Arkansas Led with BMI Letters from School. Obesity Rose.

SchoolboyTwo decades ago, the state of Arkansas became the first in the nation to require every school to send parents BMI report cards – also known as fat letters. Back then, in 2003, the obesity rate for children in Arkansas was 17%. Since then, obesity in Arkansas public school students has risen dramatically. In the 2021-22 school year, it hit a record – 26%.

At the time, Governor Mike Huckabee was a true believer in the raw willpower to overcome obesity. He even published a book to herald his own success with losing weight – Quit Digging Your Grave with a Knife and Fork.

Pediatrician Joe Thompson championed this concept and Huckabee signed it into law.

Good Intentions Gone Awry

It sounded good to many people at the time. So much so that a total of 25 states have implemented this idea.

There’s just one problem. What seemed like a good idea back then has not panned out. It turned out that willpower was not a cure-all for Huckabee. Millions of others who have been down that road could have told him.

Likewise, simply sending BMI letters home from school to tell Arkansas parents that their children were too fat did not make any difference. Just about any child who grew up with obesity in school could have told policymakers that their peers were already letting them know. Daily and painfully.

As early as 2007, people in Arkansas started figuring this out, but the program lived on.

Research Confirms It Doesn’t Help

If the common sense assessment doesn’t appeal, one might consult the research on this subject. In that vein, we have multiple studies to tell us that BMI letters do nothing to help children and their parents overcome obesity. Perhaps the best of these, by Kristine Madsen and colleagues, was a randomized clinical trial. It tells us that these letters do nothing to improve a child’s health status but may have the effect of causing dissatisfaction with their body image.

Still Hanging On

Nonetheless, these programs keep on keeping on. Joe Thompson, who designed the program for Arkansas, defends it, saying he has anecdotes of parents who love it. “To this day, they are still our strongest advocates.” He is President and CEO of the Arkansas Center for Health Improvement, which partners with the state on obesity prevention and BMI measurement.

But anecdotes are no substitute for evidence.

Click here for further reporting from NPR, here for the Madsen study, here, here, and here for further perspective

Schoolboy, painting by Istvan Nagy / WikiArt

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April 11, 2024

2 Responses to “Arkansas Led with BMI Letters from School. Obesity Rose.”

  1. April 11, 2024 at 6:37 am, Lise G Bjerregaard said:

    We recently published a review in this area,

    We arrived at the same conclusion – The sparse evidence available suggested that BMI screening followed by sending report cards to parents does not change BMI z-scores among children in primary, middle and high school.

    But I think an important point is that Studies using appropriate evidence-based weight management interventions as a follow-up are lacking.
    Why do a screening (and even a RCT) with no following intervention? I’m not aware that we do that in any other areas.

    • April 11, 2024 at 7:36 am, Ted said:

      Exactly right. Screening for a medical problem without offering treatment when it’s detected is unethical. But people have no qualms with obesity because of their bias toward people who live with it.