Abstract
As schools return to in-person learning, early evidence suggests that teachers and administrators will be faced with a striking increase in the prevalence and severity of obesity among their students. It is important, as we address these downstream impacts of the lockdown, to consider the benefits and harms of how we respond.
Almost two decades ago, in 2003, Arkansas became the first state to mandate BMI screening in public schools. Although this practice raised concerns from the outset,1,2 it spread quickly to other states. By 2013, 25 states required schools to screen students for high BMI and 11 states required reporting those results to parents. 3
Both Centers for Disease Control and Prevention (CDC) 4 and that American Academy of Pediatrics 5 have neither endorsed nor rejected such programs. Instead, both organizations have published cautions about minimizing the potential for harm from them.
The Possibility of Harm without Benefit
Observers have long debated the potential for benefit or harm. As with any effective screening plan, a positive screen should have a clear and evidence-based response that has a specific health benefit. What are children, parents, and teachers to do with a positive screen? Some were concerned that parents would put children on an overly restrictive diet in response to reports of a high BMI. 1 Although some argued that simply increasing parental awareness of a child's high BMI would lead to positive change, subsequent research suggests that youth who perceive themselves to have a high weight status are more likely to have obesity as adults than youth who inaccurately think they do not. 6
More recently, a randomized controlled trial of BMI reporting in California public schools 7 found this practice had no beneficial effect on BMI status after 2 years of follow-up. Furthermore, researchers found that weight satisfaction declined, and peer weight talk increased more in students weighed at school.
This adds to other evidence that BMI screening can contribute to weight stigma and weight-based teasing or bullying. The mental health consequences of these factors can be profound and long-lasting. 8 For this reason, it is not unusual for students with severe obesity to withdraw from public schools. 9
Time for Change
After two decades, the desired benefits of BMI screening in schools have not materialized. Since 2003, the prevalence of childhood obesity has continued rising without relief. At the same time, it has become ever clearer that the pernicious effects of weight stigma are serious. In 2017, the American Academy of Pediatrics adopted a policy on Weight Stigma,
10
which concludes as follows:
To best support patients' healthy changes, it is important to recognize, address, and advocate against weight stigma in all settings.
As such, the time has come to end the practice of BMI screening in schools because it serves to promote weight stigma, bullying, and victimization without helping to reduce obesity.
As child obesity continues to threaten the health and well-being of children across the world, schools continue to serve a critical role in promoting health for all students. Nonweight-based wellness policies that promote, encourage, and role-model healthy behaviors for all children, regardless of weight, are a critical part of the solution. However, BMI screening and obesity treatment is best accomplished in a pediatric health care setting in the context of a child's overall health and development.