BMI_execsumm

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Journal citation of full article:

Nihiser AJ, Lee SM, Wechsler H, McKenna M, Odom

E, Reinold C,Thompson D, GrummerStrawn L. Body

mass index measurement in schools. J Sch Health.

2007;77:651671.

To access full journal article and executive summary,

please visit CDCs website:

www.cdc.gov/HealthyYouth/Overweight/BMI

For more information on the role of schools in prevent-

ing childhood obesity, please visit CDCs website:

www.cdc.gov/HealthyYouth/KeyStrategies


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As the United States continues to search or answers to the growing

problem o obesity among children and adolescents, much

attention has ocused on body mass index (BMI) measurementprograms in schools. The BMI is the ratio o weight to height

squared. It is oten used to assess weight status because it is5-9

relatively easy to measure and it correlates with body at.

In 2005, the Institute o Medicine called on the ederal

government to develop guidance or BMI measurement programs10

in schools. With guidance rom an expert panel, the Centers or

Disease Control and Prevention (CDC) developed a report to help

inorm decision-making on school-based BMI measurement

programs. This Executive Summary presents an overview o the

report, which was published in the December 2007 issue o the

Journal o School Health. The report describes the purposes o BMI

measurement programs, examines current practices, reviews

existing research, summarizes the recommendations o experts,

identifes concerns about school-based programs, and provides

guidance on BMI measurement programs, including a list o

saeguards and ideas or uture research.

BMI measurement programs in schools may be conducted orsurveillance and screening purposes. BMI surveillance programs

assess the weight status o a specifc population (e.g., students in

an individual school, school district, or state) to identiy the

percentage o students who are potentially at risk or weight-

related health problems. Surveillance data are typically anonymous

and can be used or many purposes, including identiying

population trends and monitoring the outcomes o interventions.

BMI screening programs assess the weight status o individual

students to identiy those at risk and provide parents with

inormation to help them take appropriate action.

Some states have initiated BMI measurement programs in

recent years. Arkansas, or example, implemented a statewide BMI

screening and surveillance program in 2003 (State o Arkansas,

84th General Assembly, Regular Session. Act 1220 o 2003. HB 1583.

2003). In Caliornia, students participate in physical ftness testing11

that assesses BMI along with other ftness-related variables.

From 1980 to 2004,

the percentage of

youth who were obese

tripled from 7% to

19% in children

(611years) and 5% to

17% in adolescents(1219 years)14

* These youth were classifed a s overweight in the articles cited; the classifcation

was changed to obesity to reect the June 2007 recommendations rom the Expert

Committee on the Assessment, Prevention, and Treatment o Child and Adolescent

Overweight and Obesity.

BMI1


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Little is known aboutthe outcomes ofBMI measurementprograms, includingeffects on weightrelated knowledge,attitudes, andbehaviors of youthand their families.

Little is known about the outcomes o BMI measurement

programs, including eects on weight-related knowledge,

attitudes, and behaviors o youth and their amilies. As a

result, no consensus exists on the utility o BMI screening

programs or young people. The U.S. Preventive Services

Task Force concluded that insu cient evidence exists to

recommend or or against BMI screening programs or

youth in clinical settings as a means to prevent adversehealth outcomes;

12however, the American Academy o

Pediatrics (AAP) recommends that BMI should be calculated

and plotted annually on all youth as part o normal health

supervision within the childs medical home.13,14

The

Institute o Medicine recommends annual school-based10

screening.

BMI screening meets some o the criteria

established by the AAP or determining whetherschool-based screening should be implemented or any

15pediatric health condition: obesity is an important and

highly prevalent condition;3,4

BMI is an acceptable

measure;6,8

and schools are a logical measurement site16

because they reach virtually all youth. However, BMI

screening programs typically do not meet other AAP

criteria: eective treatments or obesity are not

available,9,17,18

research has not established the

eectiveness and cost-eectiveness o BMI screeningprograms, and communities typically do not have

resources in place to help at-risk individuals access10

treatment services. More evaluation is needed to

determine whether BMI screening programs are a

promising approach or addressing obesity among

children and adolescents.

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BMIUndetected cases must be common or new cases must occurDisease requently and the disease must be associated with adverse

consequences.

Treatment Eective treatment must be available and early intervention mustbe benefcial.

Screening Test The test should be sensitive, specifc, and reliable.

Screener The screener must be well trained.

Target Screening should ocus on groups with high prevalence o thePopulation condition/disease in question or in which early intervention will

be most benefcial.

Referral & Those with a positive screening test must receive a moreTreatment defnitive evaluation and, i indicated, appropriate treatment.

The beneft should outweigh the expenses (i.e., costs o

Cost / Benefit conducting the screening and any physical or psychosocialeects on the individual being screened).

Site The site should be appropriate or conducting the screening andcommunicating the results.

Program

Maintenance

American Academy of Pediatrics Criteria15

Criteria for a Successful Screening Program in Schools

The program should be reviewed or its value and eectiveness.


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A number o concerns have been expressed about school-based

BMI screening programs, including that they might stigmatize

students and lead to harmul behaviors.

17,19-24

Other concernsare that these programs might be ineective, waste scarce

health promotion resources, and distract attention rom other25

school-based obesity prevention activities. More research is

needed to assess the validity o these concerns. BMI surveillance

programs are less controversial, because they do not involve the

communication o sensitive inormation to parents and do not

require individualized ollow-up care or students identifed to

be at risk. Schools that initiate BMI measurement programs

should have in place a sae and supportive environment orstudents o all body sizes and a comprehensive set o science-

based strategies to promote physical activity and healthy eating.

In addition, BMI screening programs should ensure that parents

receive a clear and respectul explanation o the BMI results and

appropriate ollow-up actions; and that resources are available

or sae and eective ollow-up.

To reduce the risk o harming students, BMI measurement

programs should adhere to the ollowing saeguards:

19,26

(1) introduce the program to school sta and

community members and obtain parental consent,

(2) train sta in administering the program (ideally,

implementation will be led by a highly qualifed sta

member, such as the school nurse),

(3) establish saeguards to protect student privacy,

(4) obtain and use accurate equipment,

(5) accurately calculate and interpret the data,

(6) develop ecient data collection procedures,(7) avoid using BMI results to evaluate student or

teacher perormance, and

BMI

(8) regularly evaluate the program and its intended

outcomes and unintended consequences.

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Reference List

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the balance. Washington (DC): The National Academies

Press; 2005.

(11) Caliornia Department o Education. 2005 Caliornia

physical ftness test: report to the governor and

legislature. Sacramento, CA: Caliornia Department o

Education; 2005.

(12) U.S. Preventive Services Task Force. Screening and

interventions or overweight and children and

adolescents: recommendations statement.

Pediatrics. 2005;116(1):205-209.

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