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School systems across the country are stepping up to the plate to address the burgeoning problem of childhood obesity, although perhaps not always in the most appropriate way. Proposals in states including Arkansas, Georgia, New York, and Texas call for recording the height and weight of schoolchildren and in some cases giving parents body mass index (BMI) information along with report cards.
Informing parents of impending health issues is a valuable and important role for schools. But some are uncomfortable with the way these proposals may be executed. Including health information on report cards could tread into confidentiality and legal issues and provoke schoolyard teasing during a time when children are particularly sensitive to body image.
DOC News asked:
Should schools record BMI on report cards?
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I think that [including BMI on report cards] would be fantastic. How about waist measurement?
That's a quickie; just pull out the tape measure. Both would be good. The benefits would outweigh the other issues.
Gerald F. Fletcher, MD
Cardiology
Mayo Clinic
Jacksonville,
Fla.
It's a great idea as long as parents understand what [BMI] means. That's the problem. I look at some parents, and they don't even know what an "F" means. You'd think they'd be at the school the next day asking questions. But anything that makes awareness of the signs that lead to diabetes would be a good thing. Let's face it, to 60–70% of the parents, BMI will mean something, but for many of those who most need it, it wouldn't mean that much because it's a lifestyle thing they're teaching to their kids. I wonder with some parents, if you told them that in 5 years their kid will become a full-blown diabetic, whether they'd do anything.
John McGinnis
Track Coach
Jenks High School
Tulsa, Okla.
If the school routinely issues a fitness report as a supplement to an academic grade report as part of an overall fitness program, then I think that might have some merit. However, there are two caveats. One is that unless the school district has an active fitness improvement program that includes nutrition and physical activity in addition to the physical education class, I think it's not responsible to simply report a BMI. You need to have a comprehensive program in place to help those children whose BMI is above standard for age. And that includes a parent component.
Also, if a district is going to put BMI score anywhere on a student's report, they need to explain what a BMI is and the fact that it is not an appropriate measure in and of itself to assess health status. An athlete who has a high muscle-to-fat ratio is going to get a very distorted reading. So there needs to be an educational component so parents understand that this is only one measure. Putting BMI out there without following up with information is very dangerous. There has to be a commitment from the school district to help children modify their BMI.
Marcia Ruben, PhD, MPH
Director of Research and Sponsored
Programs
American School Health Association
Kent, Ohio
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I'm looking at two sides of it. One, schools are supposed to report how their kids are progressing, whether it's English class or history class. Phys ed class shouldn't be any different. [BMI] is certainly an indication of how a kid is in terms of his physical education abilities.
However, for schools to be pushing something like that—you're seeing phys ed classes being cut all over the place, and they're not providing the opportunities for these kids to do things—just seems a little disingenuous.
My concern is the privacy issue. But if it's just going to the parent, then that shouldn't be an issue.
Obesity among the youth is a serious concern. We should be providing opportunities for these kids to be physically active. The trend over the last 5 or 6 years has been to be cutting back on phys ed opportunities.
Gary Makowicki
President
National High School Athletic Coaches
Association
Norwich, Conn.
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There are lots of ways to inform parents about body mass index. I don't think this is the right way to do it. Kids discriminate against other kids. I'd see a lot of teasing going on. Considering the sensitive nature of obesity, [putting BMI on report cards] is one of the last things we want to do.
If [BMI] is on a report card, it's on a report card forever. It's fine for schools to track BMI, but it should be kept confidential as medical information.
Judith S. Stern, ScD, RD
Vice President
American Obesity
Association
Davis, Calif.
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Anything that focuses attention on what's going on is another helpful step, but to think that any single intervention will fix what's wrong is a failure.
Neil J. Stone, MD
Professor of Medicine (Cardiology)
Northwestern
University Medical School
Chicago, Ill.
TALK BACK: OPENING THE BOOKS
The drug industry has come under fire for allegedly keeping information about the risks of its products from the public. In recent years, the safety of a number of drugs has been questioned, most recently that of COX-2 inhibitors such as valdecoxib (Bextra, Pfizer) and rofecoxib (Vioxx, Merck).
Other drugs that have attracted attention include sibutramine (Meridia, Abbott), troglitazone (Rezulin, Parke-Davis), isotretinoin (Accutane, Roche), and salmeterol (Serevent, GlaxoSmithKline).
Some in the industry—including acting Food and Drug Administration Commissioner Lester M. Crawford, DVM, PhD—have proposed making more clinical data available to the public. Some drug companies have taken the initiative to open their books: Eli Lilly and Co. created a Web site to post information from its clinical studies, and other companies are expected to follow suit.
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In general, more information is always better than less. Or is it? Some contend that making unfiltered clinical data available to the public may needlessly frighten people and give product liability lawyers a field day.
What do you think? Should clinical drug safety data be made available to the public?
Send your comments to docnews{at}diabetes.org.
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