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In two weeks the District 65 School Board will vote on whether to continue its practice of weighing and measuring students to calculate their body mass index (BMI) and then share that information with each student and his or her parent or guardian. Known as BMI screening, the practice has generated controversy at the District but, said Board President Tracy Quattrocki at a Working Board meeting on June 3, “This is a national debate.”
Ms. Quattrocki also noted the difference between BMI “surveillance,” which keeps individual information private and anonymous but uses it in the aggregate to track the progress of a school or community, and screening, where personal information is shared. She said , “Our mission is to promote the health and wellness of students in this District.”
At the heart of the issue is whether the costs of BMI screening at the District outweigh its benefits. The social/emotional costs, as enumerated by several parents and medical professionals, are that students may develop a poor self-image, may be teased or bullied, may be humiliated in class, and may develop unhealthy eating habits.
The benefits, according to District 65 personnel and some medical professionals, are that students and their parents receive the BMI numbers, learn about the “healthy fitness zone” and can receive information about developing healthier eating habits and increasing exercise.
However, there is no hard evidence that connects knowing BMI numbers with improved health or health habits. Moreover, there is no evidence that children need their BMI number in order to learn about healthy eating habits and the benefits of exercise.
Ten people spoke during the “public comment” part of the meeting, and Board members then discussed the matter with a panel of teachers and medical professionals. Although no one alluded to the Roman poet Juvenal, the discussion seemed hinge on where, if at all, BMI screening fit into his prescription of a sound mind in a sound body.
Those who opposed the District’s practice discussed the harm to self image, degradation of self-esteem and other emotional damage arising from what many term the public humiliation of being weighed and measured in class. Further, although the students access their BMI numbers in private, the reality is that often the numbers become known. Those who defended the practice of BMI screening said they believed that the information it yields is “valuable” for students’ health and should be shared with students and their parents.
Necessary Information or Needless Humiliation?
Several speakers pointed out the obsession of some teens and pre-teens with body image and said BMI screening with its emphasis on weight can be humiliating, even devastating to a child’s self-esteem.
Michele Hayes, said, “My main concern is that this creates a problem with students. There is not adequate support [for children]; the screening is not done by a medical professional. I’m concerned about how it is being rolled out.” She said she felt Denise Rossa, the District’s Physical Education chair, is doing a good job – something that was echoed by many on both sides – but said, “I would appreciate it if you would stop and take a breath [before continuing BMI screening].”
Jan Jerome said, “I am opposed to recording BMI numbers at school. One of our core values is to raise our children’s self-esteem.”
Dr. Thivalan Spaulding, a District 65 parent, described the “current practice of injuring innocent children by potentially devaluing their self-worth…. The BMI number is simply interpreted by junior high children as a measure of fat. … There is potential emotional and psychological damage and possible damage to their bodies.”
Bullying and Body Image
Ms. Quattrocki said, parents are concerned not only about the weighing and measuring of children but about the fact that kids are “swapping that information on the playground.” Several speakers said they were concerned that BMI information, once shared with students, becomes fodder for gossip, humiliation, bullying and eating disorders.
Peggy Silkaitis, a physical education teacher at Washington School, said, “I have had many students who are self-conscious about their weight and [are] teased because of it. … Of course I reassure them and talk to my classes about being sensitive and that it’s okay to be different. But no matter how hard you try, there will still be teasing, and much of it goes without teachers hearing or seeing it. Those children who are teased may suffer in silence because they are too embarrassed or may think they deserve it.”
Kate Brady, a pediatrician at Evanston Hospital’s clinic, said, “I don’t think children should have their BMI measured in school in a gym class. It needs to be done in a private medical office. … A child’s self-esteem is so often related to body image. … I would be sad to say that some of these kids were hearing difficult news in the form of a number labeling them in front of their peers without any support or follow-up from a trusted medical professional that knows them.”
Dr. Brady said she thought that with the new Erie Family Health Clinic, established to serve low-income residents in Evanston and Skokie, and with the Evanston Township High School and hospital clinics, “we can serve all the children in the District.”
Amy Hodges, a social worker at Nichols Middle School, read a statement from Judith Matz, a clinical social worker specializing in eating and weight issues. “I would like to address two questions related to BMI,” the letter said. “Is BMI a helpful measure to promote students’ health and well-being? What are the unintended consequences of using the BMI measure?”
The letter cited studies sponsored by the National Institutes of Health that showed that children who received interventions, nutritional information, increased physical activity and special instructions on nutrition and weight loss retained the information but showed no difference in weight gain from the control groups.
Addressing unintended consequences, Ms. Matz wrote, “Receiving evaluations that use BMI as a benchmark reinforces feelings of shame as well as behaviors of bullying and competition among peers.”
Saying she had been working on the issue of bullying, Rina Campbell said BMI screening “speaks to the social and emotional wellness” of students. She said one of the primary foci of bullying is body image.
Carla Stone, a teacher at Nichols and a Golden Apple winner, made a long and passionate plea against the District’s using BMI. She said she had spoken with more than a thousand kids in the course of her teaching career. “Kids are constantly comparing themselves in middle school. … I’ve observed that if any of my students is singled out as being different, [that child] runs the risk of being bullied. … BMI is a test that should be done by a medical professional.”
Vincent Finnerman, a physical education teacher at Nichols said his daughter, a Haven student, “came home and knew her BMI and the BMI of six of her friends – and I was furious. … BMI is not always academic; the numbers [can be] incorrect. … The things that I worry about are what happens to a kid who is prone to eating disorders. … I still feel uncomfortable that we’re not talking about the way kids eat.”
Among the many reasons District 65 parent Joan Sherman gave for opposing BMI screening are that “it is not approved by the Eating Disorders Council. … It is prone to error and mislabeling; it varies significantly by culture and ethnicity; and it can distract from other [more necessary programs.
Melinda Stolley, a clinical psychologist, said she agrees that “obesity is probably the most prominent drain on a kid’s self-esteem,” but also said, “I don’t know that there is a benefit” to BMI screening.”
Several medical professionals on the panel said they supported BMI screening. Gautham Rao, a physician at University of Chicago Hospitals, said, “My passion is childhood obesity” and added he was very impressed with how Ms. Rossa conducts BMI screening. He said the number of children affected with eating disorders is “a miniscule amount” and that eating disorders are “not as threatening” as obesity.
Dr. Timothy Sanborn, a cardiologist at Northshore University HealthSystem, said he sees in his patients the results of childhood obesity. He said he agrees with those who see the need for “a plan to educate our children on exercise and nutrition. It’s up to us to instill healthy minds in healthy bodies.”
Lynn Gettleman Chehab, a pediatrician at the School-Based Health Center at ETHS and at Evanston Hospital’s Child and Adolescent Center. “I run the health-center-based obesity clinic. Each week that I go in I see students who weight 200 lbs., 300 lbs. They are bullied. They beg me to help them lose weight.”
She said 40 percent of low-income students are obese or overweight, and once a person reaches adult stature, obesity is difficult to reverse. She said she feels that students should know their BMI, starting in middle school.
“How do we reach the children who are high-obesity and low income? Most major health organizations are asking for more help for schools to work with obesity. I think we’re doing kids a disservice [by not screening for BMI and releasing the information to individual families],” said Dr. Chehab.
Ms. Rossa said, “At Chute, we’ve never had students express concerns about [BMI].” She said many students want to know their height and weight.
Ms. Rossa said the District “meets all the criteria” of the Centers for Disease Control (CDC) for BMI screening in schools – introduction of the program to parents, staff training, protection student privacy, efficient data-collection procedures, evaluation of the program and not using the results for student or teacher evaluation.
The CDC does not endorse BMI screenings but American Academy of Pediatrics lists several safeguards for school BMI screening programs “to reduce the risk of harming students.” Those mentioned by Ms. Rossa are among the eight recommended safeguards.
‘Does BMI Screening Make A Difference?’
Although several speakers said they were “passionate” about the issue of childhood obesity and how to address or prevent it, none was able to make the connection between knowing one’s BMI and a positive change in health-related habits.
Both the American Public Health Association and the Institute of Medicine endorse BMI measurement for “surveillance” purposes – that is, for an overall picture of a certain population – to monitor trends and progress in reducing childhood obesity and to identify populations at risk of childhood obesity, according to “Body Mass Index Measurement in Schools,” a 2007 article in the Journal of School Health that appears on the CDC website and under its aegis.
The CDC article, though, carefully distinguishes between using BMI measurement in anonymous surveillances and using it for screening, where – as at District 65 – the BMI number is shared with students and their parents. Regarding BMI screening, the article states, “Little is known about the outcomes of BMI measurement, including effects on weight-related knowledge, attitudes and behaviors of youth and their families.”
The article lists some concerns that have been expressed about school-based BMI screening programs: “They might stigmatize students and lead to harmful behaviors, be ineffective, waste scarce health-promotion resources and distract attention from other school-based obesity-prevention activities.” It also states, “More evidence is needed to determine whether BMI screening programs are a promising approach for addressing obesity among children and adolescents.”
Ms. Quattrocki , said, “I have yet to read something that says that BMI testing causes weight loss.” She asked whether the District had “any evidence to show that there has been a difference – that BMI has helped kids lose weight.” She asked the District administrators if there was any evidence that BMI screening has made a difference for the students in the District.
Mary Larson, Coordinator of Health Services for D65, said, “The whole point of BMI is not to make students lose weight, it is about giving students a tool.”
No District 65 administrator and no one on the panel cited any study that showed a correlation between BMI screening and positive changes in student health or health habits.
No one pointed to any study that showed that giving students a number is essential to teaching students about the importance of healthy eating and being physically active. Further, although the District has been conducting BMI screening for more than a decade at some schools, it did not present data showing cohort trends at those schools.
Maria Ragon, a clinical psychologist, cited a study that suggested that giving students their BMI numbers may in some instances cause weight gain in some students who worry about their weight. “The concern is that you can put kids at risk of gaining weight by testing BMI.” She recommended that the District use its resources to promote healthier lifestyles with increased activity and nutrition information.
Board Members’ Views
Board members agreed that there is a need to address the nationwide problem of childhood obesity at the District level. Two main points of discussion were the limitations of and potential harm caused by BMI screening and the need for low-income students to have greater access to health care.
Richard Rykhus began the Board discussion saying the District has done a lot to promote children’s health: school gardens, sports teams, walking clubs, etc. He noted that there was a lot of agreement among the parents, teachers and professionals.
Of the five elements of the Fitnessgram, four drew agreement, Mr. Rykhus said, and BMI screening “is one small component.” He added, though, “Every single parent communication [about BMI screening] I’ve gotten has said, ‘Don’t do this.’”
Mr. Rykhus suggested that the District suspend BMI screening for a next year while the District figures out how to handle it.
Candance Chow asked about the resources needed to offer the proper follow-up to BMI screenings. “Do we have the capacity to do this – ‘screening by professionals’? … If we identify those kids who are not in a healthy zone … we need to do more than send a letter. We need to have an affirmative way of connecting children to professionals.”
Claudia Garrison asked whether the middle school physical education curriculum would be wrecked if the children were not given their BMI numbers. “Could you do the program without BMI?”
“Certainly,” said Ms. Rossa. She added, though, that eliminating BMI numbers would diminish the discussion on body composition. “So I would have to send them to a doctor [to be weighed and measured]…”
“Or tell them, ‘Go home and weigh yourself,’” said Ms. Garrison.
Suni Kartha said the District should use the information ‘to talk about how health and fitness come in different sizes.”
Katie Bailey said she was struggling to find a solution to the problem – she sees the BMI issue as “the obesity epidemic vs. the social/emotional well-being of students.” She said she supported the screening. “We need to screen [for BMI] because not everybody is getting screened. … If we are not doing BMI screening – for really valid reasons – we might end up with a problem later on. … If we could make sure that everybody saw a doctor every year, that might help solve it. … If we take the information and use it in the right way, we might be able to help with a growing epidemic.”
Dr. Murphy said he thought the evening had yielded “a pretty profound discussion.” He supported continuing BMI screening because, he said, low-income families are not able to obtain BMI numbers from their physician each year. “Our P.E. department is increasing the standard of health care for low-income students,” he said.
“I don’t think we’re talking about privileging one set of children over another,” said Ms. Quattrocki. “It’s about how we best address the problem.”
She said the Board will likely vote later this month on whether the District will continue BMI screening.
D65’s Practice of BMI Screening
BMI is a ratio of weight to height, in conjunction with other measurements. 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.
Even though the School District has BMI information on all its sixth-graders, it conducts BMI screening for some students. At the middle-school level, BMI screening is said to be part of the curriculum, but it has not been implemented uniformly throughout the District. It is done at Haven and Chute middle schools and some of the grade schools but not at Nichols or either of the two magnet schools, King Lab and Bessie Rhodes.
Denise Rossa, chair of District 65’s Middle School Physical Education Department described the process at Chute Middle School: The screening is done in connection with a software program called Fitnessgram that assesses students in five health-related fitness components – cardiovascular fitness, muscular strength, muscular endurance, flexibility and body composition. 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 – 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.
“”The Fitnessgram report does not use negative terms such as obese, overweight or underweight in conjunction with BMI or body composition, nor do the physical educators,”” Ms. Rossa said. She added, “”Students are weighed and measured privately during class and not in front of their peers. Scores are never announced.””
Ms. Rossa also said that the procedure varies by school but that in all cases each student’s privacy is preserved.