Little Schoolgirl

Obesity Screening in School: Can We Please Stop Now?

In the new issue of Childhood Obesity, Sarah Armstrong and Ted Kyle tell us the time has come to stop screening for obesity in school. The reason is simple. This screening harms children, but offers them no benefit. Telling a child or the child’s parent they are fat doesn’t help. It does nothing for their health and well-being. In fact, for some, it makes things worse.

Schools Are Not Healthcare Facilities

In their editorial, Armstrong and Kyle explain:

“The time has come to end the practice of BMI screening in schools because it serves to promote weight stigma, bullying, and victimization without helping to reduce obesity.

“As child obesity continues to threaten the health and well-being of children across the world, schools continue to serve a critical role in promoting health for all students. Non–weight-based wellness policies that promote, encourage, and role-model healthy behaviors for all children, regardless of weight, are a critical part of the solution. However, BMI screening and obesity treatment is best accomplished in a pediatric health care setting in the context of a child’s overall health and development.”

Helping children and families with obesity is hard enough in a pediatric healthcare setting. It’s impossible in school. However, wellness promotion that doesn’t target kids with obesity can help everyone.

Two Decades of Wasted Effort

Two decades ago, this seemed like a good idea. Arkansas mandated it in schools statewide. People debated the possibility of harm, but advocates brushed those concerns aside. Time passed and parents started objecting. This is hurting, not helping my child, they said.

Then recently, Kristine Madsen et al published results of an RCT that validated these concerns. They found no benefit and the possibility of harm.

Obesity is a real health concern. But fat letters are supremely unhelpful. It should shock the conscience to realize that so much effort went into something that offered only harm and no benefit. It should also lead us to think more critically about other interventions for childhood obesity.

What other programs do we assume will help – without evidence for a benefit? If we continue to invest our efforts in unproven interventions, we should not be surprised at the relentless rise in obesity prevalence.

Click here for the editorial by Armstrong and Kyle and here for further perspective.

Little Schoolgirl, painting by Henri Le Fauconnier / WikiArt

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March 27, 2021

2 Responses to “Obesity Screening in School: Can We Please Stop Now?”

  1. March 27, 2021 at 8:27 pm, Allen Browne said:

    Thank you Sarah and Ted. Identifying a problem and offering no solutions or help with the problem makes no sense whatsoever!

  2. March 28, 2021 at 4:39 am, Mary-Jo said:

    Screening for obesity in schools is a sad testament about what to do when there’s nowhere else to go – a commentary on woeful lack in healthcare settings to provide attention, care for children w/ obesity. In 4 countries I lived in Europe, height, weight, growth charting were routine in schools, along w/hearing and vision checks. If concerns were assessed by school nurses (or doctors), it’s required to correct issues affecting physical, mental, intellectual growth and development. The school doctor treats, directly, or refers to colleagues. School nurses send out communications to a child’s general practitioner. It’s straightforward and discrete process. I’ve not seen weight stigma or bias. I often helped with expat children b/c of language and cultural barriers as an American RD with a specialization in pediatrics. It really worked well! I was amazed at how many children were caught early, who otherwise would have been missed, ignored. I realize medical systems different here. Now, I see it just may not work in US with possibility for more harm. But, main problem is still lack of optimal, even adequate care, in HC settings for children w/obesity, both for screening and treatment. it’s improving, but far from ideal.