BMI Report Cards: More Harm Than Good?

If expending limited school resources on BMI notifications is unnecessary, likely ineffective and may cause harm, what can parents do?
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With all due respect to the American Academy of Pediatrics, I strenuously object to their recent recommendation that all schools should notify parents if their child is overweight or obese. I believe that discussions about children's BMI should stay in the doctor's (or other health care professional's) office -- with open communication and positive relationships characterized by sensitivity, honesty, trust and respect, as recommended in a 2012 review in Pediatric Obesity.

The so-called 'fat letters' are unwarranted, unproven and potentially harmful. We can -- and should -- utilize more comprehensive strategies for promoting smart nutrition and fun physical activity for students of all sizes, shapes and weights in our schools. These controversial measures may be unnecessary. Recent headlines have been full of reports that the United States is, in fact, winning the war in childhood obesity. This month, the Centers for Disease Control and Prevention (CDC) Vital Signs acknowledged the progress: "Small but significant declines in obesity among low-income preschoolers were observed in 19 of 43 states/territories examined." Stable and decreasing childhood obesity rates have been also been confirmed in other national and local surveys, including the CDC's 2012 Pediatric Nutrition Surveillance Report, data from school districts in Philadelphia and Anchorage, and preschoolers in Massachusetts.

None of the reports have suggested that BMI (body mass index) measurements in schools or parental letters had anything to do with the reversals. In fact, a 2011 analysis of parental notifications in California, in the Archives of Pediatric and Adolescent Medicine concluded:

While BMI screening itself could have benefits, parental notification in its current form may not reduce pediatric obesity. Until effective methods of notification are identified, schools should consider directing resources to policies and programs proven to improve student health.

As a school nutrition expert, I know multiple districts where such policies and programs have been implemented -- and firmly believe that's where we should direct our limited school health resources. Make no mistake, it takes significant resources to measure and report children's BMIs accurately -- carefully calibrated equipment, well-trained school staff to take precise heights and weights and significant time to calculate, report and notify parents about BMIs. Done properly, it also takes sensitivity to protect the privacy and self-esteem of young children. This is absolutely essential because studies, including several by the Yale's Rudd Center for Food Policy and Obesity, have documented that weight stigma and weight-related bullying are significant problems starting as young as preschool.

Many experts have raised concerns BMI reports and obesity programs in schools, which may be linked to increasing rates of dieting, body image disturbances and diagnosable eating disorders among youth. In a 2011 national poll, Michigan's C.S. Mott Children's Hospital found that one in three families with school-aged children identified worrisome nutrition and physical activity behaviors as a result of obesity prevention programs in schools. In long-term studies with teens, Dr. Diane Neumark-Sztainer and colleagues at the University of Minnesota's Project EAT have also shown that BMI reports sent home can lead parents to encourage weight loss diets in overweight or obese children, a behavior that predicts weight gain in five-year follow-ups.

If expending limited school resources on BMI notifications is unnecessary, likely ineffective and may cause harm, what can parents do? What balanced policies and programs for smart nutrition and fun physical activity can be implemented in schools to benefit all children and their families? Fortunately, several national programs are already showing positive results in changing policies and behaviors. Three of the most prominent programs, with links to their websites, are listed below. And, now is the perfect time for schools and parents to work together on promoting optimal health and academic performance for all children.

Provisions of the 2010 Healthy, Hunger-Free Kids Act, which go into effect this year, require schools to update local wellness policies -- with the help of parents, teachers, health care providers and students. If you care about these issues, now is the time to join your local school wellness council or health advisory committee. They need us to focus less on 'fat letters' and put more resources toward school gardens, cooking classes and before/after-school walking programs for all students.

Alliance for a Healthy Generation: Healthy Schools Program (HSP)
Preliminary results, as reported by the CDC, indicate that eighty percent of HSP schools made progress in creating healthier environments by implementing policies and programs that improved the nutritional value of foods, health education, physical education, and access to physical activity.

Fuel Up To Play 60 (FUTP60)
FUTP60 - a student-centric wellness program - is the largest school-based health initiative in the US, enrolling nearly 73,000 schools, involving more than 11 million students and 26,000 adult program advisors in 2012. Evaluations show that FUTP60 contributes to positive changes in student eating and physical activity behaviors.

USDA HealthierUS School Challenge (HUSSC)
HUSSC, a USDA recognition program that awards Bronze, Silver, Gold and Gold with Distinction status to schools that meet strict nutrition and activity criteria, has certified 6,526 schools as of June 17, 2013. These schools serve healthy lunches, offer nutrition education and ensure that all students get daily physical activity.

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