They’ve been called “fat letters” and critics say they increase bullying and shame kids for their body weight.

But a paper published today by the American Academy of Pediatrics argues that weighing and measuring the height of schoolchildren and sending letters home with overweight kids is an important tool for combating the obesity epidemic.

This kind of screening has been going on in parts of the U.S. for over a decade, and despite the objections, has led to positive lifestyle changes for many of the children identified as obese, the paper argues.

But as Toronto Public Health gears up for its first body mass index (BMI) study, to be held in schools next year, it has announced that the study is being used for statistical purposes only and will not gather any personalized information.

It’s a more timid approach than the one being taken in the U.S. and it raises the question: are we being aggressive enough?

"Fat letters" in schools

“Obesity is an epidemic in (the United States), and one that is compromising the health and life expectancy of our children. We must embrace any way possible to raise awareness of these concerns and to bring down the stigmas associated with obesity so that our children may grow to lead healthy adult lives,” the paper’s author, Dr. Michael R. Flaherty, told the Star.

“It is a bitter pill. It’s difficult for us as pediatricians to tell a parent their child is overweight or obese. But these letters were intended to be a confidential tool, another reminder to find professional help. Maybe we need to seek out a dietician, work on diet, work on exercise,” said the Massachusetts pediatrician.

Not enough study has been done to conclusively state whether BMI testing or letters home are producing any behavioural change, Flaherty writes, though limited studies in Arkansas, the first state to implement school testing, show markedly positive outcomes.

Critics of BMI testing, which has now been implemented in 21 U.S. states, however, say the letters amount to “fat shaming” and encourage bullying, while not providing any proven solutions to parents.

“It’s a terrible idea,” said Dr. Yoni Freedhoff, founder and medical director of the Bariatric Medical Institute in Ottawa.

“There are no known, reproducible, sustainable protocols for parents to follow once these children are singled out,” he said. “Given we don’t really have a solution at this point . . . I worry tremendously about impact that well-intentioned schools and parents might have on a child’s self-esteem, body image and relationship to food.”

These arguments are gaining traction in states like Massachusetts, where there is proposed legislation to ban BMI testing in schools, arguing that it’s a flawed measure of health and can identify muscular kids as being overweight. One high-profile case highlighted a Grade 4 state wresting champion who was sent home with a letter identifying him as obese.

Canada, where 30 per cent of children are overweight or obese, lags behind the United States, where that number is 32 per cent.

The looming public health threat prompted Ontario Health Minister Deb Matthews to form a specialist panel last year. The Healthy Kids Panel report, tabled earlier this year, made dozens of recommendations, including regulation of low-nutrient and high-sugar foods.

It also recommended implementing a comprehensive system of data gathering, including BMI indexes, but fell short of recommending that BMI should be used to screen for overweight and obese students at risk of developing long term health conditions.

Toronto’s testing will look at 12,000 students from Grade 7 to Grade 12 at 160 schools across the city. Participation is voluntary and students will only find out their BMI if they ask. .

“Our purpose is to identify the proportion of Toronto students who are a healthy weight, rather than to screen individuals for weight concerns,” wrote the city’s medical officer of health, Dr. David McKeown. “We expect that by limiting the amount of information shared, we can minimize the risk of potential consequences associated with measurement such as weight-based bullying or teasing or unhealthy weight control practices.”

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But while this soft-handed approach may produce some useful statistics, it falls short of addressing the looming problem of childhood obesity, says Patrick Luciani, co-author of “XXL: Obesity and the Limits of Shame.”

“We need to get over that genteel political correctness,” he said. Letters, while unpopular, could provide the impetus for families to change their habits.

“Most parents already know what has to be done and this might encourage them to do a little bit more,” he said. Luciani is suspect of any top-down solutions, however, and doubts that anything will come of the Toronto testing.

“Obesity is the new bullying. Schools feel they have to do something. They’ll do something, and it will probably be very expensive and bureaucratic and I think the impact will also be very minimal.”