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Providing perspectives on recent research into vitamins and nutritionals


School Reporting of BMI to Parents: Helpful, Intrusive or Dangerous?

By Julia Bird

Although knowing may be half the battle, providing knowledge of a child’s weight to parents via school-based programs is a tactical quagmire in the fight against obesity. In 2003, the US State of Arkansas made history with controversial legislation requiring BMI screening of children in schools and subsequent reporting to parents. The editorial in Pediatrics today discusses more widespread uptake of school reporting of child obesity to parents (Flaherty).

The idea behind school-based BMI screening is based both on the successful implementation of other public health-related programs via schools, and findings that parents often are not aware of whether their child’s weight is healthy (see a review from Cloutier, and recent reports of this phenomenon from Heimuli, De La O, and Hudson). However, there are some critics of the programs. Parents are concerned about the intrusions of government and schools into the private sphere, potential increases in eating disorders and bullying, and the misclassification of children using BMI. In 2005, the US Preventive Services Taskforce found a lack of data on the effectiveness of school-based interventions in reducing the rate of obesity. In the meantime, the experience in Arkansas has started to provide some data on whether these programs are effective.

A key publication on the Arkansas program reports on the first four years of the voluntary program. Data are reported for each of the four years. Over 90% of parents approved their child’s participation, however due to absences only around 85% of students participated in any given year. Awareness of the BMI measurements by parents increased over four years, and 95% of parents read at least some of their child’s BMI report. The most significant changes appear to be at the school level; access to and number of vending machines decreased, and policies regarding physical activity improved. Parents offered fewer discretional calories in the form of soft drinks, chips or sweets, and parents limited child screen time to encourage physical activity. Students also reported an increase in physical activity. The survey did not find increases in unhealthy diet behavior or concern about weight among students that were healthy. There was in fact a decline in the number of parents who reported that they put their child on a diet during the survey. Although one report seems to indicate that the prevalence of overweight and obesity increased between 2003 and 2007 in Arkansas (Singh, Kogan and van Dyck), it was based on self-reported data. Self-reported data tends to underestimate weight; being provided with annual reports of weight is likely to increase weights reported. Actual measurements made during the program indicated that the prevalence of overweight and obesity remained steady (Arkansas Center for Health Improvement) at a time when overall prevalence of obesity increased nationally.

The BMI measurement is relatively simple, requiring equipment that is easy to obtain and use. The measurement can also misclassify people with a muscular build as obese. In a study of adolescent athletes, this was found to be the case to a small extent. Etchison and colleagues report that of almost 34,000 student athletes aged 11 to 19, 13% were classified as obese according to BMI, whereas only 6% were obese using the more specific skinfold measurement. This means that only 7% of athletes were misclassified. In the non-athletic population, the percent misclassified is likely to be much lower. Concerns about classifying muscular children as obese are unfounded, and also addressed in information to parents.

A school-based BMI screening program is not a silver-bullet solution in obesity prevention. Although adverse effects of the program have not been found, the cultural context in which personal information related to obesity is important and potential unintended effects should continue to be monitored to answer the question more definitively. BMI screening programs do offer a good opportunity to identify students at risk of obesity, advise parents, and monitor trends in childhood obesity. Obesity screening can be a useful addition to a comprehensive program to reduce overall obesity levels in a population.

Main citation:

Michael R. Flaherty. “Fat Letters” in Public Schools: Public Health Versus Pride. Pediatrics peds.2013-0926; published ahead of print August 19, 2013, doi:10.1542/peds.2013-0926

Supporting citations:

Cloutier MM, Lucuara-Revelo P, Wakefield DB, Gorin AA. My Weight Ruler: A simple and effective tool to enhance parental understanding of child weight status. Prev Med. 2013 Jul 17. pii: S0091-7435(13)00256-9. doi: 10.1016/j.ypmed.2013.07.014. [Epub ahead of print]

De La O A, Jordan KC, Ortiz K, Moyer-Mileur LJ, Stoddard G, Friedrichs M, Cox R, Carlson EC, Heap E, Mihalopoulos NL. Do parents accurately perceive their child's weight status? J Pediatr Health Care. 2009 Jul-Aug;23(4):216-21. doi: 10.1016/j.pedhc.2007.12.014. Epub 2008 Mar 4.

Fitzgibbon ML, Beech BM. The role of culture in the context of school-based BMI screening. Pediatrics. 2009 Sep;124 Suppl 1:S50-62. doi: 10.1542/peds.2008-3586H.

Heimuli J, Sundborn G, Rush E, Oliver M, Savila F. Parental perceptions of their child's weight and future concern: the Pacific Islands Families Study. Pac Health Dialog. 2011 Sep;17(2):33-49. 10.1016/j.pedhc.2007.12.014. Epub 2008 Mar 4.

Hudson E, McGloin A, McConnon A. Parental weight (mis)perceptions: factors influencing parents' ability to correctly categorise their child's weight status. Matern Child Health J. 2012 Dec;16(9):1801-9. doi: 10.1007/s10995-011-0927-1.

Singh GK, Kogan MD, van Dyck PC. Changes in State-Specific Childhood Obesity and Overweight Prevalence in the United States From 2003 to 2007. Arch Pediatr Adolesc Med. 2010;164(7):598-607. doi:10.1001/archpediatrics.2010.84.

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Let's post BMIs for the faculty!!! too....
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Essay Writing Service August 21, 2017 11:30 AM
I would imagine that a parent would see that his or her youngster is overweight why squander the time and paper sending report cards for bmi clearly if a parent hasn't made a move at home a report card is not going to transform anything and it may be destructive to a tyke having that much concentrate on their weight we as of now have a huge number of big names fixating on their weight and setting awful cases we will be a general public of dietary issues. In the event that the state funded schools are so worried about weight they ought to be reestablishing break and offering more physical training classes.
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The dsm showing the blog post about BMI report regarding kids health, Its like complete medical check up by the senior doctors.
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It is such a great knowledge to know about school activities. You have discussed a various Pros and Cons of educational system and it will help a lot and students can aware about the bad impacts. I really like to visit here. Thanks for sharing.
0 Replies » Reply October 4, 2017 3:31 PM
Wow! This is an eternal question. My little niece has a watch and she thinks it's only a nice accessory. But it has an option of listening and GPS-detection. I think It's too much. At schools, such screening must be limited. For instance, children writing essay or exam need to be screening. And that's all-everything behind the class is a private life.
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The promote stuff is fascinating to their children participating in extracurricular activities, these activities actually bring with them many benefits to teach students this different way to utilize the pros for students Participation gives students better heath program with the chance to practice easiest way,students might be more interested in participation.
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JCD Construction October 11, 2017 1:57 AM
I have a granddaughter living in the UK. Even though this is a sensitive topic for many I think it is helpful to know. It is a great indicator of one's nutrition, exercise, and a possibility of health concerns in the near future. The US should adopt a similar policy in my opinion.
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Gems Arcade October 12, 2017 2:11 PM
Childs weight is always a tension for the parents. From the birth of the child they are worried about the weight. The BMI screening program also help parents to understand the health of their child and make necessary action related to the result.
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Gems Arcade October 12, 2017 2:12 PM
Childs weight is always a tension for the parents. From the birth of the child they are worried about the weight. The BMI screening program also help parents to understand the health of their child and make necessary action related to the result.
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the Body mass index is necessary for regular health to check up and to be aware of your current health status. In schools and academies, the regular BMI and BMR test should be conducted and their reports should also be directed to their parents for their awareness about the child's health.
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