Weighing Your Child At School...Helpful or Harmful?

With the heightened anxiety surrounding obesity, many schools have instituted mandatory weigh-ins and BMI assessments. Although school health departments have the best interest of their children in mind, they are going about things the wrong way.  As the founder of MEDA, Inc., the Multiservice Eating Disorders Association, a non-profit eating disorder treatment and prevention agency, as well as a mother of three girls.  I am very concerned with the new proposed policy regarding the mandatory Body Mass Index (BMI) screenings. Not only does BMI reporting place an inappropriate responsibility on schools, but there is also a lack of evidence that this strategy will aid in obesity prevention. Implementing widespread interventions based on non-existent or limited research findings has the potential to exacerbate severe problems related to disordered eating and poor self esteem. The mission of schools is to promote a healthy learning environment for children. Mandatory BMI reporting may, in fact, compromise a child’s learning environment. In addition, to be weighed and measured with other peers can be not only embarrassing, but degrading for a growing child. As an eating disorder specialist, I have heard countless stories over the years of clients saying that a ‘school weigh in’ was an event that marked the beginning of their eating disorder symptoms. I am also concerned as to the reaction of guardians when a BMI letter is received. Unfortunately, the direct consequence of many parents and caretakers when faced with their child’s ‘high BMI’ report will be to restrict eating and encourage dieting. Dieting and restricted eating, are associated with attention and memory deficits as well as increased anxiety. Every day the public is bombarded with conflicting information regarding healthy eating and effective strategies for weight loss daily. This information is difficult enough to navigate as a professional in the field. What about a parent who is told that his/her child now must lose weight based on a quick test done at school? Mandatory BMI reporting laws force parents to walk the fine line between encouraging healthy eating and promoting unhealthy weight loss strategies.

In addition, according to a policy statement on the Prevention of Pediatric Overweight and Obesity (2004) by the American Academy of Pediatrics, BMI has its limits as an accurate measurement of obesity.  For example, children often grow unevenly, gaining weight before growing in height. Sometimes it is at a consistent rate, following along a particular percentile curve on her/his growth chart. However, sometimes a child may veer from her usual growth pattern. In this case, a professional needs to look for reasons why,and this is up to a child’s family and pediatrician, not a school nurse or other school staff member. Some children are more muscular due to physical activity and genetic factors so, despite a lean body mass, their weight and, therefore, their BMI, will be higher and in the “obese” range.  Hence, many athletes are miscategorized as obese.  Frame size may also affect the BMI. A child can naturally have a larger body type, without having excessive fat or any health risks.   The BMI formula can also fail to recognize children who have excessive adiposity, despite the fact that it is fat tissue and not weight per se that is considered the risk factor (Dietz & Bellizi, 1999).  None of these factors are accounted for in the BMI calculation.

Furthermore, the standard interpretations of the BMI do not include an analysis and understanding of race or ethnicity. These factors need to be considered as they will provide a more thorough picture of obesity among different populations.  For example, American Indians at BMIs significantly higher than the accepted norm do not have an increased mortality or health risk (National Institutes of Health, 1998). Additionally, African-Americans with a BMI above the norm actually have a lower death rate than those who are in the normal or lower ranges (National Institutes of Health, 1998).

I think it is important for schools to take more time and evaluate what strategies can be done as a culture to promote health, vs. a quick fix mandate with little scientific evidence of success. I encourage schools to utilize its resources by mandating additional physical education classes and by allotting more funding for school social workers. These combined arenas would aid in the development of healthier children.

If you are a parent, you have a "right' to opt out of the weigh-ins. Provide a copy of your child's most recent health form with a note to your school nurse or principal saying that you do not want your child weighed. There are many ways to ensure that your child is healthy, weighing them at school is not one of them.