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BMI Talking points 01-22-09 DWC

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					               BMI Data Collection in Schools
Some states have initiated BMI (Body Mass Index) measurement programs in schools in
recent years. These programs are not only used for state health department surveillance
purposes to track the obesity epidemic among youth, but some are also used for screening
and reporting purposes to assist parents in addressing overweight in their children.
Arkansas instituted statewide BMI screening and surveillance in 2003 which includes
reporting BMI status to parents. Over the last five years, Arkansas reports that they
continue to hold the line on the progression of childhood obesity; other states without
BMI reporting to states have seen continuing increases in childhood obesity while others,
such as Maine cannot be sure where all youth stand due to the limited availability of
surveillance data.

To assist discussions of the benefits and risks of instituting BMI surveillance and
reporting in Maine, the following points are presented for consideration. Much is drawn
from the Arkansas experience, now 5 years since implementation.


Background

       The prevalence of childhood obesity throughout the U.S. has more than doubled
        for preschool children, ages 2 to 5 years and adolescents, ages 12 to 19 years, and
        it has more than tripled for children, ages 6 to 11 years.1

       Currently Maine has no formal system in place to capture data on the heights and
        weights of Maine children. All youth weight data in Maine is self-reported and is
        obtained via the Maine Child Health Survey (MCHS) and the Youth Risk
        Behavior Survey (YRBS). Parents report the height and weight on the MCHS
        before grade 7 and in grade 8 youth self-report height and weight data via the
        YRBS.

       According to a recent survey conducted by the Maine School Nurse Consultant,
        83% of the school nurses that responded reported collecting height and weight
        data; sixty-three percent of them calculate Body Mass Index (BMI). This means
        that some height and weight data for Maine youth is available and being collected,
        but it is not aggregated nor is it statistically representative or useful for
        surveillance purposes.

       Without an across the board, accurate measure of Maine children’s weight status
        it is difficult to say if Maine is moving in the right direction regarding childhood
        obesity. Requiring schools to collect BMI data would facilitate Maine’s
        monitoring of state-wide efforts aimed at reducing the rising rates of childhood
        obesity. The data would also be utilized to identify improvement opportunities in
        current obesity prevention approaches.


       1 Created by the Maine Physical Activity & Nutrition Program | Updated January 2009
Medical and Expert Recommendations

       BMI is widely accepted as a reliable and valid tool for assessing overweight in
        children.2

       Annual BMI screening is recommended by the American Academy of Pediatrics
        (AAP) for all children and adolescents. 2

       The Institute of Medicine (IOM) recommends that schools conduct annual
        assessments of students’ height, weight, and BMI and make that information
        available to parents. 1


Parents' Perception

       Data show that parents are unable to accurately characterize their child’s weight
        status, particularly when the child is overweight. Over 50% of parents with
        children who were overweight (according to BMI for age percentiles) incorrectly
        perceived their child to be of normal weight.3

       One study found that one-third of mothers and over one-half of fathers of obese
        children thought that their child’s weight was about right.2

       In Arkansas after the enactment of the BMI ACT 1220 of 2003 it was discovered
        that 38% percent of youth were overweight or obese. These results were
        significantly higher than the self-reported weights of Arkansas youth.


Methodology/ Confidentiality

       Fears about confidentiality of BMI subsided as the Arkansas BMI screening and
        confidential reporting process was undertaken. 70% of parents and 63% of
        adolescents were comfortable with getting a confidential BMI report sent to
        parents from the school.2

       Two school districts in Maine (Dover-Foxcroft and Freeport) currently report
        BMI results to parents. Recently Houlton announced they would be doing the
        same.

       Many children don’t have regular doctors visits and when they do only a small
        percentage of doctors conduct a BMI in their physicals and evaluations.2

       More than 95% of young people are enrolled in schools making it the perfect
        setting for height-weight data collection.


       2 Created by the Maine Physical Activity & Nutrition Program | Updated January 2009
Impact

       Prevention of obesity in childhood is more effective than treatment as an adult.
        Overweight children have a 70% chance of becoming overweight as adults.
        Overweight children have a greater risk of social and psychological problems
        such as discrimination and poor self-esteem. 3

       A 2006 Arkansas analysis of BMI assessments in school children demonstrated
        that the obesity epidemic in Arkansas has been halted.4

       There is no evidence that BMI screening causes eating disorders.5

       In Arkansas teasing, frequency of skipped meals, and use of diet pills did not
        increase after BMI screening was implemented.6

       PA, AK, MA, FL, SD have successfully conducted BMI screening programs in
        schools.1

       After receiving notification of their child’s weight status parents of overweight
        children in Cambridge, Massachusetts planned to change their child’s diet and
        level of physical activity. Of these overweight children, 19% of parents planned
        dietary changes and 42% planned changing the physical activity of their children.7

       The East Penn School District in Emmaus, Pennsylvania have seen a significant
        drop in the number of overweight students since implementing efforts to fight
        childhood obesity.2

       Parents’ ability to accurately identify their child as overweight or at risk of
        overweight improved after the first year of BMI screening. They didn’t make any
        significant changes in family activity, but they did make changes in their eating
        habits. However these changes in eating habits were not significant.8


Potential Issues Associated with BMI Screening

       BMI screenings are a guide and do not directly measure body fat.6

       A BMI percentile for a child over the 85th percentile in an extremely athletic
        adolescent African American male may be high due to high muscle mass not body
        fat, generating a false positive.7

       BMI is likely to go up and down over time in children and adolescents in relation
        to one another, puberty and muscle mass.

       Some children with a lower BMI may actually have too much body fat.


       3 Created by the Maine Physical Activity & Nutrition Program | Updated January 2009
    Some children who are at-risk may not be identified as at-risk for overweight
     using BMI.8

                                     Sources
1. Institute Medicine. Preventing childhood obesity: Health in the balance.
   Washington DC: The National Academies Press. 2005
2. Arkansas BMI Task Force, a partnership of Arkansans, including Local School
   Districts, Arkansas Center for Health Improvement, Arkansas Department of
   Education, Arkansas Department of Health, and UAMS College of Public Health
   Available at
   http://www.achi.net/BMI_Info/Docs/Obesity_Fact_Sheet_050126%20.pdf
   Accessed Friday March 2, 2007

3. Maternal Child Health Services Survey 2002

4. Establishing a baseline to evaluate act 1220 o f2003 An Act of Arkansas General
   Assembly to Combat Childhood Obesity
   http://www.uams.edu/coph/reports/2003Act1220Eval.pdf

5. ACHI Arkansas Center for Health Improvement: Tracking Progress of the Annual
   Arkansas Assessment of Childhood and Adolescent Obesity, August 2006
   Available at:
   http://www.achi.net/BMI_Info/Docs/2006/Results06/ACHI_2006_BMI_National
   _rpt.pdf Accessed 3/14/07

6. Understanding Body Mass Index, a Tool Kit for Parents
   Available at: www.arkansas.gov/ha/materials/brochure_understanding_bmi_html
   Accessed March 2, 2007

7. Year Two Evaluation of Arkansas Act 1220 available @ www.uams.edu/coph
   Accessed 3/2/2007

8. Chomitz VR Collins J, Kim J, Kramer E, McGowan R, Promoting Healthy
   Weight Among Elementary School Children via a Health Report Card Approach,
   ARCH PEDIAR ADOLESC MED/VOL 157, AUG 2003

9. USDA AVRS Children’s Nutrition Research Center, Baylor College
   http://www.kidsnutrition.org/bodycomp/bmiz2.html




    4 Created by the Maine Physical Activity & Nutrition Program | Updated January 2009