Using the Public School System to identify obese children

Issue for discussion- Using public schools to calculate BMI and determine the obesity level of students.

Method:  Starting in the state of Arkansas in 2003, schools weighed, measured and charted student’s BMI ratio. They sent this information home with the students along with a guide on nutritional advice. In addition the schools removed sweet drinks and snack sales.

BMI- a scale to chart the ratio of weight to height across age ranges for children. Children at or above 85^th percentile are considered overweight while those charted over the 95^th percentile are considered obese and correlates can be made for related health risks including type2 diabetes and later development of cardiac disease.

Pros- This creates a uniform measurement for doctors to evaluate where a child’s weight and size correlate at their visit. BMI can be a tool for a comprehensive program to identify at risk children in the public.

Cons- Taken as a single factor in a setting such as the school could call attention to the problem but end up only serving to label child at the expense of privacy.

Results to date:  More awareness of the widespread nature of obesity and the ranges of overweight children have been established. Only anecdotal evidence of parents using the information sent home by these schools to improve weight related health issues.

Is it a good idea to use schools to diagnose children with higher than average BMI?

The Pediatrician’s perspective.

                A funny thing happened to me on the way to the scale; I grew up. Once we become adults we never talk about our weight.  As a child size is a fun innocent part of the conversation. How much did you grow? How big are you? Naïve comparisons are everywhere. We all took turns standing back to back to see who was taller. Numbers were just numbers. We knew who was bigger, smaller, and out of shape. There was never any stigma attached to any number or size. But as we got older new meaning was attached to the numbers. We no longer enjoy the comparisons. Just try asking anyone over the age of 25 their weight. For children today however, the conversation regarding the numbers associated with their weight and size should still be reserved for the doctor’s office.  The Pediatrician charts this information about your child during a physical. Then uses these results in conjunction with information on your child’s body type, your family’s nutritional habits, your child’s level of activity and puts it all together for a discussion about health. Advice is given as part of a personal consultation about appropriate changes that can be made.

                Doctors, nurses, and dieticians have been working with families to encourage lifestyle changes and improve nutrition and fitness for some time now. Recently the Academy of Pediatrics adopted the BMI scale as a useful tool in evaluating and discussing health, weight, and nutrition of children. BMI is a height for weight scale.  Creation of a measurement to evaluate level of obesity was necessitated by the increase in health related issues associated with childhood obesity. If your child is above the 95^th percentile on the BMI scale they are considered obese and at a much higher risk for developing  child hood Diabetes Type 2 and High Blood pressure, as well as being susceptible to early development of heart disease . The evolution of the BMI has helped doctors and patients gain a clearer reference point for the discussion of obesity and its known health risks. It has certain built in drawbacks such as muscular and athletic children having a higher BMI but not the associated obesity.  Everyone is searching for a plan and a method to stem this rise in childhood obesity. In the community of physicians, health care workers, dieticians, we are acutely aware that any approach needs to be multifaceted, comprehensive, consistent, and involve everyone including the patient, the family, and the community.

                But taken out of context of the physical exam and discussion with your family doctor the BMI can have negative implications. By labeling children in school you are setting up another grading system that is not related to education.  Once the media, the school, and especially other kids, get a hold of the numbers, a stigma will certainly be attached to anyone appearing obese and having a higher than average BMI. Diagnosis is not the same as education and real help. Negative connotations become attached to the children and their number rather than a health status or fitness level. There is no one size fits all approach to treating childhood obesity .In my experience , just bringing up the topic of weight without  sensitivity and a skilled plan, more often than not, makes matters worse, and children whom are already sensitized to the subject, shut down and will not discuss the problem further.  School may be the easiest forum to address these issues but it is not the best.  School should be a place of learning in a safe comfortable environment. By evaluating BMI’s in school you are now institutionally sanctioning a policy to single children out for what they look like not what they are capable of in the classroom.

                We need a realistic plan to make any meaningful change. In the hands of an experienced practitioner, BMI can aide in guiding the family and the child to effectively make health altering changes. Designing a series of programs to improve fitness for everyone should be our goal. What is needed is follow up, family counseling, and a team based weight loss program.  All factors have to be taken into consideration in developing the appropriate intervention. If we want to get long lasting substantial changes,we need to address the obesity issue with comprehensive programs not stop gap measures.

Warren Krantz MD., FAAP.