School BMI Screenings Can Foster Fat Shaming

Eating disorders are grounded in shame and shame is the glue that makes them stick. Shame doesn't work. We should focus on health, not obesity or weight loss. So let's join the push against school BMI screenings and look for other ways to fight childhood obesity.
fat shaming high school

(WOMENSENEWS)- The middle school gym is full of kids milling around while the Body Mass Index (BMI) screening is conducted. You wouldn't think this is a dangerous place, but for anyone who knows about eating disorders it's a chamber of horrors.

The key risk factor here is social embarrassment at an age when concern for peer regard is at a lifetime peak.

Coaches tasked with collecting student's heights and weights call out information for recording while unsupervised students taunt each other. The smell of sweat in the gym during the screening isn't the only thing that stinks. So is a process that seems to know nothing about the misery of eating disorders.

Alarmed by reports of how some schools conduct BMI screenings, the Washington-based Eating Disorders Coalition recently sent a letter signed by 24 members of congress to the Atlanta-based Centers for Disease Control and Prevention, asking them to look at BMI screenings in schools. The letter cited a 2007 Journal of School Health research study that raised concerns about the lack of appropriate safeguards to protect students' privacy and mitigate potential harm.

Children are our most precious resource; we owe them the best possible care. Teaching them how to eat healthfully and exercise is as important as any subject they learn in school. So let's rethink what we're doing about childhood obesity.

According to the Harvard School of Public Health, childhood obesity rates in the U.S. have tripled in the past three decades, where 1-in-6 children are obese. Obesity is a struggle for slightly more boys than girls, with 19 percent of boys and 15 percent of girls classified as obese.

BMI is a more eloquent measure of weight and height than recording weight alone and it has been widely embraced by the medical community. But there's no way it should be loosened on vulnerable kids surrounded by their peers.

Patients Spot a Starting Point

In my many years of counseling those with eating disorders, I've had plenty of patients identify a school BMI screening as their starting point. Even for students whose BMI was considered normal, the public collection of information set up comparisons that initiated their downward descent into an eating disorder.

To be fair, eating disorders develop because of a number of complicated factors, but it is sad to think that a screening meant to educate could trigger an eating disorder. The same goes for awareness efforts that ignore available research.

The “Stop Sugarcoating it, Georgia” campaign, by a group called Strong4Life, was fueled by 2009 research finding that Georgia had the second highest childhood obesity rate in the country. The ads featured stark black-and-white photos of morbidly obese kids with captions like “Mom, why am I fat?” and “My doctor says I have something called hypertension. I'm really scared.”

The hard-hitting, anti-drug style campaign that was intended to shock drew praise from the tough-love crowd, who considered a dose of reality the best approach to obesity. But the campaign was based on fat-shaming, which research finds only makes matters worse.

Those who experienced weight discrimination, also referred to as fat-shaming, felt less confident, were less likely to exercise and more likely to gain weight, finds a 2014 study published in the International Journal of Obesity that surveyed 2,944 British adults over age 50.

Another research study in 2013 out of Florida State University followed 6,000 adults for four years. Overweight participants who were fat-shamed were 2.5 times more likely to gain weight and become obese.

Fat-shaming doesn't work. My patients who want to lose weight struggle to find a gym where they feel accepted. Well-intended comments, like singling out the one obese person on the treadmills to tell them they are doing a good job, can feel like discrimination. Eating disorders are grounded in shame and shame is the glue that makes them stick.

Let's Focus on Health

What does work is to focus on health instead of obesity or weight loss.

A 2013 German study of 935 first and second graders used a teacher-centered school-based approach designed to prevent cardiovascular disease. It started by giving excellent training to teachers. Results showed that focusing on health made a difference. An unintended positive consequence of the educational intervention was that disordered eating also decreased. In other words, instead of calling kids fat, teach them to make good food choices and to be more active.

When BMI screenings are conducted, teachers or parent volunteers should protect privacy by not announcing weights. Screeners should be selected for their ability to work with students without judging them. Teachers need training to become allies, instead of unwilling participants who are being asked to perform one more task. Information shouldn't be gathered at all if schools can't make effective education available to students with BMIs above or below the normal range.

Sending “fat letters” home to parents may also be dangerous. Providing information such as a student's BMI to parents assumes they have the knowledge, skills, and resources to help their child change behavior. That may be a dangerous assumption. What good does it do to send a letter to parents in poverty telling them their child is fat if the parent doesn't have money to buy nutritious food or if education isn't offered?

BMI screenings may be useless in communities lacking resources to help at-risk kids gain access to treatment programs. Children can develop eating disorders at a young age. Early treatment could head off more expensive treatment later. Research shows that the recovery rate drops exponentially for individuals who struggle with an eating disorder for more than seven years.

Instead of throwing out a wide net to evaluate all students, it might be more cost-effective to identify at-risk students and refer them to a carefully designed education program. Preventing an eating disorder is less expensive then treating one and it is more empowering for those who struggle to give them the tools to win the fight.

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