This text was initially printed by Undark Journal.
Amongst Lexie Manion’s recollections of her junior 12 months of highschool in New Jersey was the expertise of being frequently hassled by a faculty nurse who was making an attempt to weigh her.
The nurse, Manion recalled, was making an attempt to get Manion’s weight on file—a standard follow at colleges throughout the US, which goal to make use of the information to enhance pupil well being. However for Manion, who had an consuming dysfunction, the expertise was deeply distressing. The considered getting on a scale at school—of somebody apart from her physician dealing with this delicate measurement—terrified Manion. It additionally triggered her consuming dysfunction: She started to limit her meals consumption extra intensely to drop some pounds earlier than the varsity nurse put her on a scale.
“I used to be apprehensive about her realizing my weight, and I used to be apprehensive the entire faculty would someway know the quantity if she weighed me,” Manion, now 29, wrote in an e mail to Undark. “I grew to become very anxious and would keep away from the dimensions and her gaze each time she inquired.”
The coverage at Manion’s faculty was a part of a nationwide effort to fight childhood weight problems by amassing—and sometimes sharing—knowledge on college students’ weight. Beginning in 2003, one research discovered, 29 states enacted insurance policies encouraging or requiring faculty districts to weigh college students, or to go additional and calculate their body-mass index, or BMI: a standard device for categorizing individuals based mostly on their weight and top. By the coverage’s peak extent, within the 2010s, hundreds of thousands of scholars annually had been receiving so-called “BMI report playing cards” within the mail—and a few college students even noticed their weight standing seem on their precise report playing cards, alongside their grades. Coverage makers hoped that by telling college students and their household a couple of little one’s weight class, the experiences would immediate them to make more healthy decisions and drop some pounds, lowering childhood weight problems one pupil at a time.
However even because the follow was turning into extra frequent, analysis was already suggesting that BMI screenings don’t have any influence on college students’ weight and might even trigger hurt. Right now, many specialists say, the proof is obvious that faculty BMI screenings do little to enhance pupil well being. Analysis has additionally linked the coverage to elevated weight-based bullying and body-image dissatisfaction, which, as in Manion’s expertise, can set off or worsen consuming issues. In response, some states, together with California, have stopped requiring screenings.
Nonetheless, BMI screening or related insurance policies that mandate or encourage weight-tracking stay on the books in a minimum of 16 states, together with Tennessee, West Virginia, Arkansas, and New York, in line with Undark’s evaluation of state legislative codes.
“To focus efforts on simply measuring the rising waistline of America is a Band-Assist,” says Kristine Madsen, a pediatrician and a public-health vitamin researcher at UC Berkeley, who carried out one of many largest research of faculty BMI screenings thus far. “It doesn’t even contact the underlying drawback, and it’s ineffective.”
Arkansas was the first state within the nation to mandate screening and reporting, again in 2003. Then, in 2005, the Institute of Medication on the Nationwide Academy of Sciences launched a 434-page report, “Stopping Childhood Weight problems: Well being within the Steadiness,” that urged extra states to undertake the follow. “It is crucial for fogeys to have details about their little one’s BMI and different weight-status and bodily health measures, simply as they want details about different well being or educational issues,” the NAS group wrote.
The group was responding to what it described as a childhood-obesity epidemic. On the time, about one-third of U.S. youngsters had been classed as obese, overweight, or severely overweight. Childhood weight problems is linked to a variety of poor well being outcomes, together with hypertension, bronchial asthma, and coronary heart illness.
Extra states moved to implement BMI screening. By 2010, simply 5 years after the NAS’s advice was printed, 29 states had been extensively conducting some type of physique evaluation on their college students, in line with a tutorial survey of state schooling departments.
These insurance policies sometimes provided little steerage on how the weigh-ins ought to be carried out. In response to one research, about half of screenings had been executed throughout health club class, typically in entrance of different college students. The health club instructor or faculty nurse would measure every pupil’s top and weight and submit them to the varsity, which, in lots of instances, would go the information alongside to state well being authorities for population-level monitoring.
Baked into that mannequin from the beginning, some specialists say, had been issues. Foremost amongst them was, in lots of insurance policies, the reliance on BMI.
The 1832 paper that first proposed the metric, and the 1972 research that sparked its trendy utilization, concerned solely males and weren’t consultant of the ethnic and racial variety of the US. BMI additionally doesn’t think about components corresponding to muscle mass. “This was meant to explain giant teams of individuals; it was not meant to be a person litmus check for well being,” says Leah Graves, a registered dietitian who makes a speciality of treating consuming issues. Graves and others query whether or not BMI affords households helpful details about college students’ general well being.
The varsity insurance policies quickly bumped into one other drawback: There wasn’t a lot proof that they labored.
Not lengthy after the NAS advice was launched, scientists started publishing research on faculty weigh-ins. In 2009, for example, two pediatrics specialists printed a evaluation of the prevailing analysis, discovering that there was no influence on college students’ weight. Mother and father, they wrote, didn’t appear to be studying a lot from BMI report playing cards, and there didn’t appear to be any enhance in wholesome behaviors at house.
In 2014, Madsen, the UC Berkeley researcher, and several other of her colleagues launched a randomized scientific trial. The researchers took almost 29,000 college students in California public elementary and center colleges and cut up them into three teams. One group didn’t get screened in any respect. The second was screened, however contributors by no means discovered the outcomes. A 3rd group acquired screenings, and the contributors’ caregivers had been despatched BMI report playing cards. The researchers adopted the group from 2014 to 2017 to trace adjustments in weight and hostile outcomes.
The crew’s outcomes, printed in 2021, confirmed that neither screening nor reporting had an influence on weight change over time. Moreover, the 2 teams that had been screened reported extra weight dissatisfaction and peer weight discuss than the group that wasn’t screened.
Madsen’s analysis has additionally discovered that the expertise may be upsetting for college kids. In a single 2022 survey of greater than 11,000 college students in California, her crew discovered that 49 p.c had been weighed by health club lecturers, versus simply 28 p.c who had been weighed by faculty nurses; the scholars had been extra prone to really feel much less comfy being weighed by a instructor than by a nurse, and had been extra prone to really feel that they lacked privateness whereas being weighed.
Different analysis has documented the potential for long-term harms from that have. The adverse results of adolescents perceiving themselves as obese can final for years into maturity, lengthy after the screenings have ended, in line with one 2023 survey. Though the research didn’t particularly ask about BMI screening, it linked a perceived obese standing to elevated self-starvation, bingeing, purging, and overexercising, in addition to the event of consuming issues.
Not each professional is satisfied that BMI screening for the sake of knowledge assortment is essentially dangerous. Researchers and faculty professionals say that it’s the way in which these screenings are carried out that may trigger issues. In consequence, some skilled organizations and authorities companies have issued tips meant to enhance the expertise.
The Facilities for Illness Management and Prevention, which has no formal place on BMI screenings, has a public set of 10 safeguards colleges can implement to deal with issues about screenings. The listing contains suggestions corresponding to measuring college students’ top and weight in a non-public place, having nurses as an alternative of lecturers take the measurements, and asking for parental consent earlier than measuring college students.
However a 2019 CDC survey of greater than 200 colleges discovered that these safeguards had not been extensively carried out. Solely 3 p.c of the colleges had a minimum of 4 of the safeguards in place, and 19 p.c had no safeguards in any respect.
“These safeguards got here out type of pragmatically, recognizing that there’s not sufficient proof at that time to say whether or not or not BMI-measuring colleges is definitively dangerous or useful, however colleges are doing it,” says the CDC school-health researcher Sarah Sliwa. “So, in the event that they’re doing it, what are some steps they will take to attempt to reduce these harms and enhance the probability that knowledge are collected in a approach that’s clear and helpful?”
As the varsity employees members who’re most frequently requested to weigh college students, bodily educators have additionally developed requirements relating to physique measurement in colleges.
The Society of Well being and Bodily Educators, or SHAPE America, knowledgeable group, has a formal assertion on health testing—which might embody BMI screenings, amongst different assessments—that states that the group finds the testing worthwhile solely when it’s built-in appropriately into the curriculum, and when the outcomes aren’t used to grade college students. SHAPE America recommends that colleges first train college students in regards to the health testing and why it’s executed, in addition to put together them for the method and assist them set customized objectives based mostly on the result of the testing. However the group doesn’t have an official advice on whether or not to conduct BMI screenings.
“There’s loads of physique stigma, and we have now different knowledge factors that we will use with out having college students really feel that they’re being judged,” says Cara Grant, the president of SHAPE America.
The American Faculty Well being Affiliation, a company of faculty nurses and different well being professionals, additionally doesn’t have an official place on BMI screenings, says Kayce Solari Williams, ASHA’s former president.
With a view to successfully understand the CDC tips, Sliwa says, colleges must implement safeguards or greatest practices. Due to a scarcity of the funding and staffing, although, they typically fail to take action.
Some states have responded to the analysis exhibiting harms from BMI screenings. In 2013, Massachusetts struck BMI reporting from its colleges however maintained a screening requirement. Illinois made BMI screening elective for its college students in 2015. California eradicated screening and reporting necessities from its annual health testing. In New York, colleges nonetheless display for BMI, however they’re now not required to ship BMI report playing cards house.
Different states haven’t made adjustments. In Georgia, screening and reporting are required by legislation. In West Virginia, which has a few of the highest ranges of childhood weight problems within the nation, state legislation requires the gathering of BMI knowledge to be reported to the Division of Training, the governor, the State Board of Training, the Wholesome Existence Coalition, and the Legislative Oversight Fee on Well being and Human Assets Accountability.
In New Jersey, the place Manion attended highschool, BMI screening just isn’t mandated, however it’s allowed on a district-by-district foundation. The state does require weight measurement, nevertheless.
“What’s the worth?” asks Madsen, the UC Berkeley researcher. She questions whether or not the insurance policies are a great use of faculty assets. “Your entire level of sending them house is definitely to assist households in creating more healthy existence,” she says. “However they’re not.”
Amanda Salazar is a contract journalist from Brooklyn, New York.