“Fat Letters” – Nice Try, Massachusetts

Massachusetts just can’t stop with the public shaming by way of letter-branding. First, it was the 17th-century version, with poor Hester Prynne struggling around Boston bearing a scarlet “A” on her chest. Now, it’s the 21st-century version, with poor elementary school students struggling around the playground wearing a letter from the Massachusetts Department of Public Health (MDPH) around their neck.

At least, that’s the story some Massachusetts parents are trying to write.

In 2009, the state government decided to improve “the screening and monitoring of the health assessment of children across the Commonwealth.” As part of that effort, the state began measuring the height and weight of public school students in certain grades and calculating their Body Mass Index, or BMI, using those numbers. The state transmitted the results to the parents of the tested students in letters mailed directly home.

Those letters are now known as the “Fat Letters.” The 2009 initiative is now being blamed for children being ostracized or becoming depressed. Proponents of the BMI tests are now being labeled as “fascists” and “Nazis”.

Let’s all take a deep breath, shall we?

Apparently, this test-and-letter practice proceeded unchallenged for three years until the mother of 10-year-old Cam Watson received The Letter. Cam is 4’7″, weighs 97 pounds, and is very physically active. He does not “look obese.” But The Letter said he was. Obese, that is.

BMI is a way to calculate a person’s body fat. It is not a perfect measurement, as it does not measure body fat directly, but it is an inexpensive and easy-to-perform screening for potential health risks associated with a suboptimal weight. Critics condemn the test because it does not account for strong bones or dense muscle mass, both of which could yield a high BMI in someone with a low fat content.

Nevertheless, the Center for Disease Control and Prevention recommends BMI screening for children starting from the age of 2. In children and teens, the BMI number is plotted on a growth chart to determine a percentile ranking, which in turn is associated with a weight categorization ranging from underweight to obese. The MDPH relied on the CDC’s guidelines for calculating and recording students’ BMI.

When Cam Watson’s parents told him that his Letter reported a BMI indicating obesity, he “didn’t really care.” He knew he wasn’t obese. So he just crumpled The Letter up.

His mother also knew The Letter was wrong about Cam, but that didn’t mean she would let it go. She reached out to her state representative, Jim Lyons. He has now introduced legislation that would prevent MDPH from collecting information relative to students’ height, weight and BMI. Because as Representative Lyons has reasoned, the state should not be able to tell parents whether to feed their children cupcakes or broccoli.

The movement against “Fat Letters” has recently gained significant media attention. The vast majority of responses to the story seem hostile to the MDPH’s practice. Message boards are full of comments warning that the next step will be to send obese people to jail, predicting that the state will soon send home letters reporting that a child is “ugly,” and suggesting that schools stick to “educating”.

People could save themselves a lot of anger if they would just read the actual letter.

First, The Letter specifically states that “BMI may not tell the whole story about your child’s weight,” including that BMI cannot “tell the difference between muscle and fat.” What is more, The Letter explains the healthy weight range and suggests consultation with a doctor or a nurse if the child does not fall within that range. The Letter does not command that a parent do anything, however, and there is no threatened follow-up or punishment if the parent, in fact, does nothing. The Letter could not be more clearly presented as a piece of information, to be taken or left.

Significantly, The Letter also makes obvious that it was being sent to parents whose child tested as underweight, healthy weight, and overweight or obese. The “fat kids” were not targeted or bullied merely by the fact their parents got a Letter. And any concern for a weight outside the “healthy” range extends to children who might not be getting enough to eat.

Equally important, MDPH sent The Letters to parents, not to children; as Ms. Watson herself acknowledged, it was her decision to share The Letter’s contents with her son. If she had not wanted him to know that he had been labeled obese by one testing protocol, she simply did not have to tell him.

As for those arguments that Massachusetts is one mustache shy of Nazi Germany, it is worth more than noting that every parent was allowed to opt out of the BMI testing for their child. In other words, if a parent did not want a child to be measured, all they had to do was say so.

No one wants to see a child ridiculed for his or her weight. No one wants a child to feel ashamed. No one wants their child’s privacy invaded.

To the extent there is ridicule, or shame, or crossed lines, the “Fat Letters” shouldn’t be blamed. They are presented confidentially to parents, and parents are given the authority and the responsibility to decide how to proceed with the information The Letters contain. Throw your Letter in the trash, use it as a talking point at your child’s next annual physical, wallpaper a room with it. Whatever.

But if you have confidence in your instincts about your child, and you believe in fostering tolerance for all shapes and sizes, then do that. Trust your instincts. And don’t make it a legislative issue when someone uses the word “obese” near your child.

Featured image via ABC 22 News.