BMI Report Cards and “Fitnessgrams”

Published: June 27, 2014

Receiving a report card is, for most of us, a standard part of our education and a marker of our progress throughout various classes. With these report cards we can evaluate our performance in a given class relative to our peers and, in some cases, to national standards that have been established. But what if we received report cards on our body weight and body mass index (BMI)? Some of our readers may be well familiar with this practice as nearly one quarter of schools in the United States require students’ heights and weights to be measured and in many cases these states also require parent notification of the results. In 2003 Arkansas implemented a statewide BMI screening and surveillance program for all primary and secondary school students, making it the first statewide program in the country. In even more recent news, this spring the New York Department of Education started a BMI report card program called “Fitnessgrams” that reports on students’ weight and BMI and even goes so far as to place students in categories based on their weight. However, it is important to note that just as with report cards for academic grades, these programs are not without their share of criticism and can be fraught with potentially dangerous outcomes.

In New York, for example, students have responded to the Fitnessgrams with confusion and lowered self-esteem, suggesting that they are ill equipped to interpret the information in a meaningful way. There is also a well-established literature in the eating disorders field suggesting that an overemphasis on physical appearance and/or weight can place people at increased risk for disordered eating and dangerous weight control practices. Thus, the Academy for Eating Disorders (AED) recently issued an official press release taking a stand against BMI report cards stating numerous concerns about the practice and its potentially unanticipated adverse effects. The AED reminds us that BMI is a poor proxy for health and even more so in children who are still developing in terms of height and muscle mass. The AED also expressed marked concern about the potential for these Fitnessgrams to contribute to even further “fat-shaming” and weight-based stigma as students are now essentially being graded on their weight. What’s worse is that once students and parents are provided with BMI/weight information, they are often not given appropriate recommendations or referrals. Dr. Allison Nihiser, a health scientist from the US Center for Disease Control (CDC), reports that an effective referral system is lacking such that students who are identified as over or underweight are not being linked to … “community health resources to make sure families get an accurate diagnosis and some evidence-based information about what the next steps are to make a healthy lifestyle.” Left without this crucial information, parents and students might be tempted to implement potentially harmful weight-loss and dieting practices.

The AED is not the only organization to have expressed concern about BMI reporting in schools. The Eating Disorders Coalition and Families Empowered and Supporting Treatment of Eating Disorders (FEAST) have also spoken out against the practice and even the American Academy of Pediatrics has stated that BMI screening should only be conducted by family physicians, “… as a part of normal health supervision within the child’s medical home.” Additionally, the CDC has stated that, “little is known about the outcomes of BMI measurement programs, including effects on weight-related knowledge, attitudes, and behaviors of youth and their families. As a result, no consensus exists on the utility of BMI screening programs for young people.” Thus, collectively it would seem that both healthcare providers and advocacy groups alike are concerned about BMI reporting in schools and, at best, there is inconclusive evidence about the efficacy of these reports.

So what can you do if you too are concerned about BMI report cards in schools? You can meet with your school’s administrators and express your concerns. You can bring evidence like that contained with in the AED press release and discuss the very real dangers of disordered eating and weight-based stigma that can occur with these reports. You can educate yourself on alternatives to these reports and guidelines for implementing healthy, supportive programs for children in schools. For example, the AED has published Guidelines for Childhood Obesity Prevention Programs and the CDC has developed a list of safeguards to reduce the risk of harming students with BMI measurement programs. And if you have children, you can talk with them about maintaining a healthy lifestyle that focuses on behaviors and not weight. You can have their health monitored by a professional and talk honestly with them about any concerns they might have. You can make sure that you model a healthy relationship with your own body and monitor how you talk about others’ bodies. Any of these have the potential to make a significant impact on not only your children, but those in your community as well. So educate yourself and use your voice to inspire change where you see fit!

photo credit: dcJohn via Creative Commons