I’ve had a number of requests recently from parents who are dealing with their kids getting weighed in at school, including one school that is doing it now and after the holidays to “inform parents and kids if dangerous holiday weight gain is happening” so I wanted to re-post this. If you’re not familiar with this practice, kids are weighed in and then their Body Mass Index (BMI) is sent home in a letter to parents letting them know if their child’s BMI is “too high” or “too low” (or, ostensibly juuuuust right) and suggesting to some that they see a medical professional to help their child get to a “healthy weight.” Let’s look at some of the many, many reasons that this is a bad idea.
First of all, there is absolutely no research to suggest that this practice improves the health of children. In fact, according to research from the University of Minnesota “None of the behaviors being used by adolescents (in 1999) for weight-control purposes predicted weight loss[in 2006]…Of greater concern were the negative outcomes associated with dieting and the use of unhealthful weight-control behaviors.”
In the last decade hospitalizations for eating disorders for kids under 12 are up 119%. Kids. Under. Twelve. Kids are plenty focused on their weight – they don’t need their gym teacher to get involved. Even Dr. Yoni Freedhoff, who is a self-described obesity researcher, said “I don’t think that it’s the role of the school to be the schoolyard bully. These six- and seven- and eight-year-olds who are going to get letters sent home, they’re not suffering from an epidemic loss of willpower. We’re not dealing with that here…Simply putting it on the kids is putting them at increased risk for bullying and increased risk for pressures at home.”
A focus on weight as a substitute for health does a disservice to kids of all sizes because of the “healthy weight” fallacy. When we try to make body size a middle man for health we tell fat kids that their healthy habits don’t support their health unless they make them thin (which is not what the evidence suggests), and we tell thin kids that they are healthy because of their size and regardless of their habits (which is also not what the evidence suggests.)
The use of BMI is another issue here. BMI is always problematic as a health measurement predominantly because it’s, well, not a health measurement – as a simple ratio of weight and height BMI doesn’t take into account any actual health measurements, body composition or anything other than weight and height. So again, even if someone believes that being fat is bad, BMI would still not be a good tool to use.
It’s even more problematic with kids than with adults because it completely fails to acknowledge not just a natural diversity of body sizes and body compositions, but also natural fluctuations in kids’ weight. If a kid gets their BMI report card taken when they’ve put on weight before a growth spurt, and their parents take them to a doctor who puts them on an diet and restricts their calories, how does that affect the kid’s growth and health? Since dieting hardly ever works, these programs are using other measures of success, one of which is an INCREASE in kids who are indicating that they are concerned about their weight. Just to be clear, they are suggesting that creating a preoccupation with weight is a good thing for kids. There is, as you might expect, no research to support this as a path to either thinness or health in kids.
Even if someone believes that all fat kids would be healthier thin, we do not know how to get it done; and saying repeatedly that we do is just a lie that has been repeated so often that people believe it’s the truth. Dr.Freedhoff has called these “non-evidence based interventions.” The CDC has admitted that there isn’t sufficient evidence to recommend these BMI Screening programs. There is not a single statistically significant controlled study where even a simple majority of kids were able to change their weight long-term. Anything that is prescribed to kids for weight control is experimental medicine at best, and at worst it’s an intervention that’s been demonstrated by research to fail – and it’s typically prescribed without the consent to the child or the parent, violating the ethical principles of evidence-based medicine and informed consent. Basically, we’re experimenting on kids without their, or their parent’s, consent.
Can you imagine the uproar if kids who were actually sick were shamed for being sick, prescribed treatments that studies had shown to not work, often making the sickness worse, lied to that “everyone who tries hard enough” gets cured on these treatments, and then were blamed and shamed when the treatments didn’t work. To be very clear, body size is neither a disease nor a diagnosis but if the medical establishment is going to treat it that way then the least they could do is practice ethical medicine.
Parents are typically allowed to opt-out but many are saying that they were not notified in advance and so kids were forced to submit to a weigh in at school that their parents would have vigorously opposed.
All of this is another dangerous example of people substituting what they think is “common sense” for actual evidence-based health interventions. Let’s be clear about what’s happening here – lawmakers have decided that kids’ body size is such a big “problem” that they should just start “doing something about it” and what they should do is the first thing that comes into their heads – even if there is no evidence basis for it, even if evidence exists suggesting that it’s actually dangerous and likely to cause harm, they believe that their “common sense” is a better guide than science when dealing with the health of kids. Yikes.
This entire thing is completely unnecessary. We could have a complete discussion about health and healthy habits for kids without even once bringing up weight. There aren’t different healthy habits based on body size, and so there is no need to pull weight into the conversation, let alone force kids to participate in weigh-ins. We can work to create programs that help kids love and appreciate their bodies, we can help kids develop healthy relationships with their bodies, and food, and movement. We can work to be fiercely anti-shame in all of the messages that we give kids about their bodies. We can do better than a useless at best, seriously harmful at worst, BMI report card. Let’s.
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