Fat: How the national obsession is coming into the classroom

Adults fret over weight and body shape, and now every child in school is to be weighed for obesity. Experts fear this will only encourage bullying and eating disorders. By Francis Elliott and Megan Waitkoff

The letters are starting to land on doormats already. "Dear Parent," they begin, "next week school nurses will be coming to school to weigh and measure the height of your child."

Barbara Richardson-Todd is readying herself for a frenetic month. "We've got about three or four weeks to weigh and measure 10,000 children," says the senior nurse in charge of collecting obesity data on Suffolk's primary school children. She would have had longer, she says, but there is a national shortage of Government-approved scales caused by this summer's mass weigh-in.

Almost without publicity, health officials have been preparing an extraordinary and controversial data-collection exercise. The Department of Health wants a detailed "fat map" of England's children. Within months we will know the most obese school in Britain, the skinniest, and every calibration in between.

The measurements are needed because the Government set a target to reduce the year-on-year increase in obesity in children under 11 by 2010, but has no standard figures to measure its progress. Ministers have decided that from next year parents of obese children will be told the results in an attempt to shock them into taking more responsibility for their children's size.

That decision, taken in secret last week, overrules the Government's own Children's Commissioner as well as some child-health experts, who fear that such a screening programme could do more harm than good. Not only will it increase bullying, they say, there is a limited amount that can be done to make fat children thinner.

Ministers, however, stung by criticism that efforts to curb childhood obesity are stalled, have decided it's time to tell parents the truth about their children. Although the food industry, advertisers and school dinner ladies all have their part to play, until parents wake up to the problem nothing will change, they say.

In all likelihood, the "fat map" that emerges from the weigh-in will match closely race and class demographics: working-class children are more likely to be overweight, as are black girls.

"Girls from black and Afro-Caribbean communities are more likely to be obese than some of their counterparts," Dr Fiona Adshead, Deputy Chief Medical Officer, told MPs this month.

But the sensitivities of weighing and measuring more than a million primary school children in two months are not limited to race and class.

"The little ones don't mind much," says Ms Richardson-Todd. Just as in measuring eyesight, school nurses play pirates to get children to wear eye-patches so they make a game out of getting on the scales, she says. "The 10- and 11-year-olds are more tricky. They are becoming body conscious, so we see them one at a time."

In one pilot project in Birmingham, the older children are weighed and measured behind a screen by teaching assistants as part of their maths class. It is a "de-medicalised" model that other schools are being urged to follow - and is designed to reduce the stigmatisation of fatter children.

Indeed, the Government's own Children's Commissioner, Professor Al Aynsley-Green, was so worried about what children would make of being measured that he commissioned research on the issue.

Reporting to MPs, health officials admitted they had found that some children feared they would be bullied as a result.

"Some of the kids, particularly the younger ones, expressed concerns about being measured. What they said is that they might be bullied, and particularly if children already have a reason why they might be bullied," said Dr Adshead.

Psychiatrists worry what sort of messages young children will pick up from the anti-obesity drive. Dr Robin Arnold, of the British Medical Association's psychiatry committee, said: "It may well be justified in public health terms but one wonders what it will do to rates of eating disorders like anorexia nervosa in the future."

It is because of such fears that the Children's Commissioner is opposed to feeding children's measurements back to parents.

Anti-obesity campaigners, however, insist that both measuring and reporting the results are justified. Dr Colin Waine, chairman of the National Obesity Forum, said: "We know that being obese in childhood can double the standard mortality rate in adults over the age of 50. It can increase the chance of cancer by 20 per cent in men and 14 per cent in women, the risk of type 2 diabetes is well known - the list goes on."

Tam Fry, of the Child Growth Foundation, agrees: "I am delighted that ministers seem to have seen sense and decided to tell parents the data about their children. I just think that it is disastrous that we are only measuring children as they enter and exit primary school - we should be doing it much more frequently."

Hugh Taylor, the Department of Health's most senior civil servant, told MPs he rejected claims that there was no effective treatment for childhood obesity, citing what he called the "chocolate biscuit test".

"If you look at what it would take to shift children out of the obesity category, we are talking about children on the cusp reducing the calorie intake by 30 to 40 calories a day. A chocolate biscuit is 80 calories a day; a packet of crisps is 120 calories a day. That gives you a measure that this ought to be a problem that is tacklable," he said.

The weighing exercise marks a return to what was routine in the age of the school medical, according to Claire Rayner. "Anyone over 50 will remember they took it for granted that they would be weighed and measured. As long as children know that it is happening to all of them there is no need to worry and, yes, parents should be told. I can imagine no better wake-up call than receiving a letter from the school," said the agony aunt and patients' rights campaigner.

Virginia Ironside, however, is sceptical about the programme. "It's not as if being fat is a hidden problem is it? It all seems a bit Germanic to measure everyone and will probably only succeed in getting parents' backs up."

Prue Leith, the celebrated cook and chairman of the British Food Trust, said: "We are getting obsessed with obesity, but weight is just too simple an answer. Children can be obese but at the same time malnourished because so many of them are protein deficient, thanks to a diet of largely pasta and bread.

"A better solution is to give schools more money to improve ingredients, upgrade kitchens and train dinner ladies so they can motivate and inspire the kids. If they can get children caring about what they put into their bodies, the children will sort it out for themselves... weighing the kids and lecturing the parents is not the path to take."

Jamie Oliver, who has led the campaign to improve the quality of school meals, has recently expressed his frustration at the lack of progress: "Last time I met Charles Clarke, he moved on the very next day. Ruth Kelly was next, and I had just lined up another meeting with her when she was replaced. And there is always the same bloody excuse - 'I've just started'. It makes it hard."

Perhaps the biggest concern about telling parents the results of the tests is that the measure used, body mass index, is notoriously misleading, especially when used to measure children. It cannot distinguish between fat and muscular physique, so paediatricians use waist circumference as a deciding measure when assessing whether a child is obese.

But plans to routinely measure children's waist circumference were dropped by health officials because it would involve the touching of children.

Caught between not wanting to hurt children's feeling or expose them to potential abuse, and wanting to save them from a life dogged by ill-health, ministers have ended up with a messy compromise.

Case study: 'She'd prefer a roast to a burger every time'

Rachel and John Taplin are in their 30s and live with their five-year-old daughter Annabel in Solihull

"I do think it is really important that children eat healthily. Both my husband and I were brought up that way and we are determined to do the same with Annabel," said Rachel. "Cooking and eating together is very important to us as a family. We buy fresh organic fruit and vegetables and lean, free-range meat."

The couple run a website that helps women find work that fits around school hours. In a typical week, the Taplins have meals like home-made cottage pie, pasta, baked potatoes and a traditional roast dinner. Annabel has managed to escape the lure of fast food, according to her mother, and takes an omega-3 and vitamin supplement every day.

"Because she's always had things like salmon and fresh pasta, she prefers home-cooked food to things like chicken nuggets and chips. She will take a home-made roast over a McDonald's any time," said Rachel. "She has not been brought up to have chocolate and sweets as rewards. They are available if she wants them, but it is not a big issue and she really would rather ask for a juicy red apple.

"As a family we make time to have a proper routine around mealtimes and eat at five so that Annabel has time to digest her meal properly before going to bed. Unfortunately, a lot of parents don't have the time and lead such busy lives that mealtimes can suffer," she said. "Good food and a good diet is part of a healthy lifestyle."

Jonathan Owen

A life in the day of a British 4-year-old

Breakfast time

This boy sometimes starts his day with a bowl of porridge (113 calories) but prefers chocolate cereal with whole milk - 275 calories

Off to school

He burns about 150 calories walking to school and back. Like 79 per cent of children, he lives within walking distance; 39 per cent are driven

Morning break

He runs around for at least 60 minutes a day as recommended by the Chief Medical Officer. One in three children don't do even this

Lunchtime

He eats a healthy packed lunch - its contents are inspected by his school. No crisps, sweets or fizzy drinks are allowed

PE lesson

He has a regular PE lesson, unlike 25 per cent of British schools that still don't offer pupils a bare two hours of PE a week

Hometime

He spends 12 hours a week in front of the telly or computer - the average. But snacks can add up to 170 calories an hour

Teatime

Home-made vegetarian shepherd's pie, mash and juice at 575 calories means he can indulge in a scoop of chocolate ice-cream

Bedtime

And so to bed, he typically sleeps the recommended 10 hours. Usually.