This text was initially printed by Undark Journal.
Amongst Lexie Manion’s reminiscences of her junior yr of highschool in New Jersey was the expertise of being usually hassled by a college nurse who was making an attempt to weigh her.
The nurse, Manion recalled, was making an attempt to get Manion’s weight on file—a standard follow at colleges throughout america, which purpose to make use of the info to enhance scholar well being. However for Manion, who had an consuming dysfunction, the expertise was deeply distressing. The considered getting on a scale in class—of somebody aside from her physician dealing with this delicate measurement—terrified Manion. It additionally triggered her consuming dysfunction: She started to limit her meals consumption extra intensely to drop a few pounds earlier than the college nurse put her on a scale.
“I used to be fearful about her realizing my weight, and I used to be fearful the entire faculty would in some way know the quantity if she weighed me,” Manion, now 29, wrote in an e-mail to Undark. “I grew to become very anxious and would keep away from the dimensions and her gaze each time she inquired.”
The coverage at Manion’s faculty was a part of a nationwide effort to fight childhood weight problems by accumulating—and infrequently sharing—knowledge on college students’ weight. Beginning in 2003, one examine discovered, 29 states enacted insurance policies encouraging or requiring faculty districts to weigh college students, or to go additional and calculate their body-mass index, or BMI: a standard software for categorizing folks primarily based on their weight and peak. By the coverage’s peak extent, within the 2010s, tens of millions of scholars annually had been receiving so-called “BMI report playing cards” within the mail—and a few college students even noticed their weight standing seem on their precise report playing cards, alongside their grades. Coverage makers hoped that by telling college students and their household a couple of baby’s weight class, the stories would immediate them to make more healthy decisions and drop a few pounds, decreasing childhood weight problems one scholar at a time.
However even because the follow was changing into extra widespread, analysis was already suggesting that BMI screenings don’t have any affect on college students’ weight and may even trigger hurt. Right this moment, many specialists say, the proof is obvious that faculty BMI screenings do little to enhance scholar well being. Analysis has additionally linked the coverage to elevated weight-based bullying and body-image dissatisfaction, which, as in Manion’s expertise, can set off or worsen consuming issues. In response, some states, together with California, have stopped requiring screenings.
Nonetheless, BMI screening or comparable insurance policies that mandate or encourage weight-tracking stay on the books in at the least 16 states, together with Tennessee, West Virginia, Arkansas, and New York, in keeping with Undark’s overview of state legislative codes.
“To focus efforts on simply measuring the growing waistline of America is a Band-Support,” says Kristine Madsen, a pediatrician and a public-health vitamin researcher at UC Berkeley, who carried out one of many largest research of faculty BMI screenings thus far. “It doesn’t even contact the underlying drawback, and it’s ineffective.”
Arkansas was the first state within the nation to mandate screening and reporting, again in 2003. Then, in 2005, the Institute of Drugs on the Nationwide Academy of Sciences launched a 434-page report, “Stopping Childhood Weight problems: Well being within the Steadiness,” that urged extra states to undertake the follow. “It is crucial for folks to have details about their baby’s BMI and different weight-status and bodily health measures, simply as they want details about different well being or educational issues,” the NAS group wrote.
The group was responding to what it described as a childhood-obesity epidemic. On the time, about one-third of U.S. youngsters had been classed as obese, overweight, or severely overweight. Childhood weight problems is linked to a variety of poor well being outcomes, together with hypertension, bronchial asthma, and coronary heart illness.
Extra states moved to implement BMI screening. By 2010, simply 5 years after the NAS’s advice was printed, 29 states had been broadly conducting some type of physique evaluation on their college students, in keeping with an educational survey of state schooling departments.
These insurance policies sometimes provided little steerage on how the weigh-ins must be carried out. In keeping with one examine, about half of screenings had been finished throughout gymnasium class, typically in entrance of different college students. The gymnasium instructor or faculty nurse would measure every scholar’s peak and weight and submit them to the college, which, in lots of circumstances, would go the info alongside to state well being authorities for population-level monitoring.
Baked into that mannequin from the beginning, some specialists say, had been issues. Foremost amongst them was, in lots of insurance policies, the reliance on BMI.
The 1832 paper that first proposed the metric, and the 1972 examine that sparked its fashionable utilization, concerned solely males and weren’t consultant of the ethnic and racial variety of america. BMI additionally doesn’t contemplate elements similar to muscle mass. “This was supposed to explain massive teams of individuals; it was not supposed to be a person litmus check for well being,” says Leah Graves, a registered dietitian who makes a speciality of treating consuming issues. Graves and others query whether or not BMI provides households helpful details about college students’ total well being.
The college insurance policies quickly bumped into one other drawback: There wasn’t a lot proof that they labored.
Not lengthy after the NAS advice was launched, scientists started publishing research on faculty weigh-ins. In 2009, as an illustration, two pediatrics specialists printed a overview of the present analysis, discovering that there was no affect on college students’ weight. Dad and mom, they wrote, didn’t appear to be studying a lot from BMI report playing cards, and there didn’t appear to be any improve in wholesome behaviors at house.
In 2014, Madsen, the UC Berkeley researcher, and a number of other of her colleagues launched a randomized medical trial. The researchers took practically 29,000 college students in California public elementary and center colleges and cut up them into three teams. One group didn’t get screened in any respect. The second was screened, however contributors by no means came upon the outcomes. A 3rd group acquired screenings, and the contributors’ caregivers had been despatched BMI report playing cards. The researchers adopted the group from 2014 to 2017 to trace adjustments in weight and adversarial outcomes.
The workforce’s outcomes, printed in 2021, confirmed that neither screening nor reporting had an affect on weight change through the years. Moreover, the 2 teams that had been screened reported extra weight dissatisfaction and peer weight speak than the group that wasn’t screened.
Madsen’s analysis has additionally discovered that the expertise might be upsetting for college students. In a single 2022 survey of greater than 11,000 college students in California, her workforce discovered that 49 p.c had been weighed by gymnasium academics, versus simply 28 p.c who had been weighed by faculty nurses; the scholars had been extra more likely to really feel much less comfy being weighed by a instructor than by a nurse, and had been extra more likely to really feel that they lacked privateness whereas being weighed.
[Read: Gym class is so bad, kids are skipping school to avoid it]
Different analysis has documented the potential for long-term harms from that have. The adverse results of adolescents perceiving themselves as obese can final for years into maturity, lengthy after the screenings have ended, in keeping with one 2023 survey. Though the examine didn’t particularly ask about BMI screening, it linked a perceived obese standing to elevated self-starvation, bingeing, purging, and overexercising, in addition to the event of consuming issues.
Not each professional is satisfied that BMI screening for the sake of information assortment is essentially dangerous. Researchers and faculty professionals say that it’s the way in which these screenings are carried out that may trigger issues. In consequence, some skilled organizations and authorities companies have issued pointers supposed to enhance the expertise.
The Facilities for Illness Management and Prevention, which has no formal place on BMI screenings, has a public set of 10 safeguards colleges can implement to handle issues about screenings. The record consists of suggestions similar to measuring college students’ peak and weight in a non-public place, having nurses as a substitute of academics take the measurements, and asking for parental consent earlier than measuring college students.
However a 2019 CDC survey of greater than 200 colleges discovered that these safeguards had not been broadly applied. Solely 3 p.c of the faculties had at the least 4 of the safeguards in place, and 19 p.c had no safeguards in any respect.
“These safeguards got here out form of pragmatically, recognizing that there’s not sufficient proof at that time to say whether or not or not BMI-measuring colleges is definitively dangerous or useful, however colleges are doing it,” says the CDC school-health researcher Sarah Sliwa. “So, in the event that they’re doing it, what are some steps they will take to attempt to reduce these harms and improve the probability that knowledge are collected in a approach that’s clear and helpful?”
As the college workers members who’re most frequently requested to weigh college students, bodily educators have additionally developed requirements concerning physique measurement in colleges.
The Society of Well being and Bodily Educators, or SHAPE America, an expert group, has a formal assertion on health testing—which may embody BMI screenings, amongst different assessments—that states that the group finds the testing beneficial solely when it’s built-in appropriately into the curriculum, and when the outcomes aren’t used to grade college students. SHAPE America recommends that colleges first educate college students in regards to the health testing and why it’s finished, in addition to put together them for the method and assist them set personalised objectives primarily based on the end result of the testing. However the group doesn’t have an official advice on whether or not to conduct BMI screenings.
“There’s a whole lot of physique stigma, and we have now different knowledge factors that we will use with out having college students really feel that they’re being judged,” says Cara Grant, the president of SHAPE America.
The American Faculty Well being Affiliation, a company of faculty nurses and different well being professionals, additionally doesn’t have an official place on BMI screenings, says Kayce Solari Williams, ASHA’s former president.
So as to successfully understand the CDC pointers, Sliwa says, colleges have to implement safeguards or finest practices. Due to an absence of the funding and staffing, although, they typically fail to take action.
Some states have responded to the analysis exhibiting harms from BMI screenings. In 2013, Massachusetts struck BMI reporting from its colleges however maintained a screening requirement. Illinois made BMI screening elective for its college students in 2015. California eradicated screening and reporting necessities from its annual health testing. In New York, colleges nonetheless display for BMI, however they’re not required to ship BMI report playing cards house.
Different states haven’t made adjustments. In Georgia, screening and reporting are required by regulation. In West Virginia, which has a number of the highest ranges of childhood weight problems within the nation, state regulation requires the gathering of BMI knowledge to be reported to the Division of Training, the governor, the State Board of Training, the Wholesome Existence Coalition, and the Legislative Oversight Fee on Well being and Human Sources Accountability.
In New Jersey, the place Manion attended highschool, BMI screening will not be mandated, nevertheless it’s allowed on a district-by-district foundation. The state does require weight measurement, nonetheless.
“What’s the worth?” asks Madsen, the UC Berkeley researcher. She questions whether or not the insurance policies are an excellent use of faculty sources. “The complete level of sending them house is definitely to assist households in creating more healthy existence,” she says. “However they’re not.”
Amanda Salazar is a contract journalist from Brooklyn, New York.
