To the editor:
Recently, BMI screening in public schools has come under fire with the emergence of letters sent home to parents indicating their child’s BMI percentile and weight category. Not only has the screening come under harsh criticism, but the increasing incidence of obesity in Massachusetts children has been challenged based on erroneous assumptions and propaganda that BMI is an inaccurate measure of a child’s body fat.
BMI screening is just that; a screening tool. It is used in the surveillance of children by the U.S. Centers of Disease Control and the World Health Organization internationally. A screening tool is used to identify children with possible weight problems and not as a diagnostic or clinical decision-making tool. While BMI in adults is reported as an absolute number — a person’s weight in kilograms divided by their height in meters squared — in the pediatric population it is reported as a percentile. Absolute BMI numbers in children are widely varied and are therefore compared with children of the same sex and age based on widely used pediatric growth curves to develop percentiles. While they clearly are not indicative of every child that is overweight, many studies have been completed which have validated BMI as an adequate measure of body fat in children and as a reasonable index of those patients at high risk of long-term complications.
Current estimates show that approximately 16 percent of Massachusetts children between the ages of 2 and 5 are overweight, and an additional 16 percent are categorized as obese. Not convinced by BMI percentiles? The rate of type II diabetes in childhood and adolescence is also on the rise, a disease primarily prevented by maintaining a healthy weight and previously seen largely in adults. The overall incidence of heart disease continues to rise in Massachusetts and is directly linked to obesity as one of its strongest risk factors.
There is no doubt that BMI screening is fraught with social and ethical concerns. There remain to be any studies demonstrating its effectiveness in leading to increased referral to weight management treatment programs or declines in chronic disease. However, the growing number of children and adolescents seen day in and day out in our clinics with hypertension, high cholesterol, diabetes, and musculoskeletal issues secondary to weight do not lie. Obesity is an epidemic in our state, and one that is compromising the health and life expectancy of our children. We as the residents of Massachusetts 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. If a so-called “fat letter” raises awareness to just one parent to seek help for their child’s weight, then one life may have been saved.
Dr. Michael Flaherty