The District 65 School Board voted on June 17 to modify its policy of weighing and measuring students to calculate their body mass index (BMI), bringing to a close a chapter that had evoked passionate debate over the past few months.
At the heart of the debate was the measuring of students to determine their body mass index (BMI) and then reporting that information to parents and students. BMI calculation is one component of a software program, Fitnessgram, used to assess students in five areas – cardiovascular fitness, muscular strength, muscular endurance, flexibility, and body composition – to see if they are in Fitnessgram’s “healthy fitness zone.”
While BMI screening was the core of the debate, an underlying issue was childhood obesity. Board members and District officials, parents, teachers and experts all agreed that childhood obesity is a growing epidemic. The two sides disagreed, however, on whether BMI screening is a meaningful way to address it and whether it is, on balance, helpful or harmful to children.
At the start of the meeting, the two choices put before the Board members on June 17 were a) a motion by Board President Tracy Quattrocki to suspend BMI testing for a year while a steering committee composed of parents, teachers and health-care professionals assesses the program and makes recommendations about it, and b) a recommendation from Superintendent Hardy Murphy to expand the program to all middle schools and down to the fourth-grade level in all elementary schools, offer professional development to principals and ask social workers to contact parents of students whose BMI raises concerns.
Dr. Murphy’s recommendation was never discussed. Ms. Quattrocki’s original motion failed 4-3, but an alternative motion by Board member Katie Bailey was approved.
The Board’s ultimate decision represented concessions to each side: The District will confine the Fitnessgram and BMI testing to middle-school students, will provide “appropriate student support,”and will notify only parents about the results of the tests, and will convene a steering committee “to ensure consistent implementation [of BMI screening] and to report back to the Board in June of 2014.”
A panel of teachers and health-care experts spoke at the June 3 Board meeting, offering the pro and the con of the District’s practices. During Board discussion that evening, Board members appeared to agree that the District should continue to promote healthy activities and good decision-making. While some said they preferred that BMI screening be eliminated, more focused on the District’s lack of follow-up and failure to provide sufficient privacy for students.
At the June 17 meeting, Ms. Quattrocki argued for the need to suspend BMI screening for a year, “We need to think about it … need to work out the details.” She cited parents’ concerns as indicative of a lack of community support for the program. She also noted that the American Academy of Pediatrics recommends several protocols for schools that conduct BMI screenings. The District, she said, does not satisfy those protocols because it does not have an anti-bullying curriculum in place, as recommended, and there is no follow-up with medical professionals at present. She said there is disagreement among the District physical education teachers on the appropriateness of BMI screening and thus inconsistent implementation of it across the District.
Board member Richard Rykhus said he was “kind of surprised at the passion that this BMI [discussion] evoked. We’re collapsing BMI with what we as a District do for health and wellness.” He said the District has made some positive strides, with school gardens, walking clubs, sports teams, better lunches and the other components of the Fitnessgram. He said he was not persuaded by the panel members on June 3 that “giving the [BMI] number to children changes anything. … We need a year to put these systems in place.”
Board member Candance Chow disagreed with the delay but supported the idea of connecting families to health care. “We are in a unique position to create an intervention … to connect a student [to health-care professionals]. This creates the opportunity to have the discussion with the family,” she said.
Board member Suni Kartha said, “I don’t think we can say the parents who didn’t contact us are not buying in [to BMI screening].” She said she thought “taking out BMI does compromise the program.”
Ms. Bailey’s alternative motion passed 6-1. The District will not expand its Fitnessgram testing to the lower grades but will implement it in grades 6-8, including at the magnet schools. The District will no longer make the BMI available to students; only parents will be notified of a student’s BMI.
Significantly, the Board’s decision will require staff to provide “appropriate student support” if a student is found not to be in the healthy fitness zone or at risk of obesity or other harmful conditions. This will entail connecting families to health services or health-care providers. This recommendation, which came out of Board discussion at the June 3 meeting, points the District in a new direction.
Mary Larson, coordinator of health services for the District, who at previous meetings defended BMI testing because, she said, low-income families do not have access to health care, said at the June 17 meeting that she sits on several health-care boards and committees and felt confident that she could connect families to needed health care and support.
Asked how many District 65 families she had connected to health care supports as a result of BMI screening in the past, she replied, “None. This is new.”
The Board is expected to appoint members to the steering committee over the summer.
Passionate discussion, edging at times toward acrimony, marked the discussions about BMI. At previous meetings, District administrators sought – with teachers, parents and health-care professionals – to defend their policy as a pedagogical strategy to promote healthier habits.
They said that BMI screening - weighing and measuring children in a separate room or behind a curtain, calculating their BMI, sharing the information through a secured website, first with parents and then with children – followed by class discussion of BMI in general suffices to give children a boost in making healthier choices.
They said giving children their BMI numbers gives them a useful tool to live a healthy lifestyle. They said that because physical exams are not required for students in seventh and eighth grades, it is important for the schools to weigh and measure the students.
Some said that by the time children get to high school – where BMI screening is also conducted – it is too late to change poor eating and health habits. Some also said that it was important that the schools do this because low-income families often do not have access to health care and 40 percent of students from low-income families are obese.
They also pointed to the District’s opt-out program, under which parents can excuse their children from any or all parts of the Fitnessgram testing.
Teachers, parents and health-care professionals who objected to the District’s procedures said the way the District weighs and measures children and the way the information is shared with parents and students can be damaging to students who are already at a vulnerable age.
It can cause embarrassment, bullying, and poor self-image and give rise to harmful eating habits. They pointed to the fact that, despite the District’s attempts at privacy, many children know each other’s numbers and speak openly about them (because there are virtually no secrets in middle school).
They pointed to the fact that some physical education teachers in the District refuse to do BMI screening because they feel it will do more harm than good.
They pointed to literature that says there is little evidence that giving students the BMI numbers helps them make better choices in health and nutrition.
Some pointed to First Lady Michelle Obama, who is promoting healthier lifestyles for children and who has said she does not discuss weight with her children. Several said that they believed that BMI discussion is best done in a physician’s office, where there is support and access to meaningful follow-up.
Opponents of the District’s practices also pointed to the fact that students entering sixth grade must have a physical exam that includes BMI calculation and that the District already has all this information on its sixth-graders.
Some said they believed that, with local hospital clinics and the new Erie Family Health Clinic that is supposed to provide free or affordable health services to low-income families in Evanston and Skokie, families in District 65 will have access to health-care providers. They also pointed out that the Centers for Disease Control (CDC) does not endorse BMI screening, that there is little evidence in professional journals to show the value of BMI.
Some District administrators said that the District follows the CDC protocols for BMI screening, though in fact the CDC does not endorse BMI screening.
Perhaps because protocols endorsed by the American Academy of Pediatrics are posted on the CDC website, District officials referred on June 17 and at at least one prior meeting to these as "CDC protocols."
While the District does provide some of the safety nets recommended by the AAP, it does not provide community education about the program, it does not have an anti-bullying curriculum in place and it has not offerd meaningful follow-up to children who are not in the "healthy fitness zone."