Weigh in Carefully on Child Obesity

Related articles

This item appeared on June 11, 2007 in the New Jersey Star-Ledger and a version also appeared on HuffingtonPost.com:

New Jersey students may soon have one more weight to carry -- their own. A new state office is considering adding an assessment of students' weight to their report cards.

Clearly, childhood obesity is a problem that needs to be addressed.

But this particular approach, while well intentioned, is misguided; it's unlikely to produce the desired effect and may even result in some serious negative consequences.

In New Jersey's latest effort to combat obesity, the Office of Nutrition and Fitness (ONF) has been created under the auspices of the Department of Health and Senior Services. Commissioned by Dr. Fred Jacobs, the ONF is charged with instilling healthy habits, and report card weight assessments are an option under consideration. Many states have structured such reports around analyzing the body mass index (BMI) of students. Report cards would be sent home to notify the parents of children whose BMIs indicate they are overweight.

Will report cards really help parents properly address their children's weight problems?

Many parents of overweight children may already be aware that their kids need help; having the school district point it out would likely just be one more frustrating part of the already daunting task of trying to keep a child healthy. And if parents aren't aware, is this the best way to tell them?

If we're going to approach obesity from a legislative standpoint, let's use our government's energies to launch public health education campaigns and give parents some useful resources for treating the problem, such as information on how to shop for healthy foods and how to find ways to exercise with their children, rather than simple numbers and restatements of obesity/disease links. Placing BMIs on report cards does little to motivate parents or create solutions.

We applaud Dr. Jacobs' plan to fight obesity with methods that have been scientifically proven to work, such as support groups and encouraging physical activity -- rather than some popular but unscientific methods, such as banning certain foods. Dr. Jacobs said that he wants to accomplish these goals "without creating a further stigma on individual people." He should follow his own advice.

Arkansas, which enacted a similar report card plan, is now considering dropping their BMI report cards after a lot of negative, unintended consequences and reports of damaged self-esteem. Report cards are a place for reporting on school performance, not a child's characteristics or non-academic habits. There's a reason report cards include math, science, and English, not tooth-brushing, sleeping, and weight (despite their undoubted significance for a child's health).

This plan might cause undue focus on body image, resulting in stress or even eating disorders, also a serious problem in schools. Most of us can remember times in school when comparing appearances lowered self-esteem; officially "grading" children on their bodies would likely be even more distressing.

Moreover, using BMI as an indicator of overall health oversimplifies the issue. The bill does not state how BMI will be calculated, except to say it involves weighing each child. This may mean the school-calculated BMIs don't include all four of the measures (weight, height, age, sex) that are known to be important in determining children's BMIs. And any BMI measure neglects the facts that muscle weighs more than fat and that simple height and weight measurements don't give the whole picture of a person's weight-related health.

Just as a report card mark for "blood pressure" wouldn't give parents a complete picture of a child's health, neither does one only for BMI. The BMI "grades" could cause unnecessary worry for some parents and give others the false belief that they need not worry about other aspects of their children's health.

Obesity is an increasingly serious public health issue, and it is important to instill healthy habits at an early age. Schools can play a role in helping promote healthy lifestyles and habits in children, and New Jersey is right to look to them for solutions.

But perhaps that means offering students more classroom instruction on healthy habits, having school nurses call home if they have concerns about a child's weight and health, or sending information to all parents about how best to keep their children healthy and how to seek help if a child is overweight. The answer might be in any number of school-based approaches, but it won't be found printed on the report card.