Questioning the School District's Use of BMI in the Fight Against Childhood Obesity
I received an email from the State College Area School District last week, sending me to a link where I could find my 11th grader's BMI or Body Mass Index number.
The email and related BMI testing is a result of a 2005 mandate from the Pennsylvania Department of Health stating that school health personnel must weigh and measure each student and then send periodic updates to the parents or guardians regarding the student's weight.
Pennsylvania legislators, as well as officials in approximately two dozen other states, thought that BMI tracking and reporting might be an effective tool in fighting the United States obesity epidemic.
I'm not an expert in nutrition, exercise science or bio-behavioral health but I'm going to have to take off my running shoes to count on my fingers and toes the number of ways that this mandate is silly.
I thought the timing of the email was particularly interesting. The television and the internet are currently blasting advertisements for weight loss plans and products to coincide with "New Year's Resolutions" to get in shape and lose weight.
Gyms and fitness centers are usually filled for the first few weeks of the year with the Resolutioners – the short term fitness warriors who decide that January 1 is the start of a new plan for health but who generally burn out by mid-February. Even my regular yoga classes had more bodies on mats doing Downward Facing Dogs last week than we had seen through the previous months.
I opened the link and smiled when I saw my son's BMI is on the lean side of normal. When this same kid was in elementary school, the school's letter said he was overweight. Fast forward to 11th grade, a growth spurt, my husband's family genetics, 5 inches taller and 35 pounds thinner, and the kid is now a toothpick.
If I didn't know that or didn't understand that kids sometimes pack on weight pre-puberty and the other factors that impact one's BMI as well as the limitations of the BMI calculation, what might have been my reaction as a parent to getting a letter saying my kid was overweight?
There is no question that the United States is in a crisis of obesity. According to the Center for Disease Control, about a third of the adults in this country are obese (a BMI of 30 or higher). When we include the people who are overweight (a BMI of 24 or higher) in with the super heavy, the number jumps to 69%.
For kids and teenagers, the numbers suggest that one in five kids has a problem with weight. The implications for health, insurance costs, loss of work hours – and quality of life – are far reaching.
Unfortunately, the reasons why we are fat and getting fatter are very complicated. Cultural influences. Socio-economic status. Self-esteem. Genetics. Geography. Gender. Level of education. A society that is turning increasingly toward a sedentary lifestyle and technology -- and away from activity and exercise. Familial patterns and value systems. Depression. Stress. Accountability and personal responsibility.
Is the time that the school district staff took to weigh each kid, calculate their BMI, enter the data and then email all the parents and guardians the link to access the information even going to make a dent?
The irony of a mandate on weight education coming from state government that (through standardized testing) is in effect squeezing physical education and recess out of public schools is not lost on this writer.
I'm admittedly sensitive to the issue as I've been on a plan of my own in the past 6 months to improve my health. With a family history of some not so good medical things, including weight issues, I try to be aware of my health. In recent years with a busy schedule and just plain old life stressors, I started to slide.
Through healthy eating, managing portions (insert plug for Weight Watchers), and increasing my activity I have lost weight, improved my fitness and stamina, and feel a whole lot better. Something kicked in for me last summer and I made the decision to regroup.
I wasn't there two years ago. Someone could have handed me cash to lose weight and it wouldn't have mattered. Motivation to bring about change in our lives often has to come from within. Similarly, do letters from school districts, health and weight related surcharges from employers or insurance companies or warnings from health professionals really work?
On the other hand, numerous studies have found that when people are asked to identify their height and weight, most are pretty accurate. However, when we ask those same people to categorize their weight, many of those who are overweight, and particularly those who are obese, fail to recognize that they are overweight and therefore at greater risk for health issues.
Similar studies have shown that many of those who are overweight report that they "didn't know" until a doctor or other health professional told them. Sadly, statistics show that many of those same health professionals fall short in raising concerns about a patient's weight.
If letting parents know where their kid currently falls on the weight scale brings about awareness and isn't used to denigrate, separate or humiliate kids, maybe it's not that bad.
Advocates view the school-based BMI assessment as similar to the vision and dental screenings that we do for kids. To some, the government intervention means that identification may lead to help for those who need it.
Since the implementation of the BMI mandate, there have been numerous studies that have looked at the impact on kids, on parent reaction and on changes in behavior. The reviews have been mixed. The best programs seem to be the letters that provide information, make suggestions for ways to improve or make referrals (i.e. seeing a doctor) and those that are paired with activity and exercise programs.
Body Mass Index is just one piece in a very complicated puzzle when it comes to weight and overall health. Let's keep it in perspective.