BMI Measurement in Schools
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
SUPPLEMENT ARTICLE
BMI Measurement in Schools
CONTRIBUTORS: Allison J. Nihiser, MPH,a Sarah M. Lee,
PhD,a Howell Wechsler, EdD,a Mary McKenna, PhD,b Erica
Odom, MPH,a Chris Reinold, PhD, RD,c Diane Thompson,
abstract
MPH, RD,c and Larry Grummer-Strawn, PhDc
BACKGROUND AND OBJECTIVE: School-based BMI measurement has
attracted attention across the nation as a potential approach to ad-
Divisions of aAdolescent and School Health and cNutrition,
Physical Activity, and Obesity, Centers for Disease Control and dress obesity among youth. However, little is known about its impact or
Prevention, Atlanta, Georgia; and bDepartment of Kinesiology, effectiveness in changing obesity rates or related physical activity and
University of New Brunswick, Fredericton, New Brunswick, dietary behaviors that influence obesity. This article describes current
Canada
BMI-measurement programs and practices, research, and expert rec-
KEY WORDS
body mass index, obesity, growth and development, school
ommendations and provides guidance on implementing such an
health services, child, adolescent approach.
ABBREVIATIONS METHODS: An extensive search for scientific articles, position state-
CDC—Centers for Disease Control and Prevention ments, and current state legislation related to BMI-measurement pro-
IOM—Institute of Medicine
AAP—American Academy of Pediatrics grams was conducted. A literature and policy review was written and
This article is based on a longer article first published in the
presented to a panel of experts. This panel, comprising experts in
Journal of School Health (Nihiser AJ, Lee SM, Wechsler H, et al. public health, education, school counseling, school medical care, and
Body mass index measurement in schools. J Sch Health. 2007; parenting, reviewed and provided expertise on this article.
77[10]:651– 671; quiz 722–724).
RESULTS: School-based BMI-measurement programs are conducted
The findings and conclusions in this report are those of the
authors and do not necessarily represent the official position of for surveillance or screening purposes. Thirteen states are implement-
the Centers for Disease Control and Prevention. ing school-based BMI-measurement programs as required by legisla-
www.pediatrics.org/cgi/doi/10.1542/peds.2008-3586L tion. Few studies exist that assess the utility of these programs in
doi:10.1542/peds.2008-3586L preventing increases in obesity or the effects these programs may
Accepted for publication Apr 29, 2009 have on weight-related knowledge, attitudes, and behaviors of youth
Address correspondence to Allison J. Nihiser, MPH, Centers for
and their families. Typically, expert organizations support school-
Disease Control and Prevention, Division of Adolescent and based BMI surveillance; however, controversy exists over screening.
School Health, 4770 Buford Hwy NE, Mailstop K-12, Atlanta, GA BMI screening does not currently meet all of the American Academy of
30341. E-mail: anihiser@cdc.gov
Pediatrics’ criteria for determining whether screening for specific
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). health conditions should be implemented in schools.
Copyright © 2009 by the American Academy of Pediatrics
CONCLUSION: Schools initiating BMI-measurement programs should
FINANCIAL DISCLOSURE: The authors have indicated they have
no financial relationships relevant to this article to disclose.
adhere to safeguards to minimize potential harms and maximize ben-
efits, establish a safe and supportive environment for students of all
body sizes, and implement science-based strategies to promote phys-
ical activity and healthy eating. Pediatrics 2009;124:S89–S97
PEDIATRICS Volume 124, Supplement 1, September 2009 S89
Downloaded from pediatrics.aappublications.org by guest on October 21, 2015Obesity among youth has become 1 of tion, school counseling, school and/or subpopulations in a school,
the most critical public health prob- medical care, and parenting. This arti- school district, state, or nation;
lems in the United States. Schools can cle presents an overview of the CDC’s ● identify demographic or geographic
play an important role in preventing guidance on this topic; it describes the subgroups at greatest risk of obe-
obesity because ⬎95% of young peo- purposes of BMI-measurement pro- sity to target prevention and treat-
ple are enrolled in schools,1 and grams, examines current practices, ment programs;
schools have historically promoted reviews existing research, summa-
● create awareness among school
physical activity and healthy eating. Re- rizes expert recommendations, identi-
and health personnel, community
search has shown that well-designed, fies research gaps, and provides guid-
members, and policy makers of the
well-implemented school-based pro- ance and safeguards for implementing
extent of obesity among the youth
grams can effectively promote these BMI-measurement programs.
they serve;
behaviors,2–4 and the Centers for Dis-
ease Control and Prevention (CDC) has PURPOSES OF COLLECTING BMI ● provide an impetus to improve poli-
identified strategies that schools can DATA cies, practices, and services to pre-
use to prevent obesity.5 vent and treat obesity among youth;
BMI is the ratio of an individual’s
Measuring the BMI of students in weight to height squared (kg/m2) and ● monitor the effects of school-based
schools is an approach to addressing is used to estimate a person’s risk of physical activity and nutrition pro-
obesity that is attracting attention weight-related health problems. It is grams and policies; and
across the nation from researchers, often used to assess weight status, be- ● monitor progress toward achieving
school officials, legislators, and the cause it is relatively easy to measure health objectives (eg, US Healthy
media.6–12 Because little research has and correlates with body fat.19–23 After People 2010 objectives) related to
been conducted on the impact of this BMI is calculated for a child or adoles- childhood obesity.
approach, it is not included in the cent, it is plotted by age on a gender-
CDC’s recommended strategies. How- specific growth chart (see www.cdc. Screening
ever, some states, cities, and commu- gov/growthcharts for the CDC’s BMI- BMI-screening programs in schools
nities have established school-based for-age growth charts for girls and are designed to assess the weight sta-
BMI-measurement programs in recent boys aged 2–20 years). BMI measure- tus of individual students to detect
years, and many others are consider- ment in schools may be conducted for those who are at risk for weight-
ing the merits of initiating such pro- surveillance and screening purposes. related health problems. Screening
grams. programs provide parents with per-
In 2005, the Institute of Medicine (IOM) Surveillance sonalized health information about
called on the federal government to de- Surveillance refers to the systematic their child. Screening results are sent
velop guidance for BMI-measurement collection, analysis, and interpretation to parents and typically include the
programs in schools.13 The CDC con- of data from a census or representa- child’s BMI-for-age percentile; an ex-
ducted an extensive search for scientific tive sample (ie, a sample that has been planation of the results; recommended
studies that evaluated school-based scientifically selected to represent a follow-up actions, if any; and tips on
BMI-measurement programs; col- specified population). Typically, the healthy eating, physical activity, and
lected related position statements healthy weight management.9,24–27 Re-
data are collected anonymously. The
published by expert organizations sults from screening programs also
purpose of BMI surveillance in schools
from public health, medicine, and edu- can be used to develop reports similar
is to identify the percentages of stu-
cation; and reviewed sources to iden- to those developed by surveillance
dents in the population who are obese,
tify state legislation on these pro- programs.28,29
overweight, normal weight, and under-
grams including policy-tracking
weight; surveillance does not involve Goals of BMI-screening programs in
services, state general assembly legis-
informing parents of their child’s schools include
lative databases, and staff in state ed-
weight status. ● preventing and reducing obesity in
ucation or health departments.14–18 An
expert panel, convened by the CDC in School-based BMI-surveillance data a population;
2005, provided input on an earlier ver- can be used to ● correcting misperceptions of par-
sion of this article. The panel com- ● describe trends in weight status ents and children about the chil-
prised experts in public health, educa- over time among populations dren’s weight;
S90 NIHISER et al
Downloaded from pediatrics.aappublications.org by guest on October 21, 2015SUPPLEMENT ARTICLE
● motivating parents and their chil- nia Code §23.21, 2004). In 1995, Califor- measurement programs in preventing
dren to make healthy and safe life- nia initiated statewide surveillance of increases in obesity among youth. A
style changes; student physical fitness levels, which few jurisdictions have monitored the
● motivating parents to take children includes BMI assessments and tests of prevalence of obesity through child-
at risk to medical care providers for aerobic capacity, flexibility, and mus- hood obesity interventions that in-
further evaluation and, if needed, cle strength.32 In Illinois, the Depart- clude BMI screening; however, the
guidance and treatment; and ment of Public Health is in the process independent effects of the BMI-
of developing a child health examina- screening program on obesity are not
● increasing awareness of school ad-
tion surveillance system. This system clear.9,28,32 Arkansas is evaluating the im-
ministrators and school staff of the
will aggregate BMI and possibly other pact of its multicomponent, childhood
importance of addressing obesity.
health information collected during obesity program that includes a state-
Schools sometimes include BMI re- students’ school physical examina- wide BMI-screening and -surveillance
sults with results from other health tions by their medical care providers program. The percentage of Arkansas
screening examinations, such as vi- (Illinois 93rd General Assembly, Public students classified as obese was 20.8%
sion or hearing tests, in reports to Act 93– 0966, SB 2940, 2004). in 2003–2004, the first year of implemen-
parents.30
tation, 20.7% in 2004 –2005, 20.4% in
CONCERNS
CURRENT PRACTICES 2005–2006 and 20.4% in 2006 –2007, and
A number of concerns have been ex- 20.5% in 2007–2008.38
The CDC’s 2006 school health policies pressed about school-based BMI-
and programs study found that 22% of A small body of research has ad-
screening programs, including that
states required schools or school dis- dressed issues related to school-
they might intensify the stigmatization
tricts to measure or assess students’ based BMI-measurement programs in-
already experienced by many obese
height and weight or body mass, and cluding perceptions of weight status,
youth, increase dissatisfaction with
73% of those states required parent parental perceptions of BMI-screening
body image, and intensify pressures to
notification of the results.31 Nation- programs, and student and parental
engage in harmful weight-loss prac-
wide, ⬎40% of schools reported that responses to the results. Additional re-
tices that could lead to eating disor-
they measure the height and weight or search is needed on possible psycho-
ders.6–8,10–12,33–36 Another concern is
body mass of their students.31 The social effects of BMI screening on
that parents might respond inappro-
study did not determine how fre- students.
priately to BMI reports by, for example,
quently students are assessed, placing their child on a restrictive and
whether BMIs are calculated from the PERCEPTIONS OF WEIGHT STATUS
potentially harmful diet without seek-
height and weight data, or the purpose ing medical advice.7,8,12,25 Other con- Several studies have found that par-
of the data collections. cerns are that these programs might ents and children commonly misclas-
At least 13 states have legislation and be ineffective, waste scarce health- sify children’s weight status.29,39–44 A
are implementing school-based BMI- promotion resources, and distract at- study of 742 mothers of adolescents
measurement programs (Arkansas, tention from other school-based found that 35% underestimated their
California, Delaware, Florida, Illinois, obesity-prevention activities such as child’s weight status and 5% overesti-
Louisiana, New York, Pennsylvania, improvements to the school physical mated it; 86% of mothers whose child
South Carolina, Tennessee, Texas, Ver- activity and nutrition environment.37 had a BMI at ⱖ95th percentile did not
mont, and West Virginia). Arkansas im- More research is needed to assess identify their child as overweight.40 A
plemented a statewide BMI-screening the validity of these concerns. BMI- study of 2032 high school students
and -surveillance program in 2003 surveillance programs are less con- found that 26% of obese students per-
(State of Arkansas, 84th General As- troversial, because they do not involve ceived themselves as underweight,
sembly, regular session, Act 1220 of the communication of sensitive infor- and another 20% perceived them-
2003, HB 1583). Pennsylvania began to mation to parents and do not require selves as “about the right weight”; only
phase in a BMI-screening and follow-up care. 6% of normal-weight students per-
-surveillance program (28 Pennsylva- ceived themselves as overweight.41 The
nia Code §23.7) for all students in RESEARCH ON BMI-MEASUREMENT evaluation of the Arkansas statewide
the 2005–2006 school year (Common- PROGRAMS BMI-screening program found that the
wealth of Pennsylvania, Height and Studies have not yet adequately evalu- percentage of parents who classified
Weight Measurements, 28 Pennsylva- ated the utility of school-based BMI- their child accurately as overweight or
PEDIATRICS Volume 124, Supplement 1, September 2009 S91
Downloaded from pediatrics.aappublications.org by guest on October 21, 2015at risk of overweight increased from ementary schools in preventing child- school nurses about their child’s BMI,
40% at baseline to 53% after the first hood obesity and found that parents and most family practitioners and pe-
year of screening.29 were least likely to support BMI- diatricians surveyed reported that
related activities. Parents rated the they were not contacted by a substan-
PARENTAL PERCEPTIONS OF BMI importance of 37 actions schools can tial number of parents wanting to dis-
SCREENING IN SCHOOLS take to address obesity through health cuss their child’s weight status.29 How-
Five studies included parent inter- education, food services, and physical ever, parents did not put students on
views and found that most parents education. Using a Likert-type scale diets with a greater frequency than
support and respond positively to (eg, not important to very important), they did before the program.48
BMI screening in their children’s the lowest-rated actions were collect-
schools.25,29,35,45,46 One of these studies ing height and weight measurements RECOMMENDATIONS FROM EXPERT
analyzed focus-group discussions with and informing parents of their child’s ORGANIZATIONS
parents of elementary school children height and weight.47 The use of BMI measurement for sur-
in Minnesota. The investigators con- veillance purposes, regardless of set-
cluded that parents in this study were STUDENT AND PARENTAL ting, has been endorsed by the Ameri-
receptive to BMI screening in schools RESPONSES TO BMI SCREENINGS can Public Health Association, The
provided it is done with care and par- Arkansas evaluated its statewide pro- American Heart Association and the
ents are involved in developing the pro- gram for any negative psychosocial IOM.13,50,51 However, views on BMI
gram.35 Parents would support pro- consequences that may have been ex- screening vary. The US Preventive Ser-
grams if they receive advanced notice perienced by the students. After 4 vices Task Force concluded that insuf-
about the BMI measurement, have the years of BMI screenings, Arkansas stu- ficient evidence exists to recommend
opportunity to decline consent, receive dents reported no increases in weight- for or against BMI-screening pro-
assurance that the measurements related teasing, no increases in con- grams for youth in clinical settings as
would be collected in a private and re- cerns about weight, and no increases a means to prevent adverse health out-
spectful manner that minimizes in dieting or using diet pills.48 However, comes such as adult cardiovascular
weight-related teasing, and receive the obese students were significantly disease risk.52 However, authors of the
results in a letter mailed to all parents more likely to be embarrassed by BMI 2007 report of an expert committee on
that uses a neutral tone and does not measurement. childhood obesity convened by the
assign blame.35 A pilot BMI-screening Three school-based screening pro- American Medical Association recom-
program was developed on the basis grams that evaluated parental re- mended that primary care providers cal-
of the findings of these focus groups; 4 sponses observed that parents do not culate and plot BMI at least annually; this
elementary schools were recruited to consistently follow-up with a medical has been endorsed by 12 organiza-
examine parental reaction to BMI mea- care provider after receiving their tions.53–56 For school-based programs,
surement.45 All 4 schools conducted child’s screening results.25,29,49 An eval- the IOM recommends annual BMI
height and weight measurements; uation of a school-based health “re- screening,13 whereas other organiza-
however, the 2 intervention schools port card” revealed that the parents tions encourage schools to exercise cau-
mailed BMI results to parents, who received their child’s BMI results tion before adopting BMI-measurement
whereas the remaining 2 schools did were more likely than parents who did programs.33,50,57
not mail results to the home. A not receive the results to report that The American Academy of Pediatrics
follow-up survey found that 78% of par- they had initiated or intended to initi- (AAP) developed criteria to guide deci-
ents in all 4 schools believed it was ate clinical services, dieting, or physi- sions on whether schools should im-
important for schools to assess and cal activity as weight control for their plement a screening program for any
mail BMI results to the home as part of children. However, 7 of the 19 families pediatric health problem (Table 1).58
annual student health-screening re- planning to initiate dieting reported BMI screening meets some of the cri-
ports. Parents of girls and older chil- that they planned to do so without teria: obesity is an important and
dren were less likely than parents of seeking medical counsel despite highly prevalent condition59,60; BMI
boys and younger children to want an- strong recommendations against is an acceptable measure20,22; and
nual BMI-screening information.45 such actions.25 The evaluation of Ar- schools are a logical measurement
A study conducted in Ohio examined kansas’ statewide screening program site, because they reach virtually all
parents’ perceptions on the role of el- revealed that parents did not consult youth.1 However, BMI-screening pro-
S92 NIHISER et al
Downloaded from pediatrics.aappublications.org by guest on October 21, 2015SUPPLEMENT ARTICLE
TABLE 1 AAP Criteria for a Successful Screening Program in Schools58
Aspect Criteria for a Successful Screening Program in Schools
Disease Undetected cases must be common or new cases must occur frequently, and the disease must be associated with adverse
consequences.
Treatment Effective treatment must be available, and early intervention must be beneficial.
Screening test The test should be sensitive, specific, and reliable.
Screener The screener must be well trained.
Target population Screening should focus on groups with high prevalence of the condition/disease in question or in which early intervention
will be most beneficial.
Referral and treatment Those with a positive screening test result must receive a more definitive evaluation and, if indicated, appropriate treatment.
Cost/benefit ratio The benefit should outweigh the expenses (ie, costs of conducting the screening and any physical or psychosocial effects on
the individual being screened).
Site The site should be appropriate for conducting the screening and communicating the results.
Program maintenance The program should be reviewed for its value and effectiveness.
grams typically do not meet other AAP ● There is a universal bullying- the likelihood of a positive impact
criteria: effective treatments for obe- prevention program that addresses on promoting a healthy weight, all BMI-
sity are not available,8,23,61 research weight discrimination. measurement programs should adhere
has not established the effectiveness ● Curricula foster acceptance of to the following safeguards.6,26
and cost-effectiveness of these pro- healthy weight by countering social ● Introduce the program to school
grams, and communities typically do pressures for excessive thinness. staff and community members and
not have resources in place to help in- obtain parental consent.
● Teachers, school counselors, school
dividuals at risk access treatment.13 ● Train staff in administering the pro-
nurses, coaches, and other staff re-
The AAP specifies that schools should gram (ideally, implementation will
ceive the professional development
not implement screening if resources be led by a highly qualified staff
and resources they need to provide
for follow-up do not exist. member such as a school nurse).
useful guidance to students with
weight-related concerns. ● Establish safeguards to protect stu-
GUIDANCE ON MEASURING BMI IN
dent privacy.
SCHOOLS If schools raise awareness about obe-
● Obtain and use accurate equipment.
Before launching a BMI-measurement sity through a BMI-measurement pro-
program for surveillance or screen- gram, they need to have in place an ● Accurately calculate and interpret
ing, decision-makers need to consider environment that helps students make the data.
whether the anticipated benefits (eg, healthy dietary and physical activity ● Develop efficient data-collection
preventing obesity, correcting misper- choices. For example, Arkansas re- procedures.
ceptions of weight) outweigh the ex- quired all elementary schools to re- ● Avoid using BMI results to evaluate
pected costs (eg, monetary, psycho- move vending machines from schools student or teacher performance.
social consequences). To minimize concurrent with implementing the ● Evaluate the program regularly for
potential harm and maximize benefits, statewide BMI-measurement program.62 its intended outcomes and unin-
schools should not launch a BMI- California’s physical performance tended consequences.
measurement program unless they tests influenced the adoption of state-
Those who implement BMI-screening
have established a safe and supportive wide, grade-specific physical educa-
programs should ensure that all par-
environment for students of all body tion content standards.63 The CDC has
ents receive a clear and respectful ex-
sizes; are implementing comprehen- identified 10 comprehensive strate- planation of the results and appropri-
sive strategies to address obesity; and gies that schools can implement to ate follow-up actions, and that
have put in place safeguards that ad- prevent obesity by promoting physical resources are available for safe and
dress the concerns raised about such activity and healthy eating (www.cdc. effective follow-up. Greater detail of
programs. gov/healthyyouth/keystrategies).5 these safeguards are described in the
The following are some key character- To ensure respect for student privacy longer version of this article in the De-
istics of a safe and supportive environ- and confidentiality, protect students cember 2007 issue of the Journal of
ment for students of all body sizes26: from potential harm, and increase School Health.64
PEDIATRICS Volume 124, Supplement 1, September 2009 S93
Downloaded from pediatrics.aappublications.org by guest on October 21, 2015Research is needed to address out- There is a need for researchers in aca- relation to the needs of their jurisdiction
standing issues regarding school- demia, government, and scientific orga- and resources available.
based BMI-surveillance and -screening nizations to develop a research agenda
programs, including around school-based BMI-measurement ACKNOWLEDGMENTS
● program impact on preventing and programs, document the impact of data
collection on obesity-prevention policies, We thank Laura Dobbs (past president,
reducing obesity;
study the data currently being collected, Georgia Parent Teacher Association),
● the types of follow-up actions taken Joyce Epstein, PhD (director, Center on
and define safe, effective, and accessible
by parents and students; School, Family, and Community Part-
follow-up services.
● the programs’ intended and unin- nerships), Suzanne Bennette Johnson,
tended physical, social, and psycho- CONCLUSIONS PhD (professor and chair, Department
logical effects; School-based BMI-surveillance pro- of Medical Humanities and Social Sci-
● student perceptions of and atti- grams are less controversial than ences, Florida State University College
tudes toward height and weight screening programs, but they still must of Medicine), Martha Kubik, PhD (asso-
measurement in schools; adhere to the safeguards identified. Sur- ciate professor, School of Nursing, Uni-
● the role and capacity of the school or veillance programs can provide valuable versity of Minnesota), Maryann Mason,
school district nurse to implement prevalence and trend data; samples PhD (associate director, Center for
and manage the BMI-measurement should be selected carefully to ensure Obesity Management and Prevention,
program; representativeness and to minimize pro- Mary Ann and J. Milburn Smith Child
gram costs. Health Research Program, Children’s
● the effects of BMI-measurement
programs on school-based efforts More research needs to be conducted to Memorial Research Center), Mary Pat
to promote nutrition and physical evaluate the impact of BMI-screening McCartney, PhD (former elementary
activity and link parents with medi- programs on weight-related behaviors vice-president, American School Coun-
cal services in the community; and outcomes. Legitimate concerns selor Association), Martha Phillips,
have been raised about the potential PhD (assistant professor, Department
● the effectiveness of treatment for
harm that might be caused by BMI- of Psychiatry and Epidemiology, Uni-
youth identified as obese, over-
screening programs; more research is versity of Arkansas for Medical Sci-
weight, or underweight;
needed to assess whether these harms ence), Shirley Shantz, EdD, ARNP
● cost/benefit analyses of these pro- (nursing projects director, National
occur. BMI-screening programs do not
grams compared with alternative Association of School Nurses), Howard
yet meet AAP criteria for a successful
strategies; Taras, MD (professor, School of Medi-
school screening program. The CDC en-
● relative efficiency of using schools courages additional research and evalu- cine, University of California San Di-
as a BMI-measurement site; and ation on school-based BMI-screening ego), and Gail Woodward-Lopez, MPH,
● effectiveness of different methods programs. Before initiating BMI- RD (associate director, Center for
for communicating BMI results and measurement programs, decision- Weight and Health, University of Cali-
related risk information to parents makers should consider the benefits fornia Berkeley), for their review and
and youth. and disadvantages of these programs in expertise.
REFERENCES
1. US Department of Commerce, Census Bureau. Historical statistics of the United States, colonial
times to 1970. Percent of the population 3 to 34 years old enrolled in school, by race/ethnicity, sex
and age: Selected years, 1980 –2003. Available at: http://nces.ed.gov/programs/digest/d04/
list㛭tables1.asp#c1㛭2. Accessed May 8, 2009
2. Centers for Disease Control and Prevention. Guidelines for school health programs to promote
lifelong healthy eating. MMWR Recomm Rep. 1996;45(RR-9):1– 41
3. Centers for Disease Control and Prevention. Guidelines for school and community programs to
promote lifelong physical activity among young people. MMWR Recomm Rep. 1997;46(RR-6):1–36
4. Gortmaker S, Peterson K, Wiecha J, et al. Reducing obesity via a school-based interdisciplinary
intervention among youth: Planet Health. Arch Pediatr Adolesc Med. 1999;153(4):409 – 418
5. Wechsler H, McKenna ML, Lee SM, Dietz WH. The role of schools in preventing childhood obesity.
State Educ Stand. 2004;5(2):4 –12
S94 NIHISER et al
Downloaded from pediatrics.aappublications.org by guest on October 21, 2015SUPPLEMENT ARTICLE
6. Crawford PB, Woodward-Lopez G, Ikeda JP. Weighing the risks and benefits of BMI reporting in the
school setting. Available at: nature.berkeley.edu/cwh/PDFs/BMI㛭report㛭cards.pdf. Accessed May
8, 2009
7. Scheier LM. School health report cards attempt to address the obesity epidemic. J Am Diet Assoc.
2004;104(3):341–344
8. Ikeda JP, Crawford PB, Woodward-Lopez G. BMI screening in schools: helpful or harmful. Health
Educ Res. 2006;21(6):761–769
9. Johnson A, Ziolkowski GA. School-based body mass index screening program. Nutr Today. 2006;
41(6):274 –279
10. Kantor J. As obesity fight hits cafeteria, many fear a note from school. New York Times. January 9,
2007. Available at: www.nytimes.com/2007/01/08/health/08obesity.html. Accessed July 21, 2009
11. Arkansas to flunk obesity report cards. The Associated Press. February 5, 2007
12. Scheier LM. Potential problems with school health report cards. J Am Diet Assoc. 2004;104(4):
525–527
13. Institute of Medicine. Preventing Childhood Obesity: Health in the Balance. Washington, DC: Na-
tional Academies Press; 2005
14. Trust for America’s Health. F as in Fat 2008: How Obesity Policies Are Failing in America. Washing-
ton, DC: Trust for America’s Health; 2008
15. Education Commission of the States. StateNotes: State Policies Related to Student Health and
Nutrition. Denver, CO: Education Commission of the States; 2005
16. National Association of State Boards of Education. State-Level School Health Policies. Alexandria,
VA. National Association of State Boards of Education; 2007. Available at: www.nasbe.org/
healthy㛭schools/hs. Accessed May 8, 2009
17. National Conference of State Legislatures. Childhood obesity: 2005 update and overview of policy
options. Available at: www.ncsl.org/programs/health/childhoodobesity-2005.htm. Accessed May
8, 2009
18. NetScan’s Health Policy Tracking Service. State Actions to Promote Nutrition, Increase Physical
Activity and Prevent Obesity: A 2005 First Quarter Legislative Overview. Falls Church, VA: Thomson
West; 2006
19. Barlow SE, Dietz WH. Obesity evaluation and treatment: expert committee recommendations.
J Pediatr. 1998;102(3):e29
20. Dietz WH, Bellizzi MC. Introduction: the use of body mass index to assess obesity in children. Am J
Clin Nutr. 1999;70(1):123S–125S
21. Himes JH, Dietz WH; Expert Committee on Clinical Guidelines for Overweight in Adolescent Preven-
tive Services. Guidelines for overweight in adolescent preventive services: recommendations
from an expert committee. Am J Clin Nutr. 1994;59(2):307–316
22. Mei Z, Grummer-Strawn LM, Pietrobelli A, Goulding A, Goran MI, Dietz WH. Validity of body mass
index compared with other body-composition screening indexes for assessment of body fatness
in children and adolescents. Am J Clin Nutr. 2002;75(6):978 –985
23. Whitlock EP, Williams SB, Gold R, Smith PR, Shipman SA. Screening and interventions for over-
weight in children and adolescents: a summary of evidence for the US preventive Services Task
Force. Pediatrics. 2005;116(1). Available at: www.pediatrics.org/cgi/content/full/116/1/e125
24. Arkansas Center for Health Improvement. Health letter to parents. Available at: www.achi.net/
sample%20child%20Health%20Reports.asp. Accessed May 8, 2009
25. Chomitz VR, Collins J, Kim J, Kramer E, McGowan R. Promoting healthy weight among elementary
school children via a health report card approach. Arch Pediatr Adolesc Med. 2003;157(8):
765–772
26. Haller EC, Petersmarck K, Warber JP, eds. The Role of Michigan Schools in Promoting Healthy
Weight. Lansing, MI: Michigan Department of Education; 2001
27. Pennsylvania Advocates for Nutrition and Activity. Growth screening communication kit for
schools and communities. Available at: panaonline.org/programs/khz/screening. Accessed May
8, 2009
28. Arkansas Center for Health Improvement. The Arkansas Assessment of Childhood and Adolescent
Obesity: Tracking Progress—State Results Year 3 (Fall 2005–Spring 2006). Little Rock, AR: Arkan-
sas Center for Health Improvement; 2006
29. University of Arkansas for Medical Sciences, College of Public Health. Year two evaluation: Arkan-
sas Act 1220 of 2003 to combat childhood obesity. Available at: www.uams.edu/coph/reports/
Act1220Eval.pdf. Accessed May 8, 2009
30. Florida Departments of Education and Health Coordinated School Health Program, Florida Depart-
ment of Health Obesity Prevention Program and School Health Services, Collier County Health
PEDIATRICS Volume 124, Supplement 1, September 2009 S95
Downloaded from pediatrics.aappublications.org by guest on October 21, 2015Department. School Health Information Program (SHIP): 2006. Presented at: the Division of Ado-
lescent and School Health’s Funded Partner’s Meeting; February 1, 2006; Atlanta, GA
31. Brener ND, Wheeler L, Wolfe LC, Vernon-Smiley M, Caldart-Olson L. Health services: results from the
School Health Policies and Programs Study 2006. J Sch Health. 2007;77(8):464 – 485
32. California Department of Education. 2007 California physical fitness test: report to the governor
and legislature. Available at: www.cde.ca.gov/ta/tg/pf/documents/reporttogov.pdf. Accessed May
8, 2009
33. Berg F, Buechner J, Parham E; Weight Realities Division of the Society for Nutrition Education.
Guidelines for childhood obesity prevention programs: promoting healthy weight in children.
J Nutr Educ Behav. 2003;35(1):1– 4
34. Killen JD, Taylor CB, Hayward C, et al. Pursuit of thinness and onset of eating disorder symptoms
in a community sample of adolescent girls: a three-year prospective analysis. Int J Eat Disord.
1994;16(3):227–338
35. Kubik MY, Story M, Rieland G. Developing school-based BMI screening and parent notification
programs: findings from focus groups with parents of elementary school students. Health Educ
Behav. 2007;34(4):622– 633
36. Neumark-Sztainer D. Addressing obesity and other weight-related problems in youth. Arch Pediatr
Adolesc Med. 2005;159(3):290 –291
37. Lobstein T, Baur L, Uauy R; IASO International Obesity TaskForce. Obesity in children and young
people: a crisis in public health. Obes Rev. 2004;5(suppl 1):4 – 85
38. Arkansas Center for Health Improvement, Year Five assessment of childhood and Adolescent
obesity in Arkansas (Fall 2007–Spring 2008), Little Rock, AR: Arkansas Center for Health Improve-
ment, September 2008. Available at: www.achi.net/ChildObDocs/080918YearFiveBMIReport.pdf.
Accessed August 4, 2009
39. Baughcum AE, Chamberlin LA, Deeks CM, Powers SW, Whitaker RC. Maternal perceptions of over-
weight preschool children. Pediatrics. 2000;106(6):1380 –1386
40. Boutelle K, Fulkerson JA, Neumark-Sztainer D, Story M. Mothers’ perceptions of their adolescents’
weight status: are they accurate? Obes Res. 2004;12(11):1754 –1757
41. Brener ND, Eaton DK, Lowry R, McManus T. The association between weight perception and BMI
among high school students. Obes Res. 2004;12(11):1866 –1874
42. Crawford D, Timperio A, Telford A, Salmon J. Parental concerns about childhood obesity and the
strategies employed to prevent unhealthy weight gain in children. Public Health Nutr. 2006;9(7):
889 – 895
43. Etelson D, Brand D, Patrick PA, Shirali A. Childhood obesity: do parents recognize this health risk?
Obes Res. 2003;11(11):1362–1368
44. Maynard LM, Galuska DA, Blanck HM, Serdula MK. Maternal perceptions of weight status of
children. Pediatrics. 2003;111(5 pt 2):1226 –1231
45. Kubik MY, Fulkerson JA, Story M, Rieland G. Parents of elementary school students weigh in on
height, weight, and body mass index screening at school. J Sch Health. 2006;76(10):496 –501
46. Murphy M, Polivka B. Parental perceptions of the schools’ role in addressing childhood obesity.
J Sch Nurs. 2007;23(1):40 – 46
47. Murnan J, Price JH, Telljohann SK, Dake JA, Boardley D. Parents’ perceptions of curricular issues
affecting children’s weight in elementary schools. J Sch Health. 2006;76(10):502–511
48. University of Arkansas for Medical Sciences, College of Public Health. Year three evaluation:
Arkansas Act 1220 of 2003 to combat childhood obesity. Available at: www.uams.edu/coph/
reports/2006Act1220㛭Year3.pdf. Accessed May 8, 2009
49. Resnicow K, Cross D, Lacosse J, Nicholes P. Evaluation of a school-site cardiovascular risk factor
screening intervention. Prev Med. 1993;22(6):838 – 856
50. American Heart Association. Policy position statement on body mass index (BMI) surveillance and
assessment in schools. Washington, DC: American Heart Association; 2008
51. American Public Health Association. Policy statements adopted by the governing council of the
American Public Health Association, October 24, 2001. Am J Public Health. 2002;92(3):451– 483
52. US Preventive Services Task Force. Screening and interventions for overweight and children and
adolescents: recommendations statement. Pediatrics. 2005;116(1):205–209
53. American Academy of Pediatrics, Committee on Nutrition. Prevention of pediatric overweight and
obesity. Pediatrics. 2003;112(2):424 – 430
54. Barlow SE; Expert Committee. Expert committee recommendations regarding the prevention,
assessment, and treatment of child and adolescent overweight and obesity: summary report.
Pediatrics. 2007;120(suppl 4):S164 –S192
55. John-Sowah J. Introduction. Pediatrics. 2007;120(suppl 4):S163
S96 NIHISER et al
Downloaded from pediatrics.aappublications.org by guest on October 21, 2015SUPPLEMENT ARTICLE
56. Murray R. Response to “Parents’ Perceptions of Curricular Issues Affecting Children’s Weight in
Elementary Schools.” J Sch Health. 2007;77(5):223; author reply 223
57. Taras H, Duncan P, Luckenbill D, Robinson J, Wheeler L, Wooley S. Health, mental health and safety
guidelines for schools. Available at: www.nationalguidelines.org/guideline.cfm?guideNum⫽4-18.
Accessed May 8, 2009
58. American Academy of Pediatrics, Committee on School Health. School Health: Policy & Practice.
6th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2004
59. Ogden CL, Flegal KM, Carroll MD, Johnson CL. Prevalence and trends in overweight among US
children and adolescents, 1999 –2000. JAMA. 2002;288(14):1728 –1732
60. Ogden CL, Carroll MD, Flegal KM. High body mass index for age among US children and adoles-
cents. JAMA. 2008;299(20):2401–2405
61. Summerbell CD, Ashton V, Campbell KJ, Edmunds L, Kelly S, Waters E. Interventions for treating
obesity in children. Cochrane Database Syst Rev. 2003;(3):CD001872
62. University of Arkansas for Medical Sciences, College of Public Health. Establishing a Baseline
to Evaluate Act 1220 of 2003: An Act of the Arkansas General Assembly to Combat Childhood
Obesity. Little Rock, AR: University of Arkansas for Medical Sciences, College of Public Health;
2005
63. McLean H. State Schools Chief Jack O’Connell Announces 2005 Physical Fitness Test Results for
California Students [news release 05–146]. Sacramento, CA: California Department of Education;
2005
64. Nihiser AJ, Lee SM, Wechsler H, et al. Body mass index measurement in schools. J Sch Health.
2007;77(10):651– 671; quiz 722–724
PEDIATRICS Volume 124, Supplement 1, September 2009 S97
Downloaded from pediatrics.aappublications.org by guest on October 21, 2015BMI Measurement in Schools
Allison J. Nihiser, Sarah M. Lee, Howell Wechsler, Mary McKenna, Erica Odom,
Chris Reinold, Diane Thompson and Larry Grummer-Strawn
Pediatrics 2009;124;S89
DOI: 10.1542/peds.2008-3586L
Updated Information & including high resolution figures, can be found at:
Services http://pediatrics.aappublications.org/content/124/Supplement
_1/S89.full.html
References This article cites 38 articles, 10 of which can be accessed free
at:
http://pediatrics.aappublications.org/content/124/Supplement
_1/S89.full.html#ref-list-1
Citations This article has been cited by 11 HighWire-hosted articles:
http://pediatrics.aappublications.org/content/124/Supplement
_1/S89.full.html#related-urls
Subspecialty Collections This article, along with others on similar topics, appears in
the following collection(s):
Endocrinology
http://pediatrics.aappublications.org/cgi/collection/endocrinol
ogy_sub
Obesity
http://pediatrics.aappublications.org/cgi/collection/obesity_ne
w_sub
Permissions & Licensing Information about reproducing this article in parts (figures,
tables) or in its entirety can be found online at:
http://pediatrics.aappublications.org/site/misc/Permissions.xht
ml
Reprints Information about ordering reprints can be found online:
http://pediatrics.aappublications.org/site/misc/reprints.xhtml
PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly
publication, it has been published continuously since 1948. PEDIATRICS is owned, published,
and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk
Grove Village, Illinois, 60007. Copyright © 2009 by the American Academy of Pediatrics. All
rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.
Downloaded from pediatrics.aappublications.org by guest on October 21, 2015BMI Measurement in Schools
Allison J. Nihiser, Sarah M. Lee, Howell Wechsler, Mary McKenna, Erica Odom,
Chris Reinold, Diane Thompson and Larry Grummer-Strawn
Pediatrics 2009;124;S89
DOI: 10.1542/peds.2008-3586L
The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://pediatrics.aappublications.org/content/124/Supplement_1/S89.full.html
PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly
publication, it has been published continuously since 1948. PEDIATRICS is owned,
published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point
Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2009 by the American Academy
of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.
Downloaded from pediatrics.aappublications.org by guest on October 21, 2015You can also read
