By Carol Chmelynski
3/15/05 -- As school and health officials become increasing concerned with tackling the obesity epidemic, a growing number are turning to the idea of reporting children’s body mass index to parents. A handful of states have even flirted with the idea of adding the BMI on report cards.
In 2003, Arkansas -- where 38 percent of children are overweight or at risk of becoming overweight -- became the first state in the nation to make school weigh-ins a state law and mandated that parents be sent an annual report stating their child’s BMI. The reports also explain what the BMI means, the health effects associated with obesity, and ways to combat the problem.
Similar proposals have surfaced in Georgia, Texas, and other states.
BMI is a measure of body fat based on height and weight. It is calculated by dividing weight (in kilograms) by height (in meters) squared. For children, appropriate BMI ranges change by age and gender.
These ranges are plotted on a standard growth curve to obtain a percentile ranking for each child. Children whose BMI is between the 85th and 94th percentile are considered to be at risk of being overweight. Children whose BMI is above the 95th percentile are considered overweight. (The term obese is not generally used for children.)
In Arkansas, the original law called for schools to include BMI information on school report cards, but in a special session in 2004, legislators modified the law to require that the information be mailed to parents separately in letters.
The Arkansas Center for Health Improvement -- a health policy research center sponsored by the Arkansas Department of Health, the University of Arkansas for Medical Sciences, and Arkansas Blue Cross Blue Shield -- coordinates and funds the effort to calculate the BMI of the state’s 450,000 students.
Joy Rochenbach, director of the center’s BMI initiative, says schools send students’ height and weight information, and the center calculates the BMI and sends reports to parents.
In Georgia, state Rep. Stephanie Stuckey Benfield introduced a bill last month to require schools to calculate students’ BMI and list it on report cards. But she dropped plans to pursue the measure after receiving angry e-mails and phone calls.
The most legitimate complaints concerned potential harm to students’ self-esteem, Benfield says. “That was certainly never my intent, but I’m sensitive to that.” She plans to continue to work on childhood obesity in Georgia, where an estimated 37 percent of the state’s schoolchildren are overweight.
Previously, Georgia legislators have tried and failed to ban soft drink machines in schools, require recess, and add physical education classes.
In Texas, state Sen. Leticia Van de Putte filed a bill in January that would require schools to measure children’s BMI and send the information home to parents. She considered but rejected the idea of having BMI added to report cards.
In recent years, Texas lawmakers restricted student access to vending machines, banned deep-frying of food and candy sales in schools, and made daily physical education mandatory for elementary students.
Legislation also has been introduced in Connecticut, Iowa, New Jersey, New York, Oregon, and Tennessee to require or encourage schools to measure students’ BMI, says Amy Winterfeld, spokesperson for the National Conference of State Legislatures
Some school administrators balk at the extra burden and expense of mandated health procedures. For example, the cost of postage alone to send separate first-class letters to the homes of all Arkansas students is $166,500.
The entire Arkansas program cost just over $1 million the first year, says Rochenbach, including state funds and grants from private sources. The program will cost only about a third of that next year.
There also have been complaints that BMI reports are intrusive, embarrassing to students, and a waste of time. And there is no evidence that BMI reports are effective.
“There is no consensus in the health community on the value of BMI testing,” says Brenda Greene, director of school health programs at NSBA. “Data is good to have, but BMI testing is only one part of the solution.”
“If schools have that but don’t change their food services, nutrition education, and physical education opportunities, and the environment in families and the whole community doesn’t change,” she says, “then what’s the point of this data?”
But others say school is the most logical place to begin to address the obesity crisis because schools already test vision and hearing and a document from school has credibility. Perhaps most compelling is the argument that it is in schools’ best interest to have healthy children.
“Students with poor nutrition, inactivity, and weight problems have a higher prevalence of physical conditions and psychological/ social problems that are frequent causes of absenteeism,” says The Learning Connection, a report by Action for Healthy Kids, a partnership of more than 40 national organizations and government agencies, including NSBA.
Sixteen percent of school aged children, or nine million, are overweight, and that figure has risen threefold since 1980, the report states. Between 70 and 80 percent of overweight children and adolescents remain overweight or become obese adults.
Being overweight can contribute to elevated cholesterol and blood pressure, which are risk factors for heart disease, gallbladder disease, asthma, sleep apnea, and diabetes.
The Centers for Disease Control and Prevention estimates that if current obesity trends continue, one-third of all children -- and one half of African American and Hispanic children -- born in 2000 will develop diabetes.
Rochenbach says, when Arkansas began BMI testing, “We were not quite aware of all the ramifications. It created a dialogue around the state -- both good and bad.”
“For the first time, we have data that says we are heading toward some very bad health problems for the children of our state,” she says. “Already we have schools that are beginning to implement policy and program changes, and we will have something that we can bring back to them over time to tell them if their changes are working.” And she’s heard from parents, who say they are eating healthier and exercising together.