Focus on weight unsettles some parents

The school district is sending home letters to inform parents whether their child is overweight or underweight. Some fear the letters will provoke ridicule.

By BARBARA BEHRENDT

© St. Petersburg Times,
published October 28, 2001

INVERNESS -- Parents learn whether their child is passing or failing academically by looking at report cards.

Hundreds of parents this year also will get a different kind of report card.

It will tell them that their child is overweight or underweight.

The notices are being generated through an initiative of the Citrus County Health Department and Citrus schools in an effort to combat what state health officials have called Florida's obesity epidemic.

Officials say they want to instill in children at the earliest age that wise eating choices and exercise should be lifelong habits. Such habits will improve their health and make them less likely to encounter problems that could haunt them socially and medically for years to come.

The first letters already have gone to parents, some of whom have called school and health officials demanding answers.

The parents have been incensed, accusing officials of stigmatizing their children and expressing concern that distributing the letters provided an opportunity for youngsters to ridicule the recipients.

"This is a civil rights issue. I think it is also a discrimination issue, a mental health issue and a bad situation medically," said Miriam Berg, an advocate for people of above-average size. "We're appalled at this type of action."

Such action can have long-term effects on youngsters.

"I think it's cruel and I think it will result in lower self esteem on the part of larger kids," Berg said.

But school and health officials said they are obliged to make parents aware of the potential medical dangers their children face.

"This has finally become an issue and it's something that needs to be addressed because it is a health concern," said Teresa Goodman, the pediatric nurse practitioner who coordinated the program for the Health Department. "We're not targeting obese students" with the message to eat better and exercise, she said.

"We're targeting everyone."

Helping overweight children follow a healthier path is not easy, Goodman said.

"It's extremely difficult to treat," she said. "If people could start to think about it like cigarette smoking, it would help. Years ago it was socially acceptable, but how the state fought it was by addressing it in the schools with the kids . . . .

"Telling the parents, who were smoking themselves, didn't work," she said.

That is why Goodman said the Health Department wanted to target youngsters with this important health message.

The state recently was informed by the Centers for Disease Control and Prevention that it would receive a grant to combat obesity, which had risen to what the agency considered epidemic proportions in Florida.

Currently, 38.3 percent of Florida adults are overweight and another 18.5 percent are considered obese, according to the Florida Department of Health. That is a 17.5 percent increase in the number of overweight individuals and a 94 percent increase for those considered obese since 1986.

"The problem is, over the last couple of years, the numbers are going up fast," Goodman said. "It's because of our high-calorie, high-fat foods, our fast foods, and our sedentary lifestyle."

Goodman noted that it was not a big surprise to hear that a youngster spent six hours a day watching television when one hour a day is recommended by pediatricians. "You can find studies where they turned the TV off and the kids lost weight."

But, as Goodman pointed out, parents don't often want to turn off the television because then they are responsible for finding something else to keep the child occupied.

The Citrus County Health Department devised the parent notification project as one way to begin addressing the problem.

"Weight is something that is controlled by their parents," Goodman said.

Under the plan, students are put through the normal health screenings for their age and grade, including vision and hearing tests and checks of their height and weight. Then the school district and Health Department take those height and weight statistics and, using a calculation called the Body Mass Index, determine whether the youngsters are underweight or overweight.

Letters detailing the results are sent to parents.

If children are listed as underweight, the letter recommends parents seek a medical assessment and notes that the child might be at risk for undernutrition, and developmental and growth delays that could cause learning problems.

For those who would be considered at risk for being overweight, the letter suggests a medical assessment may be necessary if there are other risk factors in the family including a history of heart disease, high cholesterol or high blood pressure.

The letters for the children considered overweight also tell parents their children are at increased risk for chronic diseases.

Obese youngsters often become obese adults, and that means health risks from joint problems to bone problems to heart problems. One of the biggest effects seen from the increasing number of obese children has been an alarming increase in the number of young people developing what is known as type II diabetes, something previously seen mostly in middle-age adults.

All elementary school students in the county will have been screened by January. Students in the sixth and ninth grades also will be screened.

The state, when handing out the dollars to target students, was specific about the grade levels. Only kindergarten and third grades were identified, but Citrus decided all elementary children should get the benefit of knowing whether their weight falls in line.

Starting early to change behavior is important, Goodman said.

"If they learn these things as a child, hopefully it will be a lifestyle," she said. "If kids grow up thinking it's a normal thing, like brushing their teeth, hopefully it will stick."

Following good eating habits and being active is good advice for children of any size, said Berg, who is president of the Council on Size and Weight Discrimination, a nonprofit advocacy council based in Mount Marion, N.Y.

But singling out children because of their size and telling parents to get to a doctor are counterproductive ways for schools and health departments to address the issue, Berg said in a telephone interview last week.

"This is a new approach that doesn't surprise me because from the federal to the local level there is now what is called a war on obesity," Berg said. "Obesity is not the issue. The issue is health rather than weight. This culture is obsessed with the appearance of health and not health."

The decision to send out letters to overweight students is even more objectionable given the school district's other recent decision to turn soft drink vending machines on all day long in the district's high schools, she said.

"That's ridiculous," Berg said. "How dare they send those letters out when they're doing that?"

While she understood that the machines provide much-needed dollars for the school's programs, Berg noted, "health is more important than the almighty dollar."

Instead of telling parents to get to the doctor, the district should be steering clear of the soft drinking vending business or, at the very least, subsidizing the healthier choices that might be available in the vending machines such as fruit juices and bottled water, she argued.

Such subsidies, which reduce the price of health drink or snack alternatives, have been shown to work, she said.

Berg said there are several fallacies with the approach being taken by the district.

Encouraging student assessments by doctors based on their Body Mass Index could land children in a bad situation. First of all, she said there are questions about whether the BMI is even a good gauge to use for measuring children. More than that, doctors have few tools to battle the weight issue.

"There is not much the doctors can do but yell at the kids and that is not going to help," she noted.

Attempts to put children, or adults for that matter, on a diet are not effective, she said.

Since nearly all people who go on diets and lose weight gain it back, Berg said diets just encourage bad eating decisions such as skipping meals, eating foods loaded with artificial ingredients or gorging on so-called low fat items that actually are full of sugar.

"Diets are an unnatural way of eating," Berg explained. "If you want to tell them to add more fruits and vegetables, that's good. But they should be doing that, not for the fat kids, but for all kids."

At the Citrus school district headquarters, student health specialist Cathy Reckenwald already has gotten her share of phone calls from parents asking why their children have been singled out as overweight.

More calls could be coming: only about a quarter of the screenings have been done and letters sent out.

"They say they're upset because we're telling them their child is fat," Reckenwald said. "I know that there are a lot of people unhappy about this . . . there is really no good way of saying to parents that your child may have a weight problem. They don't want to hear it."

But Reckenwald said the message is too important not to deliver. "You know, we've got 20 percent of the population that is obese," Reckenwald said. "We look at this as a national health crisis . . . .

"I know people are not going to be taking it well because the numbers may be very high, but then the statewide numbers are very high," Reckenwald said.

At the Health Department, callers have been more focused on the issue of children considered underweight.

"They feel as if we are accusing them of not feeding their children," Goodman said.

She said she talks to the parents awhile and offers them a variety of options including information on nutrition programs. "Usually after I talk to them, they understand that it's just a screening process and we're not judging you," she said.

There are also plans to do some community programs to address the issues pointed out by the letters including some positive parenting workshops. And the Health Department is planning to do a pilot program with one of the elementary schools to begin to incorporate more of the healthy lifestyle messages into the schools.

Although Goodman said health issues have been taught in the health classes "it's a topic that's really brushed over."

Goodman noted that parents should not have a concern about their child being singled out as a fat child in front of other classmates for several reasons. The letters are not distributed immediately after the screenings and students could be getting letters for a variety of reasons, including alerting parents to hearing or vision deficits.

Plus, Goodman points out, children zeroing in on a classmate's weight because of these letters doesn't compare to the kinds of prejudices an overweight adult will deal with all their lives if they don't turn their habits around.

She said that weight problems must be addressed and parents must provide a big part of the solution.

"Once they're educated and they understand the risks, they're going to do something about this," Goodman said. "Nobody wants their child to grow up that way."

-- Staff writer Barbara Behrendt can be reached at behrendt@sptimes.com or 564-3621.

Body mass index

The Body Mass Index, or BMI, is a calculation designed to indicate an individual's fatness and it correlates to men and women based on their height and weight. The formula for BMI is calculated by dividing a person's weight in kilograms by their height in meters, squared. An Internet site that provides a calculator for figuring your BMI can be found at www.halls.md.

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