Health Advice



Arkansas led the nation in measuring obesity in kids. Did it help?

Kavitha Cardoza, KFF Health News on

Published in Health & Fitness

All that highlights a question: What purpose do BMI school measurements and letters serve? Nearly 20% of American children were classified as obese just before the pandemic — up from only 5% some 50 years ago — and lockdowns made the problem worse. It’s unclear what sorts of interventions might reverse the trend.

Joe Thompson, a pediatrician who helped create Arkansas’ program and now leads the Arkansas Center for Health Improvement, said BMI letters are meant to be a screening tool, not a diagnostic test, to make parents aware if their child is at risk of developing serious health issues, such as heart disease, diabetes, and respiratory problems.

Sharing this information with them is critical, he said, given that many don’t see it as a problem because obesity is so prevalent. Arkansas is also a rural state, so many families don’t have easy access to pediatricians, he said.

Thompson said he’s heard from many parents who have acted on the letters. “To this day, they are still our strongest advocates,” he said.

The program also led to new efforts to reduce obesity. Some school districts in Arkansas have instituted “movement breaks,” while others have added vegetable gardens, cooking classes, and walking trails. One district sought funding for bicycles. The state does not study whether these efforts are working.

Researchers say the BMI data also serves an important purpose in illuminating population-level trends, even if it isn’t helpful to individuals.


Parents are generally supportive of weighing children in school, and the letters have helped increase their awareness of obesity, research shows. At the same time, few parents followed up with a health care provider or made changes to their child’s diet or physical activity after getting a BMI letter, several other studies have found.

In what is considered the gold-standard study of BMI letters, published in 2020, researchers in California found that the letters home had no effect on students’ weight. Hannah Thompson, a University of California-Berkeley assistant professor who co-authored the study, said most parents didn’t even remember getting the letters. “It’s such a tiny-touch behavioral intervention,” she said.

Arkansas now measures all public school students in even grades annually — except for 12th graders because by that stage, the pediatrician Joe Thompson said, the students are “beyond the opportunities for schools to have an impact.” The change also came after many boys in one school wore leg weights under their jeans as a prank, he said.

Kimberly Collins, 50, remembers being confused by the BMI letters sent to her from the Little Rock School District stating that all her children were considered overweight, and that one daughter was classified as obese.


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©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.


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