We all know rates of overweight and obesity among children are high in this country But is it the job of schools—or should they even have the right—to tell parents that their kids don't make the grade when it comes to their weight?
A report this week by ABC News discussed a growing trend in which schools calculate each student's Body Mass Index—a measure of weight and height—and essentially share with parents whether their children weigh too much, weigh too little, or are just right. According to the ABC News report, schools across 19 states currently provide BMI report cards to parents.
Using BMI to gauge the state of a child's weight costs little and is easy to do. And even though BMI doesn't directly measure body fat, it does correlate with it—children with high BMIs usually (but not always) have high body fat levels. Both the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) recommend using BMI to screen children between the ages of 2 and 19 for overweight, obesity, healthy weight, or underweight. And clearly, several schools are jumping on the bandwagon with the intent to reduce overweight and obesity among children.
One expert who supports the measure is David Katz, MD, Editor in Chief of Childhood Obesity journal and Founding Director of Yale University Prevention Research Center. He says, "Whether or not knowledge is power-ignorance is certainly disempowering. We can't even begin to fix what we don't know is broken. With both obesity and type 2 diabetes widespread among our children, there is something broken in our culture. Parents need to know when the threat of obesity has overtaken their children." And while Katz supports the measure, he urges caution when it comes to addressing the issue with parents. He says, "We want to inform and empower, not blame and shame! In this obesigenic environment of ours, parents are not 'to blame' for the weight gain to which kids are almost universally vulnerable. But we can all share in the responsibility to address this problem, if we are empowered to do so. That begins with knowing the problem exists."
But not everyone supports schools doling out BMI report cards. According to Jennifer Ashton, MD, ABC News Senior Medical Contributor, "Though well-intentioned I am sure, the concept of reporting kids' BMI on school report cards has the real potential to do more harm than good. By exacerbating children's already sensitive self-image, making them feel more self-conscious and opening them up to stigma and possible bullying, defining BMI as overweight without offering real help does little to reverse the childhood obesity epidemic." Ashton also points out that the BMI percentiles are dynamic in childhood, do not account for muscle mass and other physiologic issues, and are likely not the ideal way to screen for obesity. Although she urges schools should take the lead in providing healthy food options and daily physical education opportunities for kids, Ashton feels that the obesity problem is best managed by medical professionals and trained nutrition professionals like registered dietitians. She adds, "Leave the academics to the schools, the medicine to the health care providers, and keep parents as quarterbacks for the entire team."
Yoni Freedhoff, MD, an assistant professor of family medicine at the University of Ottowa, is also concerned about the impact BMI report cards can have on children and families. According to Freedhoff, "To date there simply isn't a proven, reproducible, evidence-based, response for concerned parents to implement. As a consequence I have no doubt many well intentioned parents, upon receipt of a scarlet BMI letter, will put their children on strict diets, turn their kitchens into battle grounds, lecture their kids about "personal responsibility," and suck the joy out of exercise by making it a mandatory because you need to lose weight activity. In so doing they will erode their children's self esteem, their relationships with food, further deflate their body images, and in turn increase their risk of developing eating disorders and potentially putting them on a lifelong course of yo-yo dieting." For schools to improve the health and weights of their students, Freedhoff suggests they serve healthful foods in their cafeterias, ditch vending machines, reform their nutrition curricula, bring back home economics, and make it mandatory for kids to learn to cook nourishing meals from fresh whole ingredients. He adds, "BMI report cards are simply a means for schools to pass the buck."
What's your opinion? Do you say yay or nay to a BMI report card?
Image of morbidly obese child, extreme underweight child, and average weight child on scale via Shutterstock.