Height and weight screenings in public schools have sparked controversy in recent years since many schools began sending "report cards" that notify parents if their child is overweight or obese. But such reports are necessary in the fight against childhood obesity, according to a new paper from the American Academy of Pediatrics.
The data collection is nothing new. Nearly a quarter of all states require schools to measure children's height and weight, and the majority of those states also send letters home. But some opponents argue the measurements could lead to negative consequences, and are inaccurate because they could miscategorize more muscular and athletic children.
If a child has a high body mass index (based on a height-to-weight ratio) and is deemed "overweight" or "obese," the school sends a confidential report to the child's parents, encouraging them to discuss the child's weight status with his or her doctor.
Although some children with a "higher lean body mass" could fall into overweight categories, that misclassification affects only a small percentage of children, highlighting the fact that BMI values should be used for screening and not diagnosis, the report says. The Centers for Disease Control and Prevention and the American Academy of Pediatrics recommend using BMI values to screen for obesity in children.
Naim Alkhouri, a pediatrician at Cleveland Clinic Children's, told U.S. News that although BMI measurements may not be the most accurate in all cases, it is the most practical way to identify obesity and provides a good starting point for families and doctors.
"Some kids can have a high BMI and be metabolically healthy," Alkhouri says. "But there's no way to know unless you receive an assessment."
Alkhouri says the measurements should not be seen as a judgment, but rather as a "wake-up call" for parents and health care providers that can help determine if the excess bodyweight is affecting other aspects of their health.
"Parents should look at it and put it in the right context. It's a good idea to at least identify the problem early on because small changes will go a long way," Alkhouri says. "Not everyone may need a significant intervention, but you can identify those at risk for metabolic problems."
In Massachusetts, angry parents have called the report cards "fat letters," arguing that collecting the data is a governmental overreach into a private issue that should be handled within a family. Legislators are considering a bill that would ban the state's Department of Public Health from collecting any height or weight data on public school children.
But some national health organizations, such as the Institute of Medicine and the Centers for Disease Control and Prevention, have said it is necessary to run such BMI-measurement programs in schools in order to fight the obesity epidemic. The CDC estimates that obesity has more than doubled in children during the past 30 years and reports that in 2010, more than one-third of children were overweight or obese.
"The growing number of children and adolescents seen daily in our clinics with weight management issues, decreased physical activity, and increasing screen time is alarming," writes the paper's author, Michael Flaherty, a physician at the Baystate Medical Center in Springfield, Mass. "Obesity is an epidemic in our country, and one that is compromising the health and life expectancy of our children."
Flaherty argues in the paper that although BMI-measurement programs are "fraught with social and political concerns," public schools have implemented other public health programs that have proven to be successful, such as entrance vaccinations, dental examinations and vision and hearing screenings.
"BMI screening letters are an additional awareness tool to promote conversations about healthy eating habits, exercise, and weight in the safety and confidential environment of the child's home," Flaherty writes.
But some still say the data collection ostracizes children and could bring the potential for an increase in bullying and the number of children with eating disorders.
However, in Arkansas, a state where the screenings have been most studied, surveys of parents, children and school officials do not show negative consequences associated with the program over four years. In fact, the surveys found that more parents began signing their children up for sports or exercise classes and showed improvement in family diets and nutrition.
"No parent would be proud to receive a letter stating their child is in the overweight or obese category" but acknowledgement that there could be a problem helps families move toward a change sooner, Flaherty writes. "It is time to put aside this pride for the future of our children's health."