Finding some answers
As soon as I was able, I called the number on the letter which signed off ‘from the School Nursing Service’.
I was put through to a school nurse, albeit not the one attached to my child’s school and I asked her why I had been sent a letter informing me that my child is ‘obese’. And I asked where I could get some advice for what exactly to do about it since the links in the letter gave me nothing specific at all about managing the weight of an obese four year old.
She explained to me that although the letter was signed off from the School Nursing Service, they had not sent it. It came from the Richmond Public Health. The nurses had taken part in the National Child Measurement Programme – their role had been to weigh and measure the children and submit the data.
This was the first year that the government had decided to send automated letters to the parents.
But she could not give me any advice as she had no information to give me – she couldn’t tell me what weight he should be, what portion size I should serve or anything. She didn’t know how the Government had arrived at the conclusion about my child – how they calculated BMI.
I was baffled! The number I was given in the letter for ‘free local support’ could not offer me any.
The School Nursing Service had asked the health service not to send the letter as they had predicted they would receive calls like this. She also said she’d ask the school nurse attached to my son’s school to give me a call on Monday.
I was not satisfied. Since the School Nursing Service had had nothing to do with it, could I track down someone who was responsible for sending the letter? I pressed the school nurse for a name and she gave me the details of someone based in the Civic Centre in Twickenham.
The view from my son’s school nurse
Come Monday morning, I received a call, as promised, from the school nurse attached to my son’s school. And I posed my questions again – why have I received a letter informing me that my child is obese? And what exactly should I do about it? What should he weigh? How many calories? How much weight loss?
This nurse reiterated exactly what her colleague had told me on Friday. But at least was able to give me a little peace of mind.
She said that the School Nursing Service had not agreed to the letters, but that they had had to follow orders from the Government. In the past, school nurses would measure the children, but if the data flagged up any potential issues, they would contact the parents and talk to them about it.
The new system was taking one set of measurements and calculating a BMI score. The nurses have always used height and growth charts that indicate which centile of measurement the child is on in comparison to the population. The 98 centile for height means that just 2% of the population is that tall at that certain age. The nurses would compare that to the child’s growth to date. And the height and weight of the parents if they have access to that data. They seek to make an informed, contextual assessment of whether the child is progressing well.
The nurse told me that she’d weighed my son and that in her view there was nothing to be concerned about. He is around the 96-97th centile for weight but around the 98th centile for height. He’s a big boy in other words, but in proportion.
She said that if she’d been sent a letter like the one we’d received, she would have been furious. She was very sorry.
So I asked what weight he should be and again she couldn’t answer, saying that every child is different. And what is normal for one child is not normal for everyone.
I explained that I’d looked in vain on the links supplied to see which calorie intake, ideal weight, ideal weight loss, reduced calorie diet, portion size etc I should be considering. The nurse made it clear a child shouldn’t be made to lose weight. The advice is to let the child ‘grow into the weight’.
I was glad that we’d spoken. I could have already been planning to put my child on a reduced calorie diet. Which the School Nurse clearly felt was not a healthy thing to do. But I was still not satisfied.
Next, I called Civic Centre lady.
I asked why she’d sent me a letter telling me my child is obese.
She explained the National Child Measurement Programme again. Children in reception and year 6 are weighed and their height noted, and the data is sent to the Government. This year ‘it was decided’ to send everyone a letter with the ‘results’.
How had they reached the analysis that my child is obese? Because he hit a certain BMI centile, I was told, And on the basis of that one data point he was assessed as ‘very overweight’.
Once again, I asked what he should weigh, how much he should lose a week, what a child size portion size is etc. And explained that the NHS sites in the letter had lead me to believe that calorie counting with MyFitnessPal might be a good way to keep track.
Civic Centre lady did echo the school nurse at this stage. She said that from a health of the child perspective, they did not advise restricting calories in any way.
She suggested that we should look to change his lifestyle instead.
How much exercise does he get in Richmond Council’s care?
I explained that he is a very active four year old boy. He never sits still. Outside of school, he is in a football club, he rides his bike, we’re out and about at the weekend. So I asked how much exercise he gets when he is in Richmond Council’s care.
Civic Centre lady let me know that at school he would have 15-20 mins activity at morning playtime. Lunch is an hour, with half an hour for eating that probably gives him a further 30 mins of playtime. And on top of that 90 minutes supervised PE a week.
Where was he supposed to get the extra exercise then, I wondered, since I was sure he was getting at least enough at the weekend?
Well we can look at how they get to school in the morning, she said. At this point I’m sure I brayed with frustration. I have no choice but to drive him in! Richmond Council couldn’t offer him a place at the local school!
Well she said it does sound rather like you’re doing all the right things.
Irresponsible, ill-advised, ill-supported
I said that I’d spoken to the school nurse, who knows my son, and who, using their established methods, informed me it was their opinion that he is in proportion and does not have a weight problem.
I asked Civic Centre Lady if she agreed, on this basis, that it looked like my son probably didn’t have a weight problem? She said yes she agreed.
I asked if then, on this basis, since he didn’t have a problem, and especially since the information they’d suggested I look up inferred I should put him on a diet – even though we’d established this would be detrimental to a child’s health – if then she considered that her letter had been irresponsible?
Yes, she said, she agreed.
She asked what I wanted to do, whether I wanted her to set up an appointment with the Borough nutritionist (according to the school nurse there is only one)? I said given my child clearly does not have a weight problem that I didn’t want to waste their time.
Civic Centre Lady said that the school nurse could weigh my son again in three months. I explained the nurse had offered me this. But given she felt he was in proportion – she said no there was no need to.
Civic Centre lady apologised for the situation. She asked what I thought they should do in future. She said that they had followed orders in sending the letter. Other Boroughs were doing it and they were just catching up. It was just a standard letter. But that she would be changing the letter according to my feedback.
I explained that I was not satisfied.
My child has been wrongly labelled as obese. This is a painful thing for any parent to hear. But the information that is readily available to those who’ve received these letters would have them inferring – since nothing specific is available – that their child should go on a diet. Which would damage the child’s health. And the responsibilities of the programme are such that they don’t intervene again until they weigh the child in year six. Six formative, foundational years of child development later.
Somebody must be made to be accountable for this. I am still not satisfied.
This is unacceptable as well as dangerous.