1. Joiner, Cynthia I. MPH, RN

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In my opinion, body mass index (BMI) report cards in schools offer an opportunity to help tackle childhood obesity and should be encouraged. Among children 6 to 11 years of age, the prevalence of obesity has increased from 6.5% to 17% over the past three decades, and among adolescents aged 12 to 19 years of age, the rate of obesity has more than tripled, increasing from 5% in 1980 to 17.6% in 2006 (Ogden, 2008). Childhood obesity has reached epidemic proportions.


BMI report cards can provide a means to annually gather detailed data on childhood obesity, and to follow individual and group trends. The data collected can include information on all ages, gender, race, and ethnicity, and can thus provide valuable data necessary to monitor obesity trends at both the state and local level where data often is limited. Information obtained from the report cards can be used to help plan and target public health interventions for specific populations. Although BMI is not a perfect measurement, the BMI report card is intended to be used as a screening tool to help identify potential health risks, identifying the percent of students who are underweight, normal weight, overweight, and obese, detecting those children who are at risk for weight-related health problems (Nihiser, 2007).


Schools are well equipped to take on the responsibility of BMI screening and reporting. They manage other screening programs using standardized protocols (such as those for vision, hearing and scoliosis), and BMI screening is no different. Managing the assessment and findings in a private, sensitive manner, and including education as a key component of the screening and assessment helps to insure that children would not be emotionally harmed or threatened by the process.


BMI screening and reporting programs need to be comprehensive in nature, and should be administered and managed with the assistance of healthcare professionals. School nurses are the appropriate professionals to perform the BMI screening, for accuracy in measurements is essential. Results of the assessment should be individualized and sent to parents in a confidential manner; the findings should include educational information about healthy diet, physical activity, and referral information for those who might wish additional assistance in managing their child's weight.


The Institute of Medicine (IOM) endorses BMI reporting and recommends that schools measure children's weight, height, and BMI annually. Underscoring the importance of BMI screening in preventing childhood obesity, the Institute of Medicine (2005) has called upon the federal government to develop guidance for measuring BMI in schools, where children spend a majority of their developmental years; 95% of American children ages 5 to 17 are enrolled in school (Institute of Medicine, 2005). Since schools strongly influence a child's health, diet, and physical activity for a greater part of their youth, they are the perfect place for promoting a healthy lifestyle. Schools also have frequent contact with and access to parents, so BMI assessments can be discussed with them along with other health issues they may not have considered to be a problem for their child.


If school-based BMI screening and report cards are part of a comprehensive program, including other strategies such as limiting access to low-nutrient, high-sugar foods during the school day and increasing the frequency and duration of school-based physical exercise, they can provide important information about the effectiveness of interventions to prevent childhood obesity.




Institute of Medicine. (2005). Preventing childhood obesity: Health in the balance. Washington, DC: National Academies Press. [Context Link]


Nihiser, A. J., Lee, S. M., Wechsler, H., McKenna, M., Odom, E., Reinhold, C., Thompson, D., & Grummer-Strawn, L. (2007). Body mass index measurement in schools. Journal of School Health, 77, 651-671. [Context Link]


Ogden, C.L., Carroll, M.D., Flegal, K.M. (2008). High body mass index for age among US children and adolescents, 2003-2006. JAMA, 299, 2401-2405.