurements.
Fritz March 02, 2013 at 05:03 PM
Terence, it's less about the letters and MORE about the study... Please read my comments under the follow up article Bryan wrote. This initiative is part of Michelle Obama's fitness effort and includes lots of free money for schools that apply. Our school got a nutritionist AND a STAFFED salad bar for the school lunch program. The Ymca, Blue Cross, and the CDC ponied up almost 200k in grants.
Fritz March 02, 2013 at 05:15 PM
Imagine if these politicians focused on improving their own town rather than starting a smear campaign for the demise of a much needed study... They too might have a salad bar! Which is an undeniable improvement! Our slad bar visits make up a third of all students!! Also, look at Mississippi who had the fattest kids on the planet. They took advantage of this grant program in a big way and are already realizing a statistically signifigant improvement!
paula rockwood March 02, 2013 at 10:26 PM
In the pediatric office I work in I have literally seen a fat kid sitting on the exam table,flab hanging over the wasteband of his underwear,double chin, and the parent saying she just does not see a weight problem.
Terence Michael Pinkston MSN, RN March 02, 2013 at 11:09 PM
well Paula, society has gotten a custom to seeing overweight people and fat people like to hang around fat people. You see a heavy person say all the time they would like to lose weight but when ask what they do and you get a nothing replied. Americans are very lazy anymore. As for Michelle Obama's fitness, well school isnt the answer because you still have classes all day and the problem still lay with the parents. They are in control of what they buy the kids to eat,and they have the power to tell the kids to turn off the video games and go outside....
Carl Reppucci March 03, 2013 at 02:20 AM
From July 2012 till Feb 2013, approximately $230,000 in revenue from the meals tax, a tax that is 0.75 percent of the sale of a prepared meal; to achieve that revenue approximately $31 million had to be pent in this town alone; Peabody and Danvers each nearly at $70-90 million sales in each town to achieve their meals tax dollar revenues. May be the government should raise the tax high enough to keep people from eating bad food, just like cigarettes, maybe a MacMeal for $5 should cost you $25. Remember, Tracy mentioned saving $15000 by not having these "fat letters". $15000 is nothing, the state government and school department don't really care. The money is so big, who wouldn't want slice of that pie. This is why we should have voted no to the meals tax in a much bigger way.
Carl Reppucci March 03, 2013 at 02:20 AM
I stated similar figures at the No vote second vote meals tax session.
CoachRaf2 March 08, 2013 at 06:27 PM
I think Tracy Watson's hot... in a Kathleen Turner sort of way.
MikeA March 08, 2013 at 07:10 PM
Many imitators ... no equals

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