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Discussion at the March 13 meeting of School District 65’s Policy Committee seemed to cover the good, the bad and the ugly of body-mass-index (BMI) screening at the District, as administrators, Board members, parents and professionals tried to tease out policy and direction for this portion of the District’s middle school health/physical education curriculum.
BMI, a ratio of weight to height, in conjunction with other measurements can be an indicator of being overweight or obese, conditions that can lead to heart problems or diabetes. The Illinois Department of Public Health mandates that every child entering kindergarten, sixth and ninth grades undergo a physical exam by a medical professional and that BMI be a part of that exam. This information, along with other health information, is given both to the school district and the state.
At District 65, part of the physical education curriculum in sixth grade is connected with a software program called Fitnessgram. It assesses students in five health-related fitness components – cardiovascular fitness, muscular strength, muscular endurance, flexibility and body composition. Denise Rossa, chair of District 65’s Middle School Physical Education Department, said the results of tests in each of these five areas chart a student’s numbers along a “healthy fitness zone.”
In the “body composition” part, students are weighed and measured during a class – behind a screen or in a separate room, when possible, according to the District – and the BMI information is shared first with parents though a secure website. Families who do not have Internet access receive this information by letter, District administrators said. Two weeks later, during class period, each student can see his or her own BMI by logging onto that same secure website.
Although District officials say that this has been done for 12-15 years, in practice, the weighing, measuring and sharing information takes place only at Chute and Haven middle schools, not at Nichols or either of the two magnet schools.
This process, with its individualization and sharing of information on a personal basis, is called “BMI screening.” A less personalized procedure, involving weighing and measuring but not sharing individual information, is called “BMI surveillance.” BMI surveillance is used to track trends in obesity, risks, etc.
The Centers for Disease Control (CDC) endorse BMI surveillance for schools and but has strong cautions against BMI screening in schools because of the risk of teasing, bullying, stigmatization and other harmful results. A school implementing BMI screening should have a strong anti-bullying curriculum and other safeguards in place, the CDC recommends.
Parental objection to BMI screening, communicated to some Board members, put the topic on the Board’s Policy Committee agenda. Policy Committee chair Tracy Quattrocki said, “We’re addressing [the District’s policy of BMI screening] because parents have said there are negative consequences for their children – and I think we have to respond to it – particularly in light of the fact that there is no evidence that it benefits our children.”
Solid Curriculum or Harmful Policy?
At the March 13 meeting, District 65 personnel defended their practices as pedagogical, saying they are “part of the curriculum” and said they favored continuing the program. Parents, as well as other professionals who attended the meeting, said they saw little or no benefit to students – and some potential harm –
in continuing the program.
Clinical psychologist Melinda Stolley said, “There is absolutely no precedent for reporting BMI to children. … Policy is meant to do good. Policies for public health and in schools are … meant to be evidence-based. We have no evidence to say that this will do no harm. … Telling people they’re overweight does absolutely nothing – except to make them feel bad.”
District 65 parent and food-blogger Michelle Hayes said, “BMI in particular has been dinged as an inaccurate picture of body fat.”
Kate Brady, a pediatrician in the Child and Adolescent Center of Evanston Hospital, described the difficulty of “telling a child what their BMI is and the ramifications of that. I do it in the context of sitting with child and the parents, watching their body language. … I always give them concrete suggestions about what to do.”
Dr. Brady said it is “incredibly problematic to do BMI screening and talk about BMI without individual counseling and individual follow-up … Children are so vulnerable at this age. … I think we can do everything we need to do without labeling them. Instead of measuring them let them do exercise. Let’s give them some fruit; let’s give them some water. Let’s see if they have gotten their basal heart rate lower. Can they run the mile 5 seconds faster? We have all the information we need for surveillance purposes: Height weight and BMI are all filled out [on the required physicals]. You can get that for every child.”
Ms. Hayes said, “The American Academy of Pediatrics has made a statement that they do not think BMI measurement in schools is appropriate.”
“But they’re talking about mass screening, not about curriculum,” said Coordinator of Health Services for D65, Mary Larson, RN, BSN, ILCSN.
Ms. Quattrocki said, “The CDC says BMI screening has to be surrounded by a strong anti-bullying curriculum, and I have not heard that we have that in place.”
Speaking as a parent, Dr. Thawivann Spaulding said, “I realize a lot of the time D65 and gym teachers have really good intentions about what do to with BMI, but from my kids and their friends and the mothers I see and talk with say BMI has simply been interpreted as ‘I’m fat’ or ‘I’m skinny’ and not ‘I’m healthy,’ no matter
what the language is or how detailed the information is. … All the friends got everyone’s BMI. I’m concerned because I have two more girls coming up. … All the girls are devastated. … I think it would be better, if you’re really concerned about BMI, to have a family forum where parents can come in with their children and learn. The whole focus with gym teacher and children puts a huge responsibility on the children and 90 percent of this is beyond their control.”
Assistant Superintendent Susan Schultz said, “It’s important for me to say how much I respect our professionals and how they handle [this in the context of education]. I hear from principals about how kids come to them and say, ‘I’m working on my fitness,’ and that kids are talking with their P.E. teachers privately and saying, ‘What can I do to change where I am [in terms of health]?’ … There are no problems related to this.”
Ms. Larson, who is also a public health nurse, said, “I’m confused as to why, when we are fighting a battle of childhood obesity, you think educating children on how to be fit would be an unfit way of educating them. Why is BMI such a boogeyman?” She compared parents’ objections to those voiced by parents when the District first offered sex education. “Parents were afraid their kids would get pregnant because they knew more.”
Ms. Quattrocki said, “In sex education, we don’t go down to the individual level.”
“In sex ed, most kids know if they’re involved or not,” said Ms. Larson, to which Ms. Quattrocki responded, “Most kids know if they’re fat or not.”
Ms. Stolley said, “Telling people they’re overweight does absolutely nothing – except to make them feel bad.”
“That’s because the information has been given too late. Everybody knows it’s easier to change when people learn it early,” said Ms. Larson.
Haven Principal Kathy Roberson said, “It’s about making good decisions. … I don’t know that the numbers change what’s going on, but it does open a conversation.”
Jeff Brown, principal of King Lab School, said he had neither heard reports nor seen incidents of bullying over BMI. “Bullying comes between the haves and the have-nots. It is not about BMI – but about being excluded from groups.” There is no BMI screening at King Lab.
As for giving kids information, Mr. Brown said, “Middle schoolers want to know. … I think we owe it to our kids to be up-front with them.” He analogized sharing BMI information this way to talking to kids about guns, gangs, drugs and sex.
Board member Richard Rykhus said, “When we teach our kids about gangs, we don’t give them an index of their likelihood of joining a gang based on some life circumstance, and we don’t try to predict their drug usage [based on an index]. We try to help them make smarter choices.”
Dr. Murphy said, “I’m not sure that we’re really sure that we have a problem – I’ve just heard anecdotal evidence. … Everything we’re talking about tonight is anecdotal. We had people refer to research results. So the question is, ‘Are we going to change policy based upon the opinions heard around the table?’”
Opt In or Opt Out?
The District has an opt-out procedure for its programs, used for students whose parents choose for their children not to participate in one or more aspects of the screening, said Ms. Rossa. There are two tiers of opting out for the BMI part of the physical education class: Students in the Tier 1 opt-out will be weighed and measured but the data will not be reported. Students in Tier 2 will be placed in a separate room where they will write a
five-paragraph paper, one paragraph on each of the health-related fitness components of the Fitnessgram, she said.
Both Ms. Quattrocki and Board President Katie Bailey, who attended the meeting but is not a member of the Policy Committee, objected to the essay requirement. Ms. Quattrocki also said she felt an opt-in policy would be preferable for BMI screening.
Dr. Murphy objected to having an opt-in procedure for BMI screening and an opt-out procedure for everything else.
The Larger Issue
Ms. Bailey separated the opt-in/opt-out vote from what she termed a “larger issue. … Maybe we should step back and say, ‘What is the goal?’ Kids and families should start thinking about healthy issues. That’s the discussion we should be having. I kind of think from what I’m hearing tonight is that BMI might not be the way to do it.”
Ms. Quattrocki said, “I think the question of BMI testing and how or whether kids should receive this info is a policy question. … Can we do what we want to do [encourage exercise and promote healthy choices] without putting a label on it? I would argue that, yes, we can do everything without the potential downside. … I’m convinced that BMI screening … is not the way to go.” She added that the physical education department is “doing wonderful things.”
Mr. Rykhus said, “Everyone is here because they care about the health and wellness of all kids in the District. There probably is a much bigger conversation about what is happening with the wellness council and what’s going on in the schools – and this can go on over the next several months. … What I have not heard is that BMI is the motivator for students to change their behavior. Given all the different perspectives, I would come down on the side of not using BMI and using all the other elements – Fitnessgram, curriculum and other tools – to drive the behaviors that we want.”
The opt-in/opt-out issue will be on the Board agenda for April 8 with a vote expected on April 22. The larger issue of whether BMI screening accomplishes a curricular goal without the risk of harming students will be a full-Board discussion but one that will likely occur after the
new Board members are sworn in the first week of May.
At the March 13 meeting of the School District 65 Policy Committee, Kate Brady, a pediatrician in the Child and Adolescent Center of Evanston Hospital, described how she discusses BMI with her patients and their families: “I talk with the parents – and I watch the reactions. I start by saying, ‘You’re a beautiful child inside and outside, and I’d like to help you stay that way. I’d like to help you get even more comfortable and healthier. And when I talk to an adolescent I have to decide whether they’re pubescent, pre-pubescent or fully developed because I speak about it differently. If they are pre-pubescent with a high BMI, I can encourage them to stay at that weight and wait for the growth spurt. If they’re pubescent, I talk about hormones and the fact that the growth spurt has already happened and how to maintain what they’ve capitalized on. If they are fully developed, I talk about after they’ve had the growth spurt they don’t need to eat so much. … Never once do I give them a number for their BMI and never once do I recheck BMI. I have done that in the past and had a few failures. … No one is going to say, ‘Thank you for telling me I’m fat;’ they’re going to think, ‘I’ve failed my child.’”
She said a recent study completed in conjunction with Children’s Memorial Hospital found that children are more likely to be bullied if they are identified as obese, perceive themselves as even slightly overweight, trying to lose weight or measured at school and told they need to lose weight.
CDC OKs BMI Surveillance, Not ScreeningThe place and the role of BMI screening are unclear at the national level – the CDC does not endorse the practice – as well as here.
A report on the CDC website, “Body Mass Index Measurement in Schools,” published in 2007 in the Journal of Health, found that using “school-based BMI measurement for surveillance purposes, that is, to identify the percentage of students in a population who are at risk for weight-related problems, is widely accepted.”
The study also acknowledged that “considerable controversy exists over BMI measurement for screening purposes, that is, to assess the weight status of individual students and provide this information to parents with guidance for action. Although some promising results have been reported, more evaluation is needed to determine whether BMI-screening programs are a promising practice for addressing obesity.”
The report concluded that, based on the information available, “BMI screening meets some but not all of the criteria established by the American Academy of Pediatrics for determining whether screening for specific health conditions should be implemented in schools.” It also concluded that schools that use BMI screening should “adhere to safeguards to reduce the risk of harming students, have in place a safe and supportive environment for students of all body sizes, and implement science-based strategies to promote physical activity and healthy eating.”District 65’s Procedures
BMI screenings are conducted in at least two District 65 middle schools: Chute and Haven, as part of the sixth-grade health/physical education curriculum. In the “body composition” part, students are weighed and measured during a class – behind a screen or in a separate room, when possible, according to the District. Kids have their backs to the scale and are asked not to look down, said Denise Rossa, chair of the District’s middle school physical education department, “but 90 percent of the time kids ask for the numbers.”
The information is written on an iPad, she said, so there is no paper trail, and the BMI information is shared first with parents though a secure website. Families who do not have Internet access receive this information by letter, District administrators said.
Two weeks later, during a class period, students can see their own BMI by logging onto that same secure website. The software, Fitnessgram, charts the information so kids can see how their numbers compare along what is called the “Healthy Fitness Zone,” she said.
BMI is discussed in class but not on an individual level, Ms. Rossa said. Parents can opt out of the entire process or opt out of having the students get their numbers, she added.