The first few days of March were mega eventful in my house. Not only did we have to deal with National Offer Day, my eldest also got braces and on the Friday came the "fat" letters.

Not just 1 but 2. I'm the lucky parent with two children: one in reception as well as one in year 6. So in Friday's schoolbags came those NCMP letters. As I read them, it caused me to wonder aloud to my husband and children about the messages we give our children regarding healthy weight.

For context - One's BMI was on the 34th centile and the other 30th. Both "healthy" weight category - yet the letters were referred to as the "fat" letters; imbuing the information in them with all the negative consequences of being called fat. And I could totally understand why my daughter was confused: because whilst the letter said that her centile was healthy (in bold) it also went on to say a whole lot of other things about the consequences of being overweight: ? very encouraging for an 11year old ?

The letters also came with a Change 4 Life leaflet. I had the privilege of chairing a small focus group discussion I.e. the lovely 10-11-year-old girls on the school run with me. They reported enjoying the app and ability to scan their foods - when asked directly if it helps them to make choices knowing how much sugar and fat are in their foods - they all said, "No!".

When discussing the NCMP letters with some mums of my focus group (I.e. The crowd at our kid's Saturday morning activities) one mum tore hers to pieces - why should her 10-year-old be told she's fat just as adolescence is hitting - especially as she's active? Why subject her to body image issues right on the cusp of secondary school and all the traumas that would bring?

Another mum also commented on the effect of pubescence - did the measurements consider her daughter's body-shape? Her daughter loves her food - why should she be penalised for that?

Every year, as part of the NCMP, children in Reception (aged 4-5 years) and Year 6 (aged 10-11 years) have their height and weight measured during the school year to inform local planning and delivery of services for children; and gather population-level surveillance data to allow analysis of trends in growth patterns and obesity (ref: ).

Per PHE; the NCMP is a useful vehicle for engaging with children and families about healthy lifestyles and weight issues. (ref: )

The responses of my own family and those of my daughter’s peers indicate the opposite. Indeed, it seems that the NCMP scheme has learned little from the evaluation carried out in the Wirral

Of what use is an anonymous letter telling you your child is very overweight without any tangible solutions that the child and their family would be willing to engage with?

For many children - they get measured and then what? Their environments continue to be obesogenic, restrictions on public funding mean interventions are reduced, and they may be subject to negative attitudes and bullying. For health professionals; keeping on top of the many changes in services, and ensuring you are making referrals to a service that is still running ... is a challenge at best.

Obesity is a public health emergency. Children are developing diabetes, obstructive sleep apnoea and other disorders caused by being overweight. Some in turn develop eating disorders, depression and anxiety.

We must find a way to engage with our children and families to end this epidemic. The NOO in their trend report of body weight changes in children from 2006/7 to 2014/15 shows that there remains a significant upward trend in obesity for Year 6 children ( ref: ).

Whilst the NCMP is a significant and purposeful repository of growth data at a population level; it's utility to the individual child in this current environment of severe reduction in public resources should be evaluated further.

We must find a way to remove the stigma associated with obesity so that we can have frank, meaningful conversations with our children, young people and the families we work with.
Our young people independently and freely access immunisations and sexual and reproductive health services. Perhaps we should strive to create that same openness and accessibility so that weight management becomes a health issue rather than a “personal” issue.


Dr. Stacy John-Legere
Consultant Paediatrician

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