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Many students already stress about the grades on their report cards, but now, some students are worrying about a whole new scholastic measurement: their body mass index (BMI).

Schools in 19 states have started to conduct annual weigh-ins for students that test for BMI, Medical Daily reported. Their measurements are then sent home to parents as reports, which note whether or not the child is considered overweight.

Kids have started calling the reports “fat letters.”

Many families and health experts have started pushing back against the reports, arguing they could damage children’s self-esteem.  However, others say the reports are the best way to know whether a child’s weight is healthy or unhealthy.

An individual’s BMI is calculated by dividing their weight by the square of their height.  This figure is then compared to growth charts accounting for the person’s age and gender, in order to understand how they compare to the rest of their peers.  BMI is the primary measurement used to determine if a person is considered overweight and obese.

According to the Centers for Disease Control and Prevention (CDC), more than one-third of children and adolescents are considered overweight or obese.  These children are at increased risk for a variety of health issues, such as asthma, sleep apnea, high blood pressure and type 2 diabetes.

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