|2/27/2013 1:42:00 PM|
Editorial: District 65 Should Discontinue BMI Screening
Childhood obesity is becoming a nationwide health problem. The Centers for Disease Control (CDC) report that between 1980 and 2004, the percentage of youth who were obese tripled from 7 percent to 19 percent in children aged 6 to 11 years and from 5 percent to 17 percent in adolescents aged 12 to 19 years.
Stemming the tide of childhood obesity is a nationwide, statewide and Citywide goal. Children need to be encouraged to follow a healthy lifestyle, with appropriate exercise and good nutrition.
District 65 is doing its part. Promoting a healthy lifestyle is part of its physical education curriculum. For diagnostic testing of some aspects of students’ physical fitness, the District uses a software program, FITNESSGRAM, recommended for public schools by the Illinois Department of Public Health.
One aspect of the FITNESSGRAM program is the calculation of body mass index, or BMI. BMI is a proportion of height to weight that shows, as one health-care worker put it, “the degree of fatness of a child.”
The CDC describes two ways school districts can handle BMI information they have collected. It can be shared it on an individual basis with students and parents, a process called “screening,” or it can be shared on an aggregate and anonymous basis, a process called “surveillance.”
District 65 conducts BMI screening with many of its sixth-graders and says it plans to expand that practice to all middle schools.
The District has taken measures to try to ensure privacy in both the collecting and the sharing of BMI data. Kids are weighed and measured behind a curtain or in a separate room. Information is shared with parents on a secure website (or by letter) and then with students, again through a secure website.
We have no doubt that the District’s purpose is to help promote a healthy lifestyle and to help kids understand the consequences of their choices – e.g., to eat fruit or vegetables instead of junk food or to be active rather than spend time in front of a computer or a television. Yet we do not believe the District should conduct BMI screening. We think the benefits are outweighed by the risks.
According to literature on the CDC website, it is unclear what effect, if any, BMI screening has on the youth and their families – whether their attitudes or habits change because of this knowledge. The potential for adverse effects on children, however, is significant.
The article, “Body Mass Index Measurement in Schools” on the CDC website (www.cdc.gov/HealthyYouth/Overweight/BMI) notes some concerns about the “unintended negative consequences for youth” of BMI screening, found under its heading “Challenges to BMI Measurement Programs in Schools.” These additional pressures put overweight children “at even greater risk of being discriminated against or bullied and having psychological problems.” Discomfort with their body image, real or perceived, could lead to harmful weight loss practices or eating disorders, says the report.
The flip side of the stigmatization of the overweight child or youth is the skewed body image of the child or youth whose weight and proportions are normal but who succumbs to pressures – real or imagined – to be even thinner.
Again, from the CDC (same article): “In 2005, the Youth Risk Behavior Survey found that approximately 1 in 6 U.S. high school students engaged in unsafe practices to lose or maintain weight, such as fasting, taking diet pills, or laxatives, or inducing vomiting. Weight concerns are a major risk factor for the onset of eating disorders.”
We do not slight the problem of childhood obesity. It can snowball deleteriously into teen years and adulthood. And BMI is one tool to assess obesity and possibly find underlying problems and risk factors. But bringing it into the sixth-grade classroom seems, at best, to add a needless embarrassment to young teens and preteens already uncomfortable with their bodies and the incipient changes of puberty.
With the new federally qualified health center, operating temporarily in the Morton Civic Center, every District 65 family has the opportunity to have BMI and other health data ascertained in the privacy of a physician’s office.
The District is treating these serious issues responsibly. We come down, however, on the side of discontinuing BMI screening.
The health of our young people is of critical importance, and the District is on track to promoting good health habits in many areas already.
It does not appear to us that discontinuing a practice that is embarrassing at best, is sometimes humiliating and whose effectiveness is unclear, will derail those efforts.
Posted: Tuesday, March 5, 2013
Article comment by:
I am writing in response to the Round Table’s editorial on BMI Screening in District 65. Currently, the American Academy of Pediatrics expert committee on childhood obesity recommends annual BMI assessment by health care providers, along with an assessment of dietary intake and physical activity. BMI assessment is a helpful tool in determining whether children are at a healthy weight. Numerous studies have shown that parents commonly do not perceive their child’s weight status accurately. A study conducted by the Consortium to Lower Obesity in Chicago’s Children (CLOCC) showed that 85% of parents with children that were overweight did not perceive them as overweight. However, the utility of BMI screening (shared on an individual basis with students and parents) by schools and any adverse effects it may have on individual students is controversial. The American Academy of Pediatrics cautions schools implementing BMI screening to do so within the confines of a “safe and supportive” environment. That safe and supportive environment should include a universal bullying prevention program that specifically addresses weight discrimination, a curriculum that encourages a healthy weight and discourages excessive thinness, and training for school staff to provide appropriate guidance to students with weight related concerns.
BMI surveillance (collected anonymously as an aggregate), as opposed to screening, is endorsed by a number of health care organizations including the American Heart Association, the American Public Health Association, and the Institute of Medicine. There are a number of benefits from BMI surveillance. Surveillance would define the extent of obesity among students in District 65. It would allow us to follow trends in weight status by school, intensively target school- based activity and nutritional programs and assess their effectiveness. It would also be interesting and useful to find out if obesity rates vary by neighborhood. In another study, performed by CLOCC, obesity prevalence rates varied dramatically by Chicago neighborhood. Identifying any variability within Evanston may help the city assist schools in focusing their efforts at combating this epidemic within a particular neighborhood. So although the concerns of BMI screening expressed in last week’s editorial by The Round Table have some merit, the benefits of BMI surveillance are indisputable. I would encourage District 65 to continue collecting BMI on students so that we can better understand the scope of this problem and better focus limited resources on the children that need them most.
Marjorie Fujara MD
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