1. Gulledge, Betsy Di Benedetto MSN, RN

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The inclusion of body mass index (BMI) report cards as a component of a school's responsibility is disadvantageous on multiple levels. Several states have already implemented BMI report cards as a component of a state-wide initiatives to fight obesity; thus far only Arkansas has demonstrated significant change in BMI among students from 2003 to 2005 (Story, Nanney, & Schwartz, 2009). Does sending home a report of a child's weight classification really contribute to preventing overweight and obese children? Some parents of overweight children who have been a part of BMI report card program have reported that they feel the assessments are counter-productive and perhaps even harmful (Story et al., 2009). Parents of overweight and obese children do not need anyone pointing out the obvious. What they need are real solutions that can be incorporated into real life.


In a society intent on labeling every child, such approaches as BMI report card can have disastrous consequences including low self-esteem. In my opinion, the role of the school environment is primarily education, not health assessment. There is also a great irony in the prospect of schools assuming the responsibility of determining body mass index when many school systems have significantly limited the amount of instructional time spent engaged in physical education. Parents who are concerned about their child's weight might desire the school's input, but it would be more appropriately focused on how the school can provide additional educational opportunities about health and wellness, not measuring BMI.


An additional concern is the maintenance of confidentiality. Although schools are accountable to provide privacy for student information, there is the significant concern students may disclose such personal information to one another and then suffer the consequences in the form of bullying, thus being further ostracized from their peer group (Story et al., 2009). Children may also experience feelings of fear and anxiety related to a weight classification associated with serious health issues. These feelings may then lead to the development of psychological distress and associated eating disorders.


Opposition to BMI report cards has also come from healthcare practitioners. BMI has not been shown to be the most accurate measure of body composition in children. When considering body size, stature, and muscle composition, BMI, has questionable validity (Maynard et al., 2001). The use of BMI during childhood, particularly adolescence, can contribute to over-estimations in level of body fat (Kimm et al., 2005). Healthcare practitioners also caution against the use of BMI as a definitive measurement tool since there is a distinguishable difference in body mass and body fat. Whereas obesity refers to the amount of body fat, BMI refers to body weight, and the relationship between age and body fat versus body mass may significantly change as the child ages.


Finally, research on childhood overweight and obesity has yet to reach any causal conclusions. Disagreement exists over the classifications of at-risk for overweight, overweight, obese, and severely obese categories. There is, however, consensus that prevalence rates of unhealthy weight among children have increased and there is an immediate need for solutions. However, solutions do not lie in merely the identification and reporting of those children meeting criteria for a high BMI. If the healthcare and education communities are to unite in assisting parents and children achieve a healthy lifestyle, initiatives should be focused on interventions and education, not counterproductive labeling.




Kimm, S., Glynn, N., Obarzanek, E., Kriska, A., Daniels, S., Barton, B., & Liu, K. (2005). Relation between the changes in physical activity and body mass index during adolescence: a multicentre longitudinal study. Lancet, 366(9482), 301-307. [Context Link]


Maynard, L., Wisemandle, W., Roche, A., Chumlea, W., Guo, S., & Siervogel, R. (2001). Childhood body composition in relation to body mass index. Pediatrics, 107(2), 344-350. [Context Link]


Story, M., Nanney, M. S., & Schwartz, M. B. (2009). Schools and obesity prevention: Creating school environments and policies to promote healthy eating and physical activity. The Milbank Quarterly, 87(1), 71-100. [Context Link]