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The Psychological Consequences of “Fat Letters”

Schools in 21 states currently measure children’s body mass index (BMI) to screen for obesity. Eight of those states require reports be sent home to parents to encourage treatment. However, substantial evidence suggests that this practice can lead directly to poor self-image and even eating disorders. We should rethink this program in light of the potential consequences. Read More

These letters may not help

These letters may not help because they are sent to fat parents who think eating is recreation. I'm not a fan of Dr Oz, but he did say that if you are fat, you probably have a fat dog, too, and THAT cannot be blamed on genetics.

Doctor Friedman seems to have

Doctor Friedman seems to have an intense fear that students will be, as they say, 'scarred for life' if they receive a letter from school about their weight.

I do not believe people are so mentally weak, however much psychologists and their 'studies' insist we are...however, this focus on the possible harmful effects of the letters is stepping around the real problem, which is the child's obesity.

We must ask what is worse - some embarrassment a child may feel about being told they are seriously overweight, or the weight problem itself....?

As far as needing physical education programs based on 'facts-based research' said research seems to be a large waste of money to me. Fact is, Americans are overweight because we eat too much (just like we consume too much of everything) and are too inactive. Do we really need researches to tell us these things?

The worst part of this is

The worst part of this is that it is based on BMI.

My medical practice was recently incentivized to "address" childhood obesity by one of the major health insurance companies. We had an additional reimbursement offered if we could document that we had "discussed" and "addressed" nutrition with any child above a certain BMI.

So, we had our nurse review all of the charts for children insured by that company, and she searched visits in the past year filtered by a threshold BMI and read the chart to see if modifying diet and nutrition was documented. (Electronic Health Records.)

If it wasn't documented, she'd call the family and say that the child's BMI was high and recommend a healthy diet, document it, and we'd become compliant with the health insurance's program. Getting the incentive was that easy, and, as you'll see, meaningless.

Many of the children who were above the threshold BMI had documentation of healthy nutrition counseling - the doctors could see who was "fat" without calculating their BMI. Most of the families who the nurse called said, "What? My son isn't obese, he's an athlete."

The muscle mass of athletic adolescents puts their BMI outside of the normal range. And, none of those patients had any documentation of a recommendation to lose weight. The doctors could tell who was overweight just by looking at them - no BMI calculation necessary.

The insurance company's program that used BMI to "capture" the obese children that were being missed just wasted time and money. NO ONE needs BMI to identify obesity. The parents, the doctor, the kid, AND the kid's peers know who's overweight without a calculator and, without a letter from the school.

Cornell University just did a pilot study on an intervention that may address the real issue - food choices.

What does Dr. Friedman think about that idea?

child maltreatment does warrant attention

It seems to me that a good, responsible school *should* be obligated to send a letter(s) of concern to parents regarding *any* type or form of suspected child abuse or neglect.

So, for example, if one of their young students is assessed as being badly *underweight*, literally starving or malnourished, would that not also prompt a letter of concern from school administrators? (a "skinny letter", I suppose it would be called?)

Deliberately overfeeding a child to obesity (or negligently allowing the child to over-feed himself/herself into obesity) IS a form of child abuse, equally as abusive as underfeeding a child or medically neglecting a child.

It indicates that the parents are either shockingly unconcerned about their child's health, or amazingly ignorant about proper child care, or possibly it indicates parents who are frequently physically absent due to work (or virtually "absent" due to substance abuse) which in any case constitutes child neglect.

Or, possibly it indicates parents who have some form of mental illness or personality disorder that negatively impacts their ability to parent well. A morbidly obese parent who allows her child to become morbidly obese may be in deep denial about the genuine negative health impact of morbid obesity on her own self AND on her children.

In my opinion, not only should letters be sent, but if the child abuse, maltreatment and/or neglect continues over time with no signs of improvement, then social workers from child protective services should be sent instead of letters.

Children under age 10 or so have very little ability to even comprehend that they're being neglected, abused, or exploited by their own parents. Its up to the child's relatives, teachers, coaches, neighbors, friends, pastors, and other responsible adults to notice and make a point of calling attention to suspected child abuse and neglect, so these kids can get help sooner rather than later.

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Michael Friedman, Ph.D. is a clinical psychologist specializing in how social relationships influence mental and physical health.

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