Letters F, A, and T

Should Schools Send Fat Letters Home?

“Fat letters” is the derisive label parents use for the BMI reports that many schools send them if their children are judged to have an unhealthy weight. It should be no surprise that they’re unpopular.

Overweight Student - Staten IslandThis week, the New York Post published a story and photograph of a slender third grader in Staten Island, whose mother was shocked when she received one of these fat letters. Four feet and one inch tall, weighing 66 pounds, Gwendolyn Williams was given a Fitnessgram to take home to her mother and told not to look at it. Of course she looked. It said she was overweight.

In this case, the report was an obvious mistake. The Post didn’t bother to mention it, but the the data for this girl yields a BMI in the 20th percentile — a healthy weight. We have two non-surprises here. No one should be surprised that New York’s least credible news outlet (according to a Pace University study) would gloss over the facts for a sensational story.

But equally obvious is the fact that these letters are fraught with problems. One problem is illustrated nicely by the Post. Mistakes will happen that make everyone look stupid. Another problem is that these letters have very little value. If a child has a real issue with obesity, a Fitnessgram is not going to deliver any news to either parent or child. Adults and kids with obesity already have way too many people telling them they’re fat. It’s not helpful.

Fatima Cody Stanford and Elsie Taveras pointed this out in a review of the experience in Massachusetts with fat letters, which the state ultimately abandoned. They concluded that:

Single sector interventions will have limited effectiveness in improving children’s weight trajectories. Approaches that aim to support families across multiple sectors and that create meaningful partnerships between families, clinicians, and community agencies can have a collective impact on reducing childhood obesity.

Way too much energy goes into telling other people that they are too big. Doctors do it all the time when they tell patients to lose weight and offer no medical support to do something about it. Health plans do it when they talk about the health risks of obesity and then systematically deny access to evidence-based obesity treatment. The list goes on and on.

Schools need to worry more about weight-based bullying and shaming. They can pay attention to providing good nutrition and physical activity in school. Offering up unsolicited advice about body weight is not a help.

“We live by encouragement and die without it – slowly, sadly, and angrily.” — Celeste Holm

Click here for the story in the New York Post and here for the publication by Stanford and Taveras in Obesity.

Letters: F, A, and T. Photographs © Leo Reynolds / flickr

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