Last August, doctors at the Mayo Clinic, after finding that found that patients with a low body mess index had a higher risk of death from heart disease than those with normal BMI, decided that BMI was a flawed method for measuring obesity. That they refused to even consider that overweight was less of a factor than they believed is a subject for another blog entry. But since the BMI doesn't take into account things like body type, heredity, fitness, and activity level, it's the kind of arbitrary measure that has long been used to extrapolate health where in fact it measures very little.

But why should that stop schools from further shaming overweight kids by threatening to send reports about their BMI home to their parents?

Six-year-old Karlind Dunbar barely touched her dinner, but not for time-honored 6-year-old reasons. The pasta was not the wrong shape. She did not have an urgent date with her dolls.

The problem was the letter Karlind discovered, tucked inside her report card, saying that she had a body mass index in the 80th percentile. The first grader did not know what “index” or “percentile” meant, or that children scoring in the 5th through 85th percentiles are considered normal, while those scoring higher are at risk of being or already overweight.

Yet she became convinced that her teachers were chastising her for overeating.

Since the letter arrived, “my 2-year-old eats more than she does,” said Georgeanna Dunbar, Karlind’s mother, who complained to the school and is trying to help her confused child. “She’s afraid she’s going to get in trouble,” Ms. Dunbar said.


The practice of reporting students’ body mass scores to parents originated a few years ago as just one tactic in a war on childhood obesity that would be fought with fresh, low-fat cafeteria offerings and expanded physical education. Now, inspired by impressive results in a few well-financed programs, states including Delaware, South Carolina and Tennessee have jumped on the B.M.I. bandwagon, turning the reports — in casual parlance, obesity report cards — into a new rite of childhood.

Legislators in other states, including New York, have proposed them as well, while some individual school districts have adopted the practice.

Here, in the rural Southern Tioga School District, the schools distribute the state-mandated reports even as they continue to serve funnel cakes and pizza for breakfast. Some students have physical education for only half the school year, even though 34 percent of kindergartners were overweight or at risk for it, according to 2003-4 reports.

Even health authorities who support distributing students’ scores worry about these inconsistent messages, saying they could result in eating disorders and social stigma, misinterpretation of numbers that experts say are confusing, and a sense of helplessness about high scores.

“It would be the height of irony if we successfully identified overweight kids through B.M.I. screening and notification while continuing to feed them atrocious quality meals and snacks, with limited if any opportunities for phys ed in school,” said Dr. David Ludwig, director of the Optimal Weight for Life program at Children’s Hospital Boston.

The farmers and foundry workers here in north-central Pennsylvania have different ideas about weight than those of the medical authorities who set the standards (the percentiles are based on pre-1980 measurements because the current population of children is too heavy to use as a reference). Here, the local pizza chain is called Pudgie’s. Nearby Mansfield’s fanciest restaurant serves its grilled chicken salad piled with fries.

Nearly 60 percent of eighth graders in the district scored in the 85th percentile or higher in 2003-4; more than a quarter had scores in the 95th percentile or higher, meaning they were officially overweight.

As it is for adults, the body mass index for children is a ratio of height to weight, but the juvenile numbers are also classified by age and sex, and the word “obese” is not used.

Holly Berguson, the homecoming queen at North Penn Junior-Senior High School here, wears a size 20, a fact cited by her many admirers as proof of this community’s generous attitude toward weight, its proud indifference to the “Baywatch” bodies on television.

“I don’t care how big I am,” said Holly, 17, who is insulin resistant, a condition that often precedes Type 2 diabetes. “It’s not what you look like, it’s who you are.”

Part of the rationale behind the reports is that they are an extension of the height and weight checks that schools have traditionally conducted.

But here, the letters sent home with report cards have been a shock. Many parents threw them out, outraged to be told how much their children should weigh or unconvinced that children who look just fine by local standards are too large by official ones. Seventh graders traded scores during lunch periods. And more than a few children, like Karlind, no longer wanted to eat, students and parents said.

Isn't that wonderful? Here you have a six-year-old who is already showing signs of anorexia because she's terrified of her teachers telling her she's overeating.

I remember very well being an overweight kid. I grew up in a home where physical fitness not only didn't exist, it wasn't a factor at all. Oh sure, I was told to go out and play, but it was more out of worry that I was happier sitting alone in my room making fully-furnished dollhouses out of constructio paper than playing with other kids. Making dollhouses was something I knew I could do, whereas if I climbed trees I might fall, and there was no point in playing the kind of kickball games that kids played in those days, because I was clumsy and none of the kids, not even my friends, wanted me on their team.

I always hated gym class, because I was clumsy and also terrified -- terrified of heights, terrified of getting hurt. I had no upper-arm strength, and the combination meant I could not climb a rope to the gym's ceiling as required. If I tried to do pull-ups, gym teachers played R. Lee Ermey in in Full Metal Jacket to my Private Pyle. As early as the third grade, I remember a teacher screaming at me and calling me "weakling" during a game of dodgeball, whereupon I became the favorite target for being hit with the ball. In high school gym we had gymnastics, which involved balance beam and uneven parallel bars -- both lovely for a kid who was terrified of heights. I didn't ride a bike till I was ten. I didn't learn to swim till I was eleven. I managed to get through gym class in high school largely on the basis of taking my gym suit home for laundering every weekend. I learned very early on the following lesson: Can't do, don't try. When I went to college, I had to take nine credits of physical education. The good news was that I was able to take things like tennis and archery that while I no aptitude for them either, at least I didn't hate them.

So did I overeat as a child? Was I fat because I was stuffing my face with cookies and candy? Hardly. When I was a little kid, I wasn't allowed candy, or anything more than two or three of the most plain cookies, like vanilla wafers. And we were overweight anyway. It wasn't until I was in junior high and could go to the candy store on my way home that I started hiding Butterfinger bars in my room. And when I was 23 and moved out on my own, and could finally eat ice cream and cookies, I went nuts. I would go through an entire package of Keebler Oatmeal Cremes in one sitting. I don't even want to think about what my life would have been like on top of feeling constantly deprived of what other kids were allowed to eat, and being constantly taunted for being fat and uncoordinated, if I had had to deal with notes being sent home telling my parents that my BMI was too high. It took a good portion of my adult life to get used to the idea of having one cookie, or just a taste of dessert -- to get used to the idea that when something is not forbidden, it's possible to enjoy in moderation.

Kids today have it even worse. We have school systems that spend hundreds of thousands of dollars on football programs that exclude most of the student body but can't or won't come up with a physical education program that allows kids to choose sports or activities that interest them and won't make them miserable. And God forbid a kid should scrape a knee. We have parents who put their kids in full body armor just to ride a bicycle down to the end of the block. On Saturday it was seventy degrees here, and while taking a walk, I saw a couple walking with two kids in strollers. One of them was a toddler, but the other one looked to be at least five or six years old -- old enough to get out of a damn stroller. When I go to the supermarket, I see kids six, seven, eight years old strapped into the special seats they put on the back of shopping carts. I know it's difficult to shop and keep track of two kids at the same time, and I know you don't want your kid to run out into traffic while out on a family walk, but there has to be a better answer than putting six-year-olds in strollers.

Anyone who thinks that giving six-year-olds who aren't thin more reason to feel awful about themselves is a good thing, and a healthy thing, is an idiot. Sending BMI reports home and not doing something about the fact that foods loaded with trans fats and high fructose corn syrup are cheaper and more accessible to both school cafeterias AND busy parents with declining incomes is counterproductive.

That so many Americans, including American children, are overweight means that shame as a tactic for keeping weight down hasn't worked. Isn't it time to start further research on things like the role of inflammation in coronary and stroke risk and the role of stress in producing inflammation? Isn't it time to give credence to the positive effects of foods like cinnamon, garlic, and almonds instead of the mass production of foods in response to the latest "health" craze -- low fat, low carb, but still full of corn syrup and poisons? Isn't it time to stop telling kids that if they're overweight they're worthless, and give them REAL TOOLS -- not diets and shame -- to deal with weight while they're still young?

If I've gone on too long about this it's because I may be 51 years old, but I remember how painful it was to be an overweight kid -- and if I look at photos of myself from childhood, I wasn't even as fat as I remember being. But I was enough fatter than some of my peers that I knew my physiognomy was worthless. You wake up one day and a half-century is gone and you realize you've spent most of your life feeling less than worthy because of your weight. With everything we know now about anorexia, and about poisons in mass-produced food, I'd hate to see another generation go through this.