Junkfood Science: When schools grade looks

January 20, 2007

When schools grade looks

A news story from Hyannis, Massachusetts last week illustrated the upset created among parents and children when school officials measure a child and issue a fat letter. More importantly, it demonstrated the misinformation that these programs promote about children’s weight and why parents are increasingly thinking twice before allowing their children’s BMI (body mass index) to be measured.

Hyannis mom irate over weighty issue

Jasmine, a 4-foot tall, 66-pound, third-grader at Hyannis Elementary School, was sent home last week with a letter stating she was “at risk of becoming overweight.” ...

[S]imilar letters went to nearly half of the school's 295 students. Jasmine's mother, Vicki Elliott, said she is unhappy because the letters not only single out easily rattled youngsters for being “fat,” it's none of the school's business.

“Since my son was born, we've had the same pediatrician for the past 17 years. If there was a problem, he would have told me,” Elliott said. “She probably can eat healthier but that's for the doctor and me to decide, not the school nurse.”

Like it or not, however, a student's body weight is the school's business under a federal law passed last year that requires school districts across the country to develop and implement “wellness” policies.

School officials said Elliott is misunderstanding the intent of the letter which, said school nurse Stacey Shakel, is meant merely as an “educational tool.”

BMI is a formula that computes whether a person is too plump, thin or within a healthy weight range....And, just as school health officials do with vision and hearing screenings, letters go home only with the students whose screening raises a red flag....“Healthy children learn better.”

As anyone who’s suffered the humiliation of being weighed in school as a child understands, this little girl was visibly distressed being told by school officials that she was fat. Her mother was so upset, she shared with the local newspaper the actual letter she received from the school — the one described as an “educational tool” for parents. A downloadable pdf is here. Every assertion it made has been soundly disproven in quality research and counters that of objective experts. Here are the myths in her fat letter:

Myth: BMI is an easy way to determine if your child is carrying around too much fat.

“BMI is a measure of weight for height, calculated as weight in kilograms divided by the square of height in meters and not on body fatness per se,” according to Katherine Flegal and colleagues at the National Center for Health Statistics, Centers for Disease Control and Prevention. BMI is unable to differentiate fat from lean body mass because it is simply a mathematical computation of height and weight. It is inaccurate in women, babies, children and the elderly, when fat tissue normally constitutes a greater portion of total body mass. “The available data do not show that the BMI adequately reflects body fat mass in children and adolescents with a higher degree of adiposity,” said researchers at the University of Vienna, Austria, in a review of the evidence in the Journal of Pediatrics.

In children, height also has a disproportionately greater affect on the BMI equation, giving taller or shorter children higher BMIs unrelated to their fat. Height, however, is largely determined by our genes; although the phenomenon of generations growing taller than their parents has been well-documented as a positive indication of improved prosperity, better availability of food, less childhood disease, and good health. What is popularly unrecognized is that our body weight is even more genetically-determined than our height. As of October 2005, the human obesity gene map had identified 253 quantitative trait loci for obesity-related phenotypes. [More on that later.]

Myth: A high BMI puts your child at a great risk for chronic diseases...

“There are many different BMI references used to define childhood overweight or obesity...BMI is a screening tool [for general public health surveillance], not a diagnostic tool. Children with a BMI over these cut points do not necessarily have clinical complications or health risks,” the CDC experts with Dr. Flegal stated.

After a comprehensive review of 40 years of evidence on childhood obesity screening and interventions, the U.S. Preventive Services Task Force recently found no quality evidence to support that childhood “overweight” or “obesity” is related to health outcomes, as was reviewed here. Gregory Kline, Ph.D., MPH, a research associate and adjunct professor in the School of Public Health and Health Sciences at the University of Massachusetts, Amherst, explained in a recent Healthy Weight Journal, that even in adults, BMI is a questionable and unwarranted measure with a high potential for misclassification that only serves to “fuel our cultural obsession with body weight and dieting.” As he explained, the evidence shows that BMI fails to predict fitness, blood pressure, body composition or health risk.

Myth: Any results out of the normal range needs to be discussed with your family Physician.

Myth: Normal = >5% to <85%

The adorable little girl in this news story is the spitting image of Shirley Temple. Her fat letter states she is short and at the 23rd percentile for her height and at the 75th percentile for her weight. In the past, she would have been seen by medical professionals as falling nicely on the child growth curve and if she was growing and keeping on the curve at a range normal for her, there would be no concern. But today, her BMI is calculated (her BMI was 19) and compared to other children. At the 89.97th percentile she is somehow deemed at risk of disease simply because she falls nearer the top of the curve — a belief unsupported by any evidence.

Health is not determined by a child’s weight or BMI, nor is there such a thing as one “healthy weight” for all children. The belief that to be “normal” all children must be the same height, body shape, and size, at exactly the same age no less, disregards the fact that there has always been diversity among people and children, and always will be, and that children all grow at different rates and in different ways.

Defining normal and “overweight” in children is complicated and currently the topic of international debate. How has it been defined and how do the definitions differ, how and why have the definitions changed, and how do children normally grow? Stay tuned for “New Age Numerology: Why kids are little Tyrannosaurs rexes.”

In that local newspaper article, the school principal was quoted as saying they couldn’t cure the world of all its ills, but that with their “wellness program” at least they won’t be “part of the problem.” As if fat children are “unwell” scourges on the world that must be dealt with. It is also disconcerting to realize that educational professionals today still believe that a child who is fat cannot learn as well as others. A 1994 National Education Association position paper reported that “for fat students, the school experience is one of ongoing prejudice, unnoticed discrimination and almost constant harassment.” Such prejudices hurt children academically the NEA paper reported, noting studies finding overweight students were less likely to get into college, even though they score high on standardized tests and are academically motivated.

Parents may have been left with another misimpression from this news story: that whether they like it or not, it’s the school’s business under a federal law to screen their children. Parents needn’t be intimidated by such statements. They do have a choice and can insist that their child not be included. Growing numbers of parents are following the example of parents in England who are refusing to allow their children to be weighed by school officials, as was written about here. Although rarely mentioned, even in Arkansas with its mandated BMI screening, their recent report indicated that about 10% of the school children weren’t measured, with parental refusal to participate a key reason for the missing data. The growing evidence of harm to young people, especially girls, from today’s focus on weight, being fit and eating right is being recognized by parents and healthcare professionals. Some of those concerns were discussed here, here, here, here, here, here and here.

About those school initiatives, one astute parent shared this on an internet forum:

I filled out the kindergarten registration forms for Patrick [name changed]. On the medical history form, I was very vague, even writing in one section, “These details have no bearing on Patrick's schooling.” I wrote that the “school is expressly forbidden to monitor Patrick's health through clinical observation, weighing, measuring height, blood pressure, or pulse, or any other non-life saving method.” Hubby thought I was being a little paranoid, but when I explained what was going on in the war on fat and what I see as a teacher, he understood my perspective. It's downright scary, and I'm not willing to take any chances.

© 2007 Sandy Szwarc

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