This text was initially printed by Undark Journal.
Amongst Lexie Manion’s reminiscences of her junior yr of highschool in New Jersey was the expertise of being commonly hassled by a faculty nurse who was making an attempt to weigh her.
The nurse, Manion recalled, was making an attempt to get Manion’s weight on file—a standard follow at faculties throughout the US, which intention to make use of the info to enhance pupil well being. However for Manion, who had an consuming dysfunction, the expertise was deeply distressing. The considered getting on a scale at school—of somebody apart from her physician dealing with this delicate measurement—terrified Manion. It additionally triggered her consuming dysfunction: She started to limit her meals consumption extra intensely to drop a few pounds earlier than the varsity nurse put her on a scale.
“I used to be apprehensive about her realizing my weight, and I used to be apprehensive the entire college would by some means know the quantity if she weighed me,” Manion, now 29, wrote in an e-mail to Undark. “I grew to become very anxious and would keep away from the dimensions and her gaze each time she inquired.”
The coverage at Manion’s college was a part of a nationwide effort to fight childhood weight problems by gathering—and sometimes sharing—information on college students’ weight. Beginning in 2003, one research discovered, 29 states enacted insurance policies encouraging or requiring college districts to weigh college students, or to go additional and calculate their body-mass index, or BMI: a standard instrument for categorizing folks primarily based on their weight and top. By the coverage’s peak extent, within the 2010s, tens of millions of scholars every year had been receiving so-called “BMI report playing cards” within the mail—and a few college students even noticed their weight standing seem on their precise report playing cards, alongside their grades. Coverage makers hoped that by telling college students and their household a few youngster’s weight class, the reviews would immediate them to make more healthy selections and drop a few pounds, decreasing childhood weight problems one pupil at a time.
However even because the follow was changing into extra widespread, analysis was already suggesting that BMI screenings haven’t any influence on college students’ weight and might even trigger hurt. As we speak, many consultants say, the proof is evident that faculty BMI screenings do little to enhance pupil well being. Analysis has additionally linked the coverage to elevated weight-based bullying and body-image dissatisfaction, which, as in Manion’s expertise, can set off or worsen consuming problems. In response, some states, together with California, have stopped requiring screenings.
However, BMI screening or comparable insurance policies that mandate or encourage weight-tracking stay on the books in no less than 16 states, together with Tennessee, West Virginia, Arkansas, and New York, in response to Undark’s evaluate of state legislative codes.
“To focus efforts on simply measuring the growing waistline of America is a Band-Assist,” says Kristine Madsen, a pediatrician and a public-health diet researcher at UC Berkeley, who performed one of many largest research of college BMI screenings up to now. “It doesn’t even contact the underlying downside, and it’s ineffective.”
Arkansas was the first state within the nation to mandate screening and reporting, again in 2003. Then, in 2005, the Institute of Drugs on the Nationwide Academy of Sciences launched a 434-page report, “Stopping Childhood Weight problems: Well being within the Stability,” that urged extra states to undertake the follow. “It is vital for fogeys to have details about their youngster’s BMI and different weight-status and bodily health measures, simply as they want details about different well being or educational issues,” the NAS group wrote.
The group was responding to what it described as a childhood-obesity epidemic. On the time, about one-third of U.S. kids had been classed as obese, overweight, or severely overweight. Childhood weight problems is linked to a spread of poor well being outcomes, together with hypertension, bronchial asthma, and coronary heart illness.
Extra states moved to implement BMI screening. By 2010, simply 5 years after the NAS’s suggestion was printed, 29 states had been extensively conducting some type of physique evaluation on their college students, in response to a tutorial survey of state schooling departments.
These insurance policies sometimes provided little steering on how the weigh-ins needs to be performed. In keeping with one research, about half of screenings had been achieved throughout gymnasium class, usually in entrance of different college students. The gymnasium trainer or college nurse would measure every pupil’s top and weight and submit them to the varsity, which, in lots of instances, would move the info alongside to state well being authorities for population-level monitoring.
Baked into that mannequin from the beginning, some consultants say, had been issues. Foremost amongst them was, in lots of insurance policies, the reliance on BMI.
The 1832 paper that first proposed the metric, and the 1972 research that sparked its trendy utilization, concerned solely males and weren’t consultant of the ethnic and racial variety of the US. BMI additionally doesn’t take into account components akin to muscle mass. “This was supposed to explain giant teams of individuals; it was not supposed to be a person litmus check for well being,” says Leah Graves, a registered dietitian who focuses on treating consuming problems. Graves and others query whether or not BMI gives households helpful details about college students’ total well being.
The varsity insurance policies quickly bumped into one other downside: There wasn’t a lot proof that they labored.
Not lengthy after the NAS suggestion was launched, scientists started publishing research on college weigh-ins. In 2009, as an example, two pediatrics consultants printed a evaluate of the present analysis, discovering that there was no influence on college students’ weight. Dad and mom, they wrote, didn’t appear to be studying a lot from BMI report playing cards, and there didn’t appear to be any improve in wholesome behaviors at house.
In 2014, Madsen, the UC Berkeley researcher, and a number of other of her colleagues launched a randomized medical trial. The researchers took almost 29,000 college students in California public elementary and center faculties and break up them into three teams. One group didn’t get screened in any respect. The second was screened, however contributors by no means discovered the outcomes. A 3rd group acquired screenings, and the contributors’ caregivers had been despatched BMI report playing cards. The researchers adopted the group from 2014 to 2017 to trace adjustments in weight and opposed outcomes.
The crew’s outcomes, printed in 2021, confirmed that neither screening nor reporting had an influence on weight change over time. Moreover, the 2 teams that had been screened reported extra weight dissatisfaction and peer weight speak than the group that wasn’t screened.
Madsen’s analysis has additionally discovered that the expertise could be upsetting for college students. In a single 2022 survey of greater than 11,000 college students in California, her crew discovered that 49 % had been weighed by gymnasium academics, versus simply 28 % who had been weighed by college nurses; the scholars had been extra more likely to really feel much less comfy being weighed by a trainer than by a nurse, and had been extra more likely to really feel that they lacked privateness whereas being weighed.
Different analysis has documented the potential for long-term harms from that have. The unfavorable results of adolescents perceiving themselves as obese can final for years into maturity, lengthy after the screenings have ended, in response to one 2023 survey. Though the research didn’t particularly ask about BMI screening, it linked a perceived obese standing to elevated self-starvation, bingeing, purging, and overexercising, in addition to the event of consuming problems.
Not each skilled is satisfied that BMI screening for the sake of information assortment is essentially dangerous. Researchers and faculty professionals say that it’s the best way these screenings are performed that may trigger issues. Because of this, some skilled organizations and authorities companies have issued tips supposed to enhance the expertise.
The Facilities for Illness Management and Prevention, which has no formal place on BMI screenings, has a public set of 10 safeguards faculties can implement to handle considerations about screenings. The checklist consists of suggestions akin to measuring college students’ top and weight in a personal place, having nurses as a substitute of academics take the measurements, and asking for parental consent earlier than measuring college students.
However a 2019 CDC survey of greater than 200 faculties discovered that these safeguards had not been extensively applied. Solely 3 % of the faculties had no less than 4 of the safeguards in place, and 19 % had no safeguards in any respect.
“These safeguards got here out sort of pragmatically, recognizing that there’s not sufficient proof at that time to say whether or not or not BMI-measuring faculties is definitively dangerous or useful, however faculties are doing it,” says the CDC school-health researcher Sarah Sliwa. “So, in the event that they’re doing it, what are some steps they will take to attempt to reduce these harms and improve the chance that information are collected in a method that’s clear and helpful?”
As the varsity workers members who’re most frequently requested to weigh college students, bodily educators have additionally developed requirements relating to physique measurement in faculties.
The Society of Well being and Bodily Educators, or SHAPE America, an expert group, has a formal assertion on health testing—which might embody BMI screenings, amongst different assessments—that states that the group finds the testing helpful solely when it’s built-in appropriately into the curriculum, and when the outcomes aren’t used to grade college students. SHAPE America recommends that faculties first educate college students in regards to the health testing and why it’s achieved, in addition to put together them for the method and assist them set customized objectives primarily based on the end result of the testing. However the group doesn’t have an official suggestion on whether or not to conduct BMI screenings.
“There’s a whole lot of physique stigma, and we now have different information factors that we are able to use with out having college students really feel that they’re being judged,” says Cara Grant, the president of SHAPE America.
The American Faculty Well being Affiliation, a company of college nurses and different well being professionals, additionally doesn’t have an official place on BMI screenings, says Kayce Solari Williams, ASHA’s former president.
With the intention to successfully notice the CDC tips, Sliwa says, faculties must implement safeguards or finest practices. Due to an absence of the funding and staffing, although, they usually fail to take action.
Some states have responded to the analysis displaying harms from BMI screenings. In 2013, Massachusetts struck BMI reporting from its faculties however maintained a screening requirement. Illinois made BMI screening non-compulsory for its college students in 2015. California eradicated screening and reporting necessities from its annual health testing. In New York, faculties nonetheless display screen for BMI, however they’re now not required to ship BMI report playing cards house.
Different states haven’t made adjustments. In Georgia, screening and reporting are required by regulation. In West Virginia, which has a number of the highest ranges of childhood weight problems within the nation, state regulation requires the gathering of BMI information to be reported to the Division of Training, the governor, the State Board of Training, the Wholesome Life Coalition, and the Legislative Oversight Fee on Well being and Human Assets Accountability.
In New Jersey, the place Manion attended highschool, BMI screening is just not mandated, but it surely’s allowed on a district-by-district foundation. The state does require weight measurement, nonetheless.
“What’s the worth?” asks Madsen, the UC Berkeley researcher. She questions whether or not the insurance policies are use of college assets. “Your complete level of sending them house is definitely to help households in creating more healthy life,” she says. “However they’re not.”
Amanda Salazar is a contract journalist from Brooklyn, New York.
