Should Schools Be the "Fat" Police?

The BMI is a measure of body weight in proportion to height that provides an indicator of approximate total body fat. Though not a perfect measurement (it’s possible for a healthy, athletic 15-year-old, for example, to measure overweight if much of his weight is muscle mass), it’s a good diagnostic tool when a physician can put the numbers into context. “BMI can be extremely effective,” Murray says, pointing out that parents need to be reassured that it is merely a screening tool, “not an assessment of cosmetic appearance.”

Other parents are concerned about the framework and resources provided by schools when students take home such letters—effective intervention doesn’t end with a letter in every backpack. “For schools to just categorize the kid misses the point,” Murray says. “The next step should be the families putting this into context with their doctors. They need to be told to follow up.”

Take-home assessment letters are just a small part of interventions going on in schools across the U.S. Most schools have at least adopted a basic program of physical education for their students, and many have overhauled their school lunch programs and swapped out the stereotypical grease-soaked cafeteria pizza for healthier fare. President Barack Obama recently signed into law a measure that will raise nutrition standards in schools. School screening and intervention can be effectively used with such programs when healthcare providers are trained well and programs include follow-up with trained physicians.

Columbus City Schools, for example, in Columbus, Ohio, have mandated BMI screening as part of their Wellness Initiative campaign. “40% of our children were obese,” Murray estimates, “and 30% were showing signs of insulin resistance.” Aware that such widespread health problems would impede student learning, CCS partnered with Nationwide Children’s Hospital and called for testing on weight, BMI, hypertension and acanthosis nigricans, or a skin marker for high levels of insulin. The assessments lead to more resources, better school food choices and increased physical activity for students. Years after the program’s inception, “the environment is definitely changing,” says Murray.

And healthcare experts hope it will continue to change as schools experiment with programs to fight childhood obesity. “There have been several schools that have tried innovative programs—provision of water, fizzy beverage interventions, farm to school programs, BMI screenings, “ Krukowski adds. “However, at this point, we don’t have a definitive answer as to what is successful. Schools are likely to just be one piece of the pie.”

Over 95% of children spend around seven hours a day in school, making it a good place to educate them on healthy lifestyle choices—and health screening in schools can be part of that education. The Center for Disease Control offers ten strategies for schools wanting to promote physical activity and a healthier standard of living. “The great news,” sums up a CDC bulletin, “is that schools can help students and staff adopt healthy eating and physical activity behaviors that are the keys to preventing obesity.”