KFF Health News, LITTLE ROCK, Ark. — Sixth-grade boys were lining up to be measured in the Mann Arts and Science Magnet Middle School library. As they took off their shoes and emptied their pockets, they joked about being the tallest.
“It’s an advantage,” said one. “You can play basketball,” said another. “A taller dude can get more girls!” a third student offered.
Everyone laughed. What they didn’t joke about was their weight.
Anndrea Veasley, the school’s registered nurse, had them stand one by one. One boy, Christopher, slumped as she measured his height. “Chin up slightly,” she said.
Then Veasley asked him to stand backward on a scale so he didn’t see the numbers. She silently noted his height as just shy of 4 feet, 7 inches, and his weight as 115.6 pounds.
“It offended me as a mama. It made me feel like I wasn’t doing my job.”
His parents later would be among thousands to receive a letter beginning, “Many children in Arkansas have health problems caused by their weight.” The letter includes each student’s measurements as well as their calculated body mass index.
The BMI number categorizes each child as “underweight,” “normal,” “overweight,” or “obese.” Christopher’s BMI of 25.1 put him in the obese range.
In 2003, Arkansas became the first state to send home BMI reports about all students as part of a broader anti-obesity initiative.
But in the 20 years since, the state’s childhood obesity rates have risen to nearly 24% from 21%, reflecting a similar, albeit higher, trajectory than national rates. During the pandemic, the state obesity rate hit a high of more than 26%.
Still, at least 23 states followed Arkansas’ lead and required height and weight assessments of students. Some have since scaled back their efforts after parents raised concerns.
“One school district in Wyoming used to include a child’s BMI score in report cards, a practice it has since stopped.”
Ohio allows districts to opt in, and last year just two of 611 school districts reported BMI information to the state. And Massachusetts stopped sending letters home. Even Arkansas changed its rules to allow parents to opt out.
Multiple studies have shown that these reports, or “fat letters” as they’re sometimes mockingly called, have had no effect on weight loss. And some nutritionists, psychologists, and parents have criticized the letters, saying they can lead to weight stigma and eating disorders.
BMI as a tool has come under scrutiny, too, because it does not consider differences across racial and ethnic groups, sex, gender, and age. In 2023, the American Medical Association called the BMI “imperfect” and suggested it be used alongside other tools such as visceral fat measurements, body composition, and genetic factors.
All that highlights a question: What purpose do BMI school measurements and letters serve? Nearly 20% of American children were classified as obese just before the pandemic — up from only 5% some 50 years ago — and lockdowns made the problem worse. It’s unclear what sorts of interventions might reverse the trend.
Joe Thompson, a pediatrician who helped create Arkansas’ program and now leads the Arkansas Center for Health Improvement, said BMI letters are meant to be a screening tool, not a diagnostic test, to make parents aware if their child is at risk of developing serious health issues, such as heart disease, diabetes, and respiratory problems.
Sharing this information with them is critical, he said, given that many don’t see it as a problem because obesity is so prevalent. Arkansas is also a rural state, so many families don’t have easy access to pediatricians, he said. READ MORE.
