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F is for Fat -- A Bad Idea

Will report cards really help parents properly address their children's weight problems?
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New Jersey students may soon have one more weight to carry -- their
own. A new state office is considering adding an assessment of
students' weight to their report cards.

Clearly, childhood obesity is a problem that needs to be addressed.

While well intentioned, this approach is misguided; it's unlikely to
produce the desired effect and may even result in some serious
negative consequences. Think about it, if your child
is obese, you probably know it already. A report card telling you so
will only add to the stigma, without providing real approaches to
addressing the problem.

In New Jersey's latest effort to combat obesity, the Office of
Nutrition and Fitness (ONF) has been created under the auspices of
the Department of Health and Senior Services. Commissioned by Dr.
Fred Jacobs, the ONF is charged with instilling healthy habits, and
report card weight assessments are an option under consideration.
Many states have structured such reports around analyzing the body
mass index (BMI) of students. Report cards would be sent home to
notify the parents of children whose BMIs indicate they are overweight.

Will report cards really help parents properly address their
children's weight problems?

Many parents of overweight children may already be aware that their
kids need help; having the school district point it out would likely
just be one more frustrating part of the already daunting task of
trying to keep a child healthy. And if parents aren't aware, is this
the best way to tell them?

If we're going to approach obesity from a legislative standpoint,
let's use our government's energies to launch public health education
campaigns and give parents some useful resources for treating the
problem, such as information on how to shop for healthy foods and how
to find ways to exercise with their children, rather than simple
numbers and restatements of obesity/disease links. Placing BMIs on
report cards does little to motivate parents or create solutions.

We applaud Dr. Jacobs' plan to fight obesity with methods that have
been scientifically proven to work, such as support groups and
encouraging physical activity -- rather than some popular but
unscientific methods, such as banning certain foods. Dr. Jacobs said
that he wants to accomplish these goals "without creating a further
stigma on individual people." He should follow his own advice.

Arkansas, which enacted a similar report card plan, is now
considering dropping their BMI report cards after a lot of negative,
unintended consequences and reports of damaged self-esteem. Report
cards are a place for reporting on school performance, not a child's
characteristics or non-academic habits. There's a reason report
cards include math, science, and English, not tooth-brushing,
sleeping, and weight (despite their undoubted significance for a
child's health).

This plan might cause undue focus on body image, resulting in stress
or even eating disorders, also a serious problem in schools. Most of
us can remember times in school when comparing appearances lowered
self-esteem; officially "grading" children on their bodies would
likely be even more distressing.

Moreover, using BMI as an indicator of overall health oversimplifies
the issue. The bill does not state how BMI will be calculated,
except to say it involves weighing each child. This may mean the
school-calculated BMIs don't include all four of the measures
(weight, height, age, sex) that are known to be important in
determining children's BMIs. And any BMI measure neglects the facts
that muscle weighs more than fat and that simple height and weight
measurements don't give the whole picture of a person's weight-
related health.

Just as a report card mark for "blood pressure" wouldn't give parents
a complete picture of a child's health, neither does one only for
BMI. The BMI "grades" could cause unnecessary worry for some parents
and give others the false belief that they need not worry about other
aspects of their children's health.

Obesity is an increasingly serious public health issue, and it is
important to instill healthy habits at an early age. Schools can
play a role in helping promote healthy lifestyles and habits in
children, and New Jersey is right to look to them for solutions.

But perhaps that means offering students more classroom instruction
on healthy habits, having school nurses call home if they have
concerns about a child's weight and health, or sending information to
all parents about how best to keep their children healthy and how to
seek help if a child is overweight. The answer might be in any
number of school-based approaches, but it won't be found printed on
the report card.