Body Mass Index (BMI) Measurement in Schools – Safeguard 10

Safeguard 10. Provide all parents with a clear and respectful explanation of the BMI results and a list of appropriate follow-up actions.

Student BMI results can be sent to parents by secure means, such as by mail, and not brought home by students. To reduce the risk of stigmatizing students, letters can be sent to all parents.1,2 To avoid giving the impression that a diagnosis has been made, the letters to parents about students who need further evaluation—those classified as underweight, overweight, or obese—can avoid definitive statements about the student’s weight category.3 For example letters might:

  1. State that the student’s BMI result “suggests” that he/she “might be” overweight.4
  2. Identify the student’s height, weight, and BMI-for-age percentile, and include a table defining BMI-for-age percentile categories with images.5
  3. Communicate that the student’s weight was found to be low/normal/high for his/her height and age.6

All letters can strongly encourage parents to consult a medical care provider to determine if the student’s weight presents a health risk.7

Letters to all parents, including those whose children have been classified as normal weight, can include scientifically sound and practical tips designed to promote health-enhancing physical activity and dietary behaviors. For example, the letters might encourage families to consume a healthy diet based on the U.S. Dietary Guidelines for Americans.8 Parents can also be aware that youth can engage in 60 minutes or more of physical activity each day9 and reduce sedentary screen time such as television, video games, and computer usage. The letters can be written in appropriate languages and at appropriate reading levels to be understood by parents; the tone can be neutral to avoid making parents feel that they are being blamed for their child’s weight status.10 Motivational messages included in the letters can be guided by sound communication and health behavior change theories. To ensure comprehension and effectiveness, the letters can be tested with representative parents in advance.

If all 10 of the safeguards described above are implemented, BMI results may also be shared directly with older students – the Michigan Department of Education recommends that results not be shared with students below grade 4 – as long as staff ensure that this communication remains private and does not stigmatize or label the students.11 Because these letters could have a significant impact on the students, the school nurses and school counselors can be prepared to deal with such reactions as anxiety and despair.

The letters can include:

  1. Contact information for the school nurse or other school-linked medical care provider;
  2. Educational resources for weight, nutrition, and physical activity;
  3. Contact information for community-based health programs or medical care providers who treat weight-related health problems (including programs for those without health insurance); and
  4. Information on school- and community-based programs that promote nutrition and physical activity.

Screening programs have developed standardized letters tailored to the weight status of the child.4-6 Examples are available at:

Source: Nihiser AJ, Lee SM, Wechsler H, McKenna M, Odom E, Reinold C, Thompson D, Grummer-Strawn L. Body Mass Index Measurement in Schools. Journal of School Health. 2007; 77:651-671.


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  1. Byrd S. Dealing with controversy: the lessons of implementing BMI screenings. NASN Newsletter. 2003;18(1):18-19.
  2. Johnson A, Ziolkowski GA. School-based body mass index screening program. Nutr Today. 2006;41(6):274-279.
  3. Scheier LM. School health report cards attempt to address the obesity epidemic. J Am Diet Assoc. 2004;104(3):341-344.
  4. Arkansas Center for Health Improvement. Health Letter to Parents. Little Rock: Arkansas Center for Health Improvement; 2006. Available at:
  5. PennState Hershey, ProWellness Center. BMI Screening Letter. PennState Hershey; 2014. Available at:
  6. Ikeda JP, Crawford PB. Guidelines for collecting heights and weights on children and adolescents in the school setting. University of California Berkeley, Center for Weight and Health; 2005. Available at:
  7. Whitlock EP, Williams SB, Gold R, Smith PR, Shipman SA. Screening and interventions for overweight in children and adolescents: a summary of evidence for the U.S. preventive Services Task Force. Pediatrics. 2005;116(1):e125-144.
  8. US Department of Agriculture, US Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th ed. Washington, DC: US Government Printing Office; 2010.
  9. US Department of Health and Human Services. Physical activity guidelines for Americans, 2008. Washington, DC: US Department of Health and Human Services; 2008.
  10. Dietz WH, Robinson TN. Overweight children and adolescents. N Engl J Med. 2005;352(20):2100-2109.
  11. Haller EC, Petersmarck K, Warber JP, editors. The role of Michigan schools in promoting healthy weight. Lansing, MI: Michigan Department of Education; 2001. Available at: