LITTLE ROCK, Ark. - It's been two years since Arkansas schools started sending letters home to parents with their kids' report cards - letters telling them if their children were fat.
Plenty of parents weren't happy. But a lot of them did something about it.
Suddenly there were more visits to the pediatrician for talks about weight problems. Fitness class attendance is up. Diet pill use by high-schoolers is down.
And more states are following Arkansas' lead, including California, Florida and Pennsylvania, which have adopted similar programs.
Dr. Karen Young, medical director for the pediatric fitness clinic at Arkansas Children's Hospital, told of a mother upset when she got word from school that her child was overweight. The mother wanted a second opinion from Young, but in the meantime, she cut sweets from the family diet and slimmed the child down before the appointment.
"Even though she was upset with the letter and felt it was wrong, she still changed the family's lifestyle," Young said. "A lot of positive things have come out of those letters."
The letters record each child's body-mass index, the same weight-height formula used to calculate adult obesity. The first batch went out in the 2003-04 school year.
Across the state 57 percent of doctors said they had at least one parent bring in their child's letter from the school for discussion during the last school year.
Young said she's had more visits from parents seeking help for the entire family.
"I don't care what size their siblings are or their parents, everyone in the family should eat healthy and exercise," she said. "What's good for them is good for everybody."
A local TV news report on Young's clinic led Marsha Simon-Younger to enroll her 11-year-old daughter Nasirah in fitness classes. Since Nasirah joined this spring, she's felt better and is eating healthier, her mother said.
"At first, my daughter was really reluctant to go because she thought of it as a fat camp," said Simon-Younger. But once Nasirah arrived, she saw a friend from church and Girl Scouts and felt at ease.
"She has more self-esteem," and she tries different foods, the mother said. "Sometimes we might fall off the wagon, but we get right back on."
It's still a little early to see big results from the state's weigh-in program. After the first year, the percentage of overweight schoolchildren remained where it was at the start - 38 percent.
"We think probably, since there's been no change, that's probably good news," said Jim Raczynski, dean of the College of Public Health at the University of Arkansas for Medical Sciences. "We may have stopped the increase."
And the state has found that most parents and children are comfortable with the weigh-in program - 71 percent of parents and 61 percent of adolescents, according to a survey.
"Once they realized we didn't hand (the letters) to kids to wave around the schoolyard... a lot of the original concerns were alleviated," said Gov. Mike Huckabee, who has championed healthy diets after dropping more than 100 pounds himself. "This was not an invasive procedure where a child is asked to lift a shirt and be pinched with calipers."
Raczynski noted that only a tiny percentage of parents - 6 percent - have put their overweight children on diets that aren't medically supervised.
Schools are reacting, too. Following state Board of Education guidelines, schools in the last two years have banned using food as a reward, are offering more fruits and vegetables on lunch menus, have removed deep fryers and increased low-fat and low-sugar drinks and snacks.
Huckabee and former President Bill Clinton - known for his Big Mac excursions while Arkansas governor - helped announce this year that soft drink manufacturers had voluntarily agreed to remove sugary sodas from school vending machines.
Childhood obesity, Huckabee said, is "a real serious health and economic issue."
Arkansas' effort provides a scientific baseline to look for progress. Over time, "we'll honestly be able to know if this is something that has lasting value."