Why Are Schools Still Collecting BMI?

Yes, Kids Diabetes’ Risk Rose during the Pandemic. But Why Do We Still Think Collecting BMIs is the Way to Fix the Problem?

OPEN LETTER TO NEW YORK STATE SCHOOL HEALTH OFFICIALS

On June 25th, the American Diabetes Association (ADA) was presented with research indicating that the number of children hospitalized for type 2 diabetes (T2DM) had doubled for at least one community during the height of the pandemic. Days earlier I’d opened letters from the health offices of each of my daughter’s elementary and middle schools telling me—one in threatening bold lettering—that their body mass indexes (or BMI) must be provided in order for them to be in school.

 

If New York State health officials want to improve our children’s health after a harrowing year of limited physical activity, increased use of technology, chaotic eating routines, and multiple other stressors, they’ve got a hell of a long way to go—and they ought to start by revising the Required NYS Health Examination Form to ask parents and pediatric providers better questions.

 

According to the New York State Health Guidelines for Schools, BMI is collected as a way to screen for diabetes. As a certified diabetes counselor and education specialist (CDCES), a registered dietitian nutritionist (RDN), and clinical care provider in a pediatric endocrine care practice within a large New York City medical center, I can assure you that the policy of collecting the BMI of students is at its best ineffective and at its worst physically, emotionally, and socially harmful to kids and parents alike when it comes to reducing T2DM risk.

 

When we use BMI for screening for T2DM, we emphasize the idea to our parents that monitoring our child’s body size is a way to protect their health. This idea is false and a significant contributor to weight stigma. In an American Academy of Pediatrics Policy Statement, providers are warned against practices such as recommending weight loss or dieting for children since they are linked to binge eating, social isolation, and additional weight gain. Expert authors also add these practices perpetuate weight stigma which “dramatically impairs quality of life, especially for youth.” Children are particularly vulnerable to the negative effects of such bias—and kids as young as three have been known to suffer the physical and emotional harms of such stigma. Calling out a child’s BMI has the potential to worsen outcomes for both those with and without other risk factors for T2DM.

 

In addition to being harmful, there’s little if any clear benefit to surveying our children’s BMI. The Centers for Disease Control (CDC) does not make a clear recommendation for or against surveillance or screening of BMI measurements in schools. The CDC does warn, however, that if schools choose to collect students’ BMIs then they must also put safeguards in place to protect kids from the consequences. In fact, the CDC provides not one but ten safeguards for schools to use. If there’s no clear benefit of obtaining BMI yet there is a risk, why are we asking for it at all?

 

In four years of counseling hundreds of at-risk families face-to-face, I have learned to avoid the harmful topic of BMI entirely. Instead, I ask questions about habits that are proven that directly impact a child’s T2DM risk and overall well-being. If state officials want to improve outcomes for children at risk for diabetes, they ought to be doing the same. They should ask parents 1) if they need support in offering their kids opportunities for safe and daily physical activity, 2) if they have the resources-including time, and money—to provide regular, reliable meals, 3) if they have regular access to affordable fruits and vegetables, 4) whether they understand the importance of their child getting sufficient sleep, and 5) whether or not they feel they have access to culturally appropriate healthcare. With the answers to even just one or two of these questions, we can better understand where and how to invest our efforts to improve the quality of programs and quality of life for our kids with and at risk for T2DM.

With the answers to even just one or two of these questions, we can better understand where and how to invest our efforts to improve the quality of programs and quality of life for our kids with and at risk for T2DM.

To be sure, T2DM is a serious and significant disease that is impacting a rising number of adolescents—and yes research suggests that negative changes brought on by the pandemic sped up the progression of the disease for some children. However, drawing parents’ attention to anthropometrics is ineffective and even hurtful to both children and the parents who care for them. New York State health officials can and need to do a better job caring for our children.

 

If you live in New York State and have a child entering Kindergarten, 1st, 3rd, 5th, 7th, 9th and 11th grade in September 2021, then you received the same letter. I think you should join me in crossing out the section of the form that requests BMI. You can replace it with an all-caps request to ASK ME A BETTER QUESTION instead.

If you live in another state in the US, where does your state stand when it comes to BMI screening? Are they asking the right questions? How can we do better?

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