Barb Phelps called it "the fat letter," and when it came in the mail, she was not pleased.
"This whole thing has got me really ticked off," Phelps said. "They're telling kids who aren't fat that they're fat."
Phelps, who is president of the Parent Teacher Association at her daughters' school, Westwood Elementary, got the letter last spring from the school nurse. Her girls, ages 7 and 9 years, are overweight, according to the Pittsburgh Public Schools.
"They're going to feed these kids garbage at school and then tell them they're fat?" Phelps said. "My older daughter does tap, jazz, ballet, and my younger daughter is just plain thin. They're not fat. I try really hard to watch what they eat, because the school lunches are awful."
"In a way, I was offended," said Mary Keller, whose 9-year-old daughter attends Southmoreland School District. "I think if the schools are going to do something like that, tell you they fall into a certain range, they should make suggestions about healthier eating, or taking the paper to the doctor."
The state Department of Public Health requires school nurses to measure students' body mass index, or BMI, along with weight and height as part of its growth screening program.
A person's BMI is calculated from his or her weight and height and provides an indicator of body fatness, according to the Centers for Disease Control.
In 2005, Pennsylvania became the second state to require school nurses to measure students' body mass index and notify parents of the results.
In Pennsylvania, the growth screening program started last school year, beginning with students in kindergarten through grade 5. This year it includes students up to grade 8. High school students will be phased in during the 2007-08 school year.
Arkansas became the first state to require student BMI reporting in 2002. That state used money from a national tobacco settlement to pay for enacting the mandate. In addition to Arkansas and Pennsylvania, Delaware, South Carolina and Tennessee now require BMI notification in public schools.
"I considered it (BMI) like a tool," Keller said. "Having that BMI come home, I was able to say ... it's time to get the problem addressed, to get more healthy."
Sandra Zimmerman, school nurse at Jeannette McKee Elementary School, sends out an annual health report card, which includes a child's BMI along with height, weight and other health screening results.
Although many parents probably know their children are overweight, she said, seeing it in on paper might make a difference.
Some families have let her know they've begun walking or exercise programs.
"No one has said anything negative," she said.
Last year, the school began asking parents to send in nonedible or healthy treats for birthdays, instead of the traditional cookies, candy and cupcakes.
Lori Hall, president of the school's Parent Teacher Organization, said the PTO provides drinks for school parties, and has switched to water instead of sugary juices.
"I think it's great information to have," she said of the BMI. "Some parents do get offended if their children are on the obese level. ... I think it's a good eye-opener."
Hall incorporates some of Dr. David Wolfson, of Children's Community Pediatrics at Children's Hospital, advice in her child rearing. PlayStation is limited to weekends only. She serves healthy snacks. Family members eat dinner together six nights.
The height and weight measurements have been reported by schools to parents for 50 years, according to Richard McGarvey at the state Department of Public Health. The health screenings are conducted along with vision and hearing screenings. The form sent to parents isn't new, but it now includes the BMI number.
"It gives a much clearer sense than height and weight alone, of whether a child is growing healthfully," McGarvey said.
He said the American Academy of Pediatrics and Centers for Disease Control recommend BMI as a way to alert parents to the fact that extra weight puts a child at risk for serious health problems.
Pennsylvania Advocates for Nutrition and Activity worked with the Department of Health to develop a growth screening communication kit for schools and parents, spokesman Joel Cliff said. The kit, available on PANA's Web site, includes templates for letters to send home to parents, a PowerPoint presentation and tips on putting the growth screening program into effect. It sends the message "that BMI is only one part of a larger, overall program to improve nutrition and increase physical activity," Cliff said.
Wolfson said any attention directed toward the growing problem of childhood obesity is good. The younger the child, the better the chances of forming healthy eating habits. He acknowledged that weight management in children is a tricky subject for the child and the parents.
"A lot of times, parents are taken aback by this kind of information," Wolfson said. "It needs to be presented in a way parents can handle."
That should include more than just a number on a fitness form, he said.
Kathleen Halkins is president of the Pennsylvania Association of School Nurses and Practitioners. She is the school nurse at the Bethlehem Area School District in Bethlehem, Northampton County, and a mother of four.
"As a parent, I would hope I would realize if my kids were overweight," she said. "However, many parents think an overweight child is a healthy child. There are overweight parents, overweight doctors. It's always good to provide parents with information.
"What I would like to see is better referral resources for parents," she said. "In the beginning, we had some parents complaining. ... There will always be parents who take offense. But this helps families, not just individuals. One of my big pushes is that we as school nurses be aware of our own health. We need to step up to the plate and lose weight, quit smoking, eat better. I think we can be good role models."
Twenty years ago, she said, kids were more likely to play outside instead of watching television or playing computer games.
"It's more about lifestyle changes," Halkins said. "That's the hard thing to do."
Additional Information:
The Big 5
Children's Hospital's Dr. David Wolfson said pediatricians refer to a 'Big Five' list of behaviors that, if modified slightly, can make a major difference in children's overall health and lead to a healthier lifestyle:1) Limit fast food -- no more than once a week.
2) Limit screen time -- TV, computer and video games -- no more than two hours a day.
3) Eat family meals at least three times a week.
4) Limit sweetened drinks -- soda, juice and flavored milk -- no more than twice a week.
5) Be active -- play tag, walk or ride a bike at least 30 minutes a day
