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Parent feedback helps shape improved BMI screening letter for schools

Penn State Hershey PRO Wellness Center has developed and tested a body mass index (BMI) screening letter that leads parents to tools and resources for making healthy lifestyle changes for their families. To date, more than 200 schools across Pennsylvania have expressed interest in possibly using the new letter.

Childhood obesity has become a critical health epidemic, affecting 17 percent of all children and adolescents in the United States. In 2013, Pennsylvania was named the 20th most obese state, with 33 percent of school students either overweight or obese. Given the significant amount of time youth spend in school, school-based behavioral interventions are necessary in the fight against childhood obesity.

Students in Pennsylvania get weighed and measured to determine their BMI as a part of state-mandated annual health screenings in schools. A BMI-for-age percentile is calculated by comparing a child’s BMI to those of children of the same age and gender. These measurements are used to screen for weight categories that may lead to health problems in the future.

Assessing BMI is a quick and simple screening method that can serve as a measure of body fat. More than 25 percent of all states require schools to carry out BMI screening and parental notification programs. Despite the statewide mandate in Pennsylvania, limited evidence supports best practices for accomplishing this formidable task.

Although BMI screening and notification programs hold promise of addressing a serious issue, school-based interventions have been unsuccessful at reducing the prevalence of childhood obesity. This is believed to be due to the lack of follow-up with appropriate nutritional education programming for children who screen positive as overweight or obese.

“You wouldn't throw away a letter that says your child failed his or her vision test. So if we're telling you that your child is underweight, overweight or obese, we want you to realize the risks and take action,” said Donna Kephart, executive director of the PRO Wellness Center.

The first phase of the research project involved interviews with 42 parents from six Pennsylvania schools. They were asked to provide feedback on two different BMI notification letters: their school's standard letter and a revised letter. Based on this feedback, a new screening letter was created to include graphics and an explanation of health risks and specific actions that parents could take.

The second phase of the research involved 16 schools being assigned to distribute letters, with eight sending out the standard version and eight distributing the revised letter. Parents were invited to participate in a survey to assess their intentions and predicted actions based on information presented in the letter. Three-hundred-eighty-five parents completed surveys.

The revised letter drew a favorable reaction from parents. Among parents of overweight or obese children, more recipients of the revised letter intended to take action based on information it contained when compared to those receiving the standard letter (68 percent vs. 45 percent). In addition, parents of overweight or obese children who received the revised as compared to the standard letter were more likely to read the entire letter (82 percent vs. 77 percent).

To learn more about the Center's research and to access this letter, visit

Learn more about the importance of knowing your BMI in this week's Medical Minute.

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